神门、三阴交穴位配伍对不同主症失眠症患者临床症状和血清5-HT、GABA的影响

Effect of HT7 and SP6 acupoint compatibility on clinical symptoms and serum 5-HT and GABA of insomnia patients with different main symptoms

目的观察神门、三阴交对失眠症患者临床症状的影响以及血清5-羟色胺、γ-氨基丁酸调控机制。方法将90例失眠症患者按1∶1∶1随机分配至神门组、三阴交组、配穴组,每组30例。分别施以电针神门单穴,电针三阴交单穴,电针神门-三阴交双穴,治疗时间30min,治疗每日进行1次,5日为1个疗程,共治疗2个疗程,疗程间休息2日。在治疗前后采用自评结局量表(MYMOP)评价各组患者临床症状的严重程度,同时根据MYMOP量表的症状分类将失眠症患者进一步分为以夜间症状为主和以日间症状为主,并分别采用睡眠障碍评定量表(SDRS)与Epworth嗜睡量表(ESS)对不同主症的失眠患者的夜间睡眠质量与日间疲乏嗜睡程度进行评价,同时检测患者血清5-羟色胺(5-HT)、γ-氨基丁酸(GABA)含量以揭示神门、三阴交的作用机制。结果(1)各组患者治疗后MYMOP评分均下降(P<0.05),其中三阴交组与配穴组治疗后MYMOP评分明显低于神门组(P<0.05)。90例失眠患者中有52例以夜间症状为主,29例以日间症状为主。(2)以夜间症状为主的各组患者治疗后SDRS评分均降低,其中三阴交组、配穴组治疗后SDRS评分低于神门组(P<0.05)。神门组血清GABA含量显著升高(P<0.05),三阴交组血清5-HT含量上升(P<0.05),配穴组血清5-HT、GABA含量均明显上升(P<0.05),同时,配穴组血清5-HT含量明显高于神门组(P<0.05)。(3)以日间症状为主的各组患者治疗后三阴交组、配穴组ESS评分显著降低,配穴组血清5-HT、GABA含量明显升高(P<0.05)。各组间相比,配穴组治疗后ESS评分低于神门组(P<0.05)。结论(1)神门-三阴交穴位配伍能显著提高以夜间症状为主的失眠症患者夜间睡眠质量,改善以日间症状为主的失眠症患者日间疲乏嗜睡程度。(2)在穴位配伍效应的发挥过程中三阴交起主导作用。(3)电针神门、三阴交上调血清5-HT、GABA含量可能是其发挥夜间安眠作用的配伍效应的重要机制。

Objective To observe the effect of HT7 and SP6 on clinical symptoms of insomniacs and the regulation mechanism of serum 5-HT and GABA.Methods 90 insomnia patients meeting the diagnostic criteria were randomly assigned to HT7 group,SP6 group and HT7-SP6 group at 1:1:1,with 30 cases in each group.The use of electroacupuncture HT7 single point,electroacupuncture SP6 single point,electroacupuncture HT7-SP6 double point,the treatment time is 30min,the treatment is carried out 1 times a day,5 days for a course of treatment,a total of 2 courses of treatment,the rest between courses of 2 days.Measure yourself medical outcomes profile(MYMOP)was used to evaluate the severity of clinical symptoms in each group before and after treatment.Meanwhile,insomniacs were further divided into mainly nocturnal symptoms and mainly daytime symptoms according to the symptom classification of MYMOP scale.The Sleep dysfunction rating scale(SDRS)and Epworth sleepiness score(ESS)were used to evaluate the sleep quality at night and the degree of daytime fatigue and lethargy in insomnia patients with different main disorders.Meanwhile,the serum 5-HT and GABA contents of patients were detected to reveal the mechanism of HT7 and SP6.Results①MYMOP score of all groups decreased after treatment(P<0.05),and MYMOP score of SP6 group and HT7-SP6 group was significantly lower than that of HT7 group(P<0.05).Among the 90 patients with insomnia,52 cases had nocturnal symptoms and 29 cases had daytime symptoms.②The SDRS scores of all groups with nocturnal symptoms were decreased after treatment,and SDRS scores of SP6 group and HT7-SP6 group were lower than HT7 group after treatment(P<0.05).The serum GABA content in HT7 group was significantly increased(P<0.05),the serum 5-HT content in SP6 group was increased(P<0.05),the serum 5-HT and GABA contents in HT7-SP6 group were significantly increased(P<0.05),and the serum 5-HT content in HT7-SP6 group was significantly higher than that in HT7 group(P<0.05).③ESS scores in SP6 group and HT7-SP6 group were significantly decreased after treatment,while serum 5-HT and GABA contents were significantly increased in acupoint combination group(P<0.05).Compared with other groups,the ESS score of HT7-SP6 group was lower than that of HT7 group after treatment(P<0.05).Conclusion①The compatibility of HT7-SP6 can significantly improve the quality of sleep at night in insomniacs with nocturnal symptoms,and significantly improve the degree of daytime fatigue and sleepiness in insomniacs with daytime symptoms.②SP6 plays a leading role in the development of acupoint compatibility effect.③The upregulation of serum 5-HT and GABA by electroacupuncture may be an important mechanism for the compatibility effect of HT7 and SP6.