针刺与艾灸引气归元穴组治疗围绝经期失眠症的随机对照研究
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摘要
目的:以引气归元穴组为主穴,观察针刺与艾灸治疗围绝经期失眠症(PMI)的临床疗效差异。方法:将60例PMI患者随机分为针刺组30例和艾灸组30例,治疗过程中针刺组剔除1例、艾灸组剔除2例。针刺组采用针刺引气归元穴组治疗,艾灸组采用麦粒灸引气归元穴组治疗,1次/d,10次为1个疗程,疗程间休息2d,共治疗2个疗程。采用匹兹堡睡眠质量指数(PSQI)量表评价PMI患者睡眠质量,观察两组患者的临床疗效,并比较两组患者治疗前后血清卵泡刺激素(FSH)、雌二醇(E2)和促黄体生成素(LH)水平的变化。结果:治疗后两组患者PSQI总评分及各因子评分均显著下降(P<0.01),且艾灸组总评分、睡眠质量、睡眠时间、睡眠效率和催眠药物因子成分的评分较针刺组降低更明显(P<0.05)。艾灸组总有效率为89.29%(25/28),明显高于针刺组的75.86%(22/29),两组比较差异有统计学意义(P<0.05)。两组患者治疗后血清中FSH和LH水平均明显下降(P<0.01),E2水平均明显升高(P<0.01),且艾灸组FSH和E2的改善水平优于针刺组(P<0.05)。结论:针刺与艾灸均可改善PMI患者临床症状及血清激素水平,且艾灸优于针刺。
Objective To compare the clinical effect of manual acupuncture and moxibustion therapies in the treatment of perimenopausal insomnia(PMI).Methods A total of 60 outpatients with PMI were randomly and equally divided into an acupuncture group(29 cases)and a moxibustion group(28 cases).Acupoints Zhongwan(CV12),Xiawan(CV10),Qihai(CV6)and Guanyuan(CV4)were employed in these two groups.For acupuncture group,filiform needles were inserted slowly into these acupoints and twirled mildly for a while,and then retained for 30 min.When moxibustion performed,the ignited moxa-cone was applied to the same 4 acupoints,with 7 cones for each acupoint.The treatment was conducted once daily for 10 consecutive days,suspended for 2 days,then another 10 days' treatment followed. The Pittsburgh Sleep Quality Index(PSQI)scale(7 items:subjective sleep quality,sleep latency,duration of sleep,habitual sleep efficiency,sleep disturbance,use of sleeping medications,and daytime dysfunction,0-3 points per item,0-21 points in total)was used to evaluate the patient's sleep quality.The clinical therapeutic effect was also assessed according to the sleep rate(=sleep duration/total duration from spin-in to wake-up×100%).The contents of serum follicular stimulating hormone(FSH),estradiol(E2)and luteinizing hormone(LH)were detected using radioimmunoassay.Results After treatment,the total score of PSQI and the score of each item were all significantly reduced in the two groups relevant to their own pre-treatment(P<0.01).The scores of sleep latency,sleep disturbance and daytime dysfunction were comparable between the two groups(P>0.05),but the total score,and scores of sleep quality,sleep duration,sleep efficiency,and use of sleeping medication were significantly lower in the moxibustion group than in the acupuncture group(P<0.05).Of the 29 and 28 cases in the acupuncture and moxibustion groups,6(20.69%)and 11(39.29%)were cured,7(24.14%)and 9(32.14%)experienced marked improvement,9(31.03%)and 5(17.86%)were effective,and 7(24.14%)and 3(10.71%)ineffective,with the total effective rate being 75.86% and 89.29%,respectively.The therapeutic effect of moxibustion was obviously superior to that of acupuncture treatment(P<0.05).After the treatment,the levels of serum FSH and LH were significantly decreased(P<0.01),and that of E2 was significantly increased in both groups(P<0.01).The levels of FSH and E2 in the moxibustion group were obviously improved than those of the acupuncture group(P<0.05).Conclusion Both acupuncture and moxibustion can relieve the sleep quality of patients with PMI,which may be associated with their effect in regulating serum hormone levels.The therapeutic effect of moxibustion is superior to that of acupuncture.
Objective To compare the clinical effect of manual acupuncture and moxibustion therapies in the treatment of perimenopausal insomnia(PMI).Methods A total of 60 outpatients with PMI were randomly and equally divided into an acupuncture group(29 cases)and a moxibustion group(28 cases).Acupoints Zhongwan(CV12),Xiawan(CV10),Qihai(CV6)and Guanyuan(CV4)were employed in these two groups.For acupuncture group,filiform needles were inserted slowly into these acupoints and twirled mildly for a while,and then retained for 30 min.When moxibustion performed,the ignited moxa-cone was applied to the same 4 acupoints,with 7 cones for each acupoint.The treatment was conducted once daily for 10 consecutive days,suspended for 2 days,then another 10 days' treatment followed. The Pittsburgh Sleep Quality Index(PSQI)scale(7 items:subjective sleep quality,sleep latency,duration of sleep,habitual sleep efficiency,sleep disturbance,use of sleeping medications,and daytime dysfunction,0-3 points per item,0-21 points in total)was used to evaluate the patient's sleep quality.The clinical therapeutic effect was also assessed according to the sleep rate(=sleep duration/total duration from spin-in to wake-up×100%).The contents of serum follicular stimulating hormone(FSH),estradiol(E2)and luteinizing hormone(LH)were detected using radioimmunoassay.Results After treatment,the total score of PSQI and the score of each item were all significantly reduced in the two groups relevant to their own pre-treatment(P<0.01).The scores of sleep latency,sleep disturbance and daytime dysfunction were comparable between the two groups(P>0.05),but the total score,and scores of sleep quality,sleep duration,sleep efficiency,and use of sleeping medication were significantly lower in the moxibustion group than in the acupuncture group(P<0.05).Of the 29 and 28 cases in the acupuncture and moxibustion groups,6(20.69%)and 11(39.29%)were cured,7(24.14%)and 9(32.14%)experienced marked improvement,9(31.03%)and 5(17.86%)were effective,and 7(24.14%)and 3(10.71%)ineffective,with the total effective rate being 75.86% and 89.29%,respectively.The therapeutic effect of moxibustion was obviously superior to that of acupuncture treatment(P<0.05).After the treatment,the levels of serum FSH and LH were significantly decreased(P<0.01),and that of E2 was significantly increased in both groups(P<0.01).The levels of FSH and E2 in the moxibustion group were obviously improved than those of the acupuncture group(P<0.05).Conclusion Both acupuncture and moxibustion can relieve the sleep quality of patients with PMI,which may be associated with their effect in regulating serum hormone levels.The therapeutic effect of moxibustion is superior to that of acupuncture.
引文
[1]周子严,薛晓琳,崔玮玮,等.从肝论治女性更年期失眠的中医证候分布和用药规律的文献研究[J].中华中医药杂志,2017,32(11):4925-4928.
[2] CHAN W S,WILLIAMS J,DAUTOVICH N D,et al.Night-to-night sleep variability in older adults with chronic insomnia:mediators and moderators in a randomized controlled trial of brief behavioral therapy(BBT-I)[J].J Clin Sleep Med,2017,13(11):1243-1254.
[3]张秋霞,杨茜,武传颖.激素替代与自拟安神丸治疗更年期综合征的对照研究[J].中国生化药物杂志,2015,35(12):97-99.
[4]伍亚男,范颖,符文彬.针灸治疗围绝经期失眠症的现代文献研究[J].上海针灸杂志,2016,35(7):893-898.
[5] WHO.The ICD-10classification of mental and behavioral disorders:clinical descriptions and diagnostic guidelines.Geneva:WHO,1992:177-225.
[6]中华医学会精神科分会.CCMD-3中国精神障碍分类与诊断标准[S].3版,济南:山东科学技术出版社,2001:118-119.
[7]刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29(2):103-107.
[8]张秀华,谢于鹏,何金彩.睡眠障碍诊疗手册[M].北京:人民卫生出版社,2012:31-47.
[9]郭丽华,李红.围绝经期睡眠障碍中西医发病机制[J].云南中医中药杂志,2015,36(1):75-77.
[10]栗洪娟,唐赛雪,丁元庆.243例围绝经期失眠证候分析与病机探讨[J].成都中医药大学学报,2014,37(2):67-68.
[11]李清玲.新型揿针治疗围绝经期失眠的临床研究[J].四川中医,2017,35(6):202-204.
[12]林龙华,项洪艳,金亚蓓,等.腹针治疗围绝经期失眠疗效观察[J].上海针灸杂志,2015,34(5):438-439.
[13]韦莉莉,楼国平.腹针引气归元加开四关配合神阙艾灸在妇科疾病中运用举隅[J].浙江中医杂志,2013,48(10):752-753.
[14]徐天舒,阮建国,戴玮,等.针刺与麦粒灸对围绝经期模型大鼠血清E2、FSH、LH水平的影响[J].南京中医药大学学报,2012,28(6):564-566.
[15]王玲玲.麦粒灸临床特点及适宜病症[J].上海针灸杂志,2013,32(11):889-891.
[2] CHAN W S,WILLIAMS J,DAUTOVICH N D,et al.Night-to-night sleep variability in older adults with chronic insomnia:mediators and moderators in a randomized controlled trial of brief behavioral therapy(BBT-I)[J].J Clin Sleep Med,2017,13(11):1243-1254.
[3]张秋霞,杨茜,武传颖.激素替代与自拟安神丸治疗更年期综合征的对照研究[J].中国生化药物杂志,2015,35(12):97-99.
[4]伍亚男,范颖,符文彬.针灸治疗围绝经期失眠症的现代文献研究[J].上海针灸杂志,2016,35(7):893-898.
[5] WHO.The ICD-10classification of mental and behavioral disorders:clinical descriptions and diagnostic guidelines.Geneva:WHO,1992:177-225.
[6]中华医学会精神科分会.CCMD-3中国精神障碍分类与诊断标准[S].3版,济南:山东科学技术出版社,2001:118-119.
[7]刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29(2):103-107.
[8]张秀华,谢于鹏,何金彩.睡眠障碍诊疗手册[M].北京:人民卫生出版社,2012:31-47.
[9]郭丽华,李红.围绝经期睡眠障碍中西医发病机制[J].云南中医中药杂志,2015,36(1):75-77.
[10]栗洪娟,唐赛雪,丁元庆.243例围绝经期失眠证候分析与病机探讨[J].成都中医药大学学报,2014,37(2):67-68.
[11]李清玲.新型揿针治疗围绝经期失眠的临床研究[J].四川中医,2017,35(6):202-204.
[12]林龙华,项洪艳,金亚蓓,等.腹针治疗围绝经期失眠疗效观察[J].上海针灸杂志,2015,34(5):438-439.
[13]韦莉莉,楼国平.腹针引气归元加开四关配合神阙艾灸在妇科疾病中运用举隅[J].浙江中医杂志,2013,48(10):752-753.
[14]徐天舒,阮建国,戴玮,等.针刺与麦粒灸对围绝经期模型大鼠血清E2、FSH、LH水平的影响[J].南京中医药大学学报,2012,28(6):564-566.
[15]王玲玲.麦粒灸临床特点及适宜病症[J].上海针灸杂志,2013,32(11):889-891.