原发性失眠中医证型与睡眠脑电图参数的相关性研究
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摘要
目的:探讨原发性失眠中医证型与睡眠脑电图主要参数的相关性。方法:选择符合纳入标准的原发性失眠患者126例,其中阴虚火旺证75例,心脾两虚证34例,心胆气虚证17例。观察各证型一般资料、睡眠脑电图主要参数以及匹兹堡睡眠质量量表(Pittsburgh sleep quality index,PSQI)评分的差异性。结果:原发性失眠中医证型间性别分布比较,差异无统计学意义(P>0.05),均以60岁以上为发病高峰。各证型睡眠脑电图参数睡眠总时间(TSA)、睡眠潜伏期(SL)、觉醒时间(ATA)、睡眠效率(SE)、S1期、S2期、异相睡眠(REM)等指标比较,差异有统计学意义(P<0.05或P<0.01)。阴虚火旺证患者TSA、ATA、SE均低于心胆气虚证,差异有统计学意义(P<0.05);心脾两虚证患者SL、TSA、SE均低于心胆气虚证,差异有统计学意义(P<0.05)。阴虚火旺证患者S1高于心胆气虚证、心脾两虚证(P<0.05),S2、REM均低于心胆气虚证(P<0.05);阴虚火旺证患者S1高于心脾两虚证(P<0.05),S2低于心脾两虚证(P<0.05)。结论:原发性失眠中医各证型与睡眠脑电图TSA、SL、ATA、SE、S1、S2、REM等主要参数,存在相关性;阴虚火旺证与S1、S2、PSQI评分存在密切相关性。
Objective: To observe the relationship between TCM clinical symptom types and sleep electroencephalogram parameters in patients with primary insomnia, and explore the objective indexes of TCM syndrome classification of primary insomnia. Method: 126 cases of primary insomnia were selected, including 75 cases of Yin deficiency and fire exuberance syndrome, 34 cases of heart-spleen deficiency syndrome and 17 cases of heart-gallbladder Qi deficiency syndrome. The difference of general data of each syndrome type, main parameters of sleep electroencephalogram and scores of Pittsburgh Sleep Quality Index(PSQI) was observed. Results: There are not sex distribution difference among the TCM syndrome types of primary insomnia(P>0.05). The incidence rates peak of TCM syndromes in the three groups are all over 60 years old. The difference is found in the sleep electroencephalogram main parameters among TCM syndrome types, such as total sleep duration(TSA),sleep latency(SL), awakening duration(ATA), sleep efficiency(SE), S1, S2, paradoxical sleep(REM)(P <0.05 or P<0.01). TSA, ATA and SE in patients with Yin deficiency and fire exuberance syndrome were lower than those in patients with heart-gallbladder Qi deficiency syndrome(P <0.05), SL, TSA and SE in patients with heart-spleen deficiency syndrome were lower than those in patients with heart-gallbladder Qi deficiency syndrome(P<0.05). The S1 of patients with Yin deficiency and Fire excess syndrome was higher than that of heart-gallbladder Qi deficiency syndrome and heart-spleen deficiency syndrome(P<0.05), the S2 and REM were lower than that of heart-gallbladder Qi deficiency syndrome(P<0.05), the S1 of patients with Yin deficiency and fire excess syndrome was higher than that of heart-spleen deficiency syndrome(P<0.05), and the S2 was lower than that of heart-spleen deficiency syndrome(P<0.05). Conclusion: The key parameters of sleep electroencephalogram are different, such as TSA, SL, ATA, SE, S1, S2, REM, etc, among TCM clinical symptom types of primary insomnia,which provide an objective basic data for TCM classification and dialectical treatment. There is a more close correlation between yin deficiency and fire excess syndrome and S1, S2 of sleep electroencephalogram and PSQI index score.
Objective: To observe the relationship between TCM clinical symptom types and sleep electroencephalogram parameters in patients with primary insomnia, and explore the objective indexes of TCM syndrome classification of primary insomnia. Method: 126 cases of primary insomnia were selected, including 75 cases of Yin deficiency and fire exuberance syndrome, 34 cases of heart-spleen deficiency syndrome and 17 cases of heart-gallbladder Qi deficiency syndrome. The difference of general data of each syndrome type, main parameters of sleep electroencephalogram and scores of Pittsburgh Sleep Quality Index(PSQI) was observed. Results: There are not sex distribution difference among the TCM syndrome types of primary insomnia(P>0.05). The incidence rates peak of TCM syndromes in the three groups are all over 60 years old. The difference is found in the sleep electroencephalogram main parameters among TCM syndrome types, such as total sleep duration(TSA),sleep latency(SL), awakening duration(ATA), sleep efficiency(SE), S1, S2, paradoxical sleep(REM)(P <0.05 or P<0.01). TSA, ATA and SE in patients with Yin deficiency and fire exuberance syndrome were lower than those in patients with heart-gallbladder Qi deficiency syndrome(P <0.05), SL, TSA and SE in patients with heart-spleen deficiency syndrome were lower than those in patients with heart-gallbladder Qi deficiency syndrome(P<0.05). The S1 of patients with Yin deficiency and Fire excess syndrome was higher than that of heart-gallbladder Qi deficiency syndrome and heart-spleen deficiency syndrome(P<0.05), the S2 and REM were lower than that of heart-gallbladder Qi deficiency syndrome(P<0.05), the S1 of patients with Yin deficiency and fire excess syndrome was higher than that of heart-spleen deficiency syndrome(P<0.05), and the S2 was lower than that of heart-spleen deficiency syndrome(P<0.05). Conclusion: The key parameters of sleep electroencephalogram are different, such as TSA, SL, ATA, SE, S1, S2, REM, etc, among TCM clinical symptom types of primary insomnia,which provide an objective basic data for TCM classification and dialectical treatment. There is a more close correlation between yin deficiency and fire excess syndrome and S1, S2 of sleep electroencephalogram and PSQI index score.
引文
[1]刘敏岚,陈净.中年人睡眠质量现状调查与分析[J].现代预防医学杂志,2008,35(19):3735-3737.
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[4]刘佳,冯瑞娟,崔兴月,等.门诊老年患者安全使用镇静催眠药物相关知识和行为调查[J].护理学报,2016,18(3):56-58.
[5]冯志芬,蒋恩社.从肝、从瘀论治镇静催眠药依赖型失眠[J].中国实验方剂学杂志,2013,11(3):308-310.
[6]潘胜珂,姚培芬,李华芳.原发性失眠症多导睡眠脑电图研究及相关分析[J].精神医学杂志,2013,26(5):391-393.
[7]袁拯忠,叶人,项祖闯,等.913例失眠患者中医证型分布规律[J].中华中医药杂志,2011,29(7):1508-1510.
[8]中华医学会神经病学分会原发性失眠学组.中国成人失眠诊断与治疗指南[J].中华神经科杂志,2012,45(7):534-540.
[9]中华中医药学会.中医内科常见病诊疗指南(中医病证部分)[M].北京:中国中医药出版,2008:50-51.
[10]俞晔,丁勇民,刘昊,等.南昌、赣州两市中老年人睡眠障碍情况调查[J].中国老年学杂志,2012,32(21):4731-4732.
[11]高存友,甘景梨,李东河,等.应激相关失眠症的易患性与心率变异度及血浆皮质醇水平的关系[J].临床精神医学杂志,2015,25(3):163-165.
[12]王琳,周娟,雷红.慢性失眠患者年龄、受教育水平、人格特征与应激性生活事件的相互影响[J].重庆医学杂志,2007,36(22):2302-2303.
[13]黎柱培,蔡淑英,吴傲雯.失眠症患者睡眠质量及多导睡眠图研究[J].四川精神卫生,2013,26(2):103-105.
[14]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.
[2] Chen P J, Huang C L, Weng S F, et a1.Relapse insomnia increases greater risk of anxiety and depression:evidence from a population-based 4-year cohort study[J].Sleep medicine,2017,38(10):122-129.
[3]马欣荣,姜静,方建群.门诊老年失眠症患者生活质量及苯二氮艹卓类药物使用情况[J].临床精神医学杂志,2011,21(5):320-322.
[4]刘佳,冯瑞娟,崔兴月,等.门诊老年患者安全使用镇静催眠药物相关知识和行为调查[J].护理学报,2016,18(3):56-58.
[5]冯志芬,蒋恩社.从肝、从瘀论治镇静催眠药依赖型失眠[J].中国实验方剂学杂志,2013,11(3):308-310.
[6]潘胜珂,姚培芬,李华芳.原发性失眠症多导睡眠脑电图研究及相关分析[J].精神医学杂志,2013,26(5):391-393.
[7]袁拯忠,叶人,项祖闯,等.913例失眠患者中医证型分布规律[J].中华中医药杂志,2011,29(7):1508-1510.
[8]中华医学会神经病学分会原发性失眠学组.中国成人失眠诊断与治疗指南[J].中华神经科杂志,2012,45(7):534-540.
[9]中华中医药学会.中医内科常见病诊疗指南(中医病证部分)[M].北京:中国中医药出版,2008:50-51.
[10]俞晔,丁勇民,刘昊,等.南昌、赣州两市中老年人睡眠障碍情况调查[J].中国老年学杂志,2012,32(21):4731-4732.
[11]高存友,甘景梨,李东河,等.应激相关失眠症的易患性与心率变异度及血浆皮质醇水平的关系[J].临床精神医学杂志,2015,25(3):163-165.
[12]王琳,周娟,雷红.慢性失眠患者年龄、受教育水平、人格特征与应激性生活事件的相互影响[J].重庆医学杂志,2007,36(22):2302-2303.
[13]黎柱培,蔡淑英,吴傲雯.失眠症患者睡眠质量及多导睡眠图研究[J].四川精神卫生,2013,26(2):103-105.
[14]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.