调和阴阳法针灸结合酸枣仁汤对老年慢性心力衰竭伴睡眠障碍的临床疗效及机制研究

Harmonization of yin and yang method of acupuncture combined with sour jujube nut soup on chronic heart failure with sleep disorder in the elderly

目的:探讨调和阴阳法针灸结合酸枣仁汤在老年慢性心力衰竭伴睡眠障碍的应用效果,并分析其发挥疗效的可能机制。方法:选取2022年1月~2023年6月本院收治的86例老年慢性心力衰竭伴睡眠障碍患者为研究对象,根据治疗方案分成对照组(n=42)、研究组(n=44),对照组给予常规治疗结合酸枣仁汤,研究组给予调和阴阳法针灸结合酸枣仁汤,所有患者均持续治疗1个月。对比两组的临床疗效、治疗前后匹兹堡睡眠质量指数(PSQI)评分、N末端B型脑钠肽前体(NT-proBNP)、血清神经递质指标及中医证候积分,并检测对比两组治疗前后的辅助性T淋巴细胞(Th)1/Th2细胞因子及Th1/Th2比值。结果:研究组治疗后的临床治疗总有效率高于对照组(P<0.05)。与对照组相比,研究组治疗后的PSQI评分、血清NT-proBNP水平均更低(P<0.05)。治疗后,研究组患者的胸闷、乏力、面肢浮肿、心悸气短、喘促等中医证候积分均低于对照组(P<0.05),且5-羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)、γ-氨基丁酸(GABA)改善情况均优于对照组(P<0.05)。治疗后,研究组白细胞介素(IL)-1、IL-2水平、Th1/Th2比值均低于对照组,而IL-4、IL-10水平均高于对照组(P<0.05)。结论:调和阴阳法针灸结合酸枣仁汤可更有效改善老年慢性心力衰竭伴睡眠障碍患者的临床疗效,其可能与通过调控Th1/Th2细胞平衡及改善机体炎症反应有关。

Objectives To investigate the application effect of acupuncture combined with sour jujube nut soup by the method of harmonizing yin and yang in elderly chronic heart failure with sleep disorders,and to analyze the possible mechanism of its exerting efficacy.Methods Eighty-six elderly patients with chronic heart failure with sleep disorders admitted to our hospital from January 2022to June 2023were selected for the study,and they were divided into the control group(n=42)and the study group(n=44)according to the treatment plan;the control group was given conventional treatment combined with sour jujube nut soup,and the study group was given acupuncture combined with sour jujube nut soup by the method of regulating yin and yang,all of them were continued to be treated for 1month.The clinical efficacy,Pittsburgh Sleep Quality Index(PSQI)scores,N-terminal B-type brain natriuretic peptide precursor(NT-proBNP),serum neurotransmitter indexes,and Chinese medicine syndrome scores were compared between the two groups,and the adjuvant T-lymphocyte(Th)1/Th2cytokines and Th1/Th2ratios were detected and compared before and after treatment.Results The total clinical treatment efficiency of the study group after treatment was higher than that of the control group(P<0.05).PSQI scores and serum NT-proBNP levels were lower in the study group after treatment compared to the control group(P<0.05).After treatment,the TCM symptom scores of chest tightness,fatigue,swelling of facial limbs,palpitations,shortness of breath,and wheezing of the patients in the study group were lower than those of the control group(P<0.05),and the improvement of 5-hydroxytryptamine(5-HT),norepinephrine(NE),dopamine(DA),and γ-aminobutyric acid(GABA)was better than that of the control group(P<0.05).After treatment,the levels of interleukin(IL)-1,IL-2,and Th1/Th2ratio were lower in the study group than in the control group,whereas the levels of IL-4and IL-10were higher than in the control group(P<0.05).Conclusion The combination of acupuncture and sour jujube nut soup with the method of harmonizing yin and yang may be more effective in improving the clinical outcomes of elderly patients with chronic heart failure and sleep disorders,which may be related to the modulation of the Th1/Th2cell balance and the improvement of the body's inflammatory response.