疏肝汤联合米氮平对肝郁化火型失眠患者的临床疗效
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摘要
目的探讨疏肝汤联合米氮平对肝郁化火型失眠患者的临床疗效。方法 118例患者随机分为对照组(56例)和观察组(62例),对照组给予米氮平,观察组在对照组基础上加用疏肝汤,8周为1个疗程。然后,检测临床疗效,中医症候评分,下丘脑-垂体-靶腺轴激素(TSH、TRH、GH、Cor、FT4)水平,匹兹堡睡眠质量指数量表(PSQI)评分,焦虑、抑郁评分,生活质量评分,不良反应发生率变化。结果观察组总有效率显著高于对照组(P<0.05)。治疗后,2组中医症候评分,下丘脑-垂体-靶腺轴激素水平,PSQI评分,焦虑、抑郁评分显著降低(P<0.05),生活质量评分显著升高(P<0.05),以观察组更明显(P<0.05),不良反应发生率无显著差异(P>0.05)。结论疏肝汤联合米氮平可调节肝郁化火型失眠患者下丘脑-垂体-靶腺轴激素表达,改善睡眠质量和生活质量,安全性较高,临床疗效良好。
AIM To explore the clinical effects of Shugan Decoction combined with mirtazapine on insomnia patients due to Liver Depression Transforming into Fire. METHODS One hundred and eighteen patients were randomly divided into control group(56 cases) for 8-week administration of mirtazapine, and observation group(62 cases) for 8-week administration of Shugan Decoction and mirtazapine. Subsequently, the changes in clinical efficacy, TCM symptom score, levels of hypothalamus-pituitary-target gland axis hormones(TSH, TRH, GH, Cor, FT4), Pittsburgh sleep quality index scale(PSQI) score, anxiety and depression scores, life quality score, and occurrance rate of adverse reactions were detected.RESULTS The observation group demonstrated significantly higher total effective rate than the control group(P<0.05). After the treatment, TCM syndrome score, levels of hypothalamic-pituitary-target gland axis hormones, PSQI score, and anxiety and depression scores were markedly decreased(P<0.05) in the two groups with obviously increased life quality score(P<0.05), especially for those in the observation group(P<0.05), and no significant difference in occurrance rate of adverse reactions was found(P>0.05).CONCLUSION For the insomnia patients due to Liver Depression Transforming into Fire, Shugan Decoction combined with mirtazapine can regulate the expressions of hypothalamus-pituitary-target gland axis hormones and improve sleep quality and life quality, with high safety and good clinical efficacy.
AIM To explore the clinical effects of Shugan Decoction combined with mirtazapine on insomnia patients due to Liver Depression Transforming into Fire. METHODS One hundred and eighteen patients were randomly divided into control group(56 cases) for 8-week administration of mirtazapine, and observation group(62 cases) for 8-week administration of Shugan Decoction and mirtazapine. Subsequently, the changes in clinical efficacy, TCM symptom score, levels of hypothalamus-pituitary-target gland axis hormones(TSH, TRH, GH, Cor, FT4), Pittsburgh sleep quality index scale(PSQI) score, anxiety and depression scores, life quality score, and occurrance rate of adverse reactions were detected.RESULTS The observation group demonstrated significantly higher total effective rate than the control group(P<0.05). After the treatment, TCM syndrome score, levels of hypothalamic-pituitary-target gland axis hormones, PSQI score, and anxiety and depression scores were markedly decreased(P<0.05) in the two groups with obviously increased life quality score(P<0.05), especially for those in the observation group(P<0.05), and no significant difference in occurrance rate of adverse reactions was found(P>0.05).CONCLUSION For the insomnia patients due to Liver Depression Transforming into Fire, Shugan Decoction combined with mirtazapine can regulate the expressions of hypothalamus-pituitary-target gland axis hormones and improve sleep quality and life quality, with high safety and good clinical efficacy.
引文
[1] Dragioti E,Wiklund T,Alf?ldi P,et al.The Swedish version of the Insomnia Severity Index:Factor structure analysis and psychometric properties in chronic pain patients[J].Scand J Pain,2015,9(1):22-27.
[2] 岳莉莉,左文秀,汪辉耀,等.度洛西汀和米氮平治疗老年抑郁症的临床比较[J].国际精神病学杂志,2015,42(6):37-40.
[3] 蒋国卿,孙晓峰,张文静,等.自拟镇静安神汤辅助米氮平治疗焦虑抑郁状态伴顽固性失眠30例临床观察[J].疑难病杂志,2015,14(7):682-685.
[4] 王丽,王彩娟,芮绵,等.清心镇肝汤对肝郁化火型失眠症患者睡眠质量及血清5-HT、DA及GABA水平的影响[J].中医药信息,2017,34(6):64-69.
[5] Lawrenson J G,Hull C C,Downie L E.The effect of blue-light blocking spectacle lenses on visual performance,macular health and the sleep-wake cycle:a systematic review of the literature[J].Ophthalmic Physiol Opt,2017,37(6):644-654.
[6] 中华医学会神经病学分会睡眠障碍学组.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.
[7] 中华医学会神经病学分会神经心理学与行为神经病学组.综合医院焦虑、抑郁与躯体化症状诊断治疗的专家共识[J].中华神经科杂志,2016,49(12):908-917.
[8] Sobreira-Neto M A,Pena-Pereira M A,Sobreira E S T,et al.High frequency of sleep disorders in Parkinson’s disease and its relationship with quality of life[J].Eur Neurol,2017,78(5-6):330-337.
[9] Johansson M,Jansson-Fr?jmark M,Norell-Clarke A,et al.The role of psychiatric and somatic conditions in incidence and persistence of insomnia:a longitudinal,community study[J].Sleep Health,2016,2(3):229-238.
[10] Andreeva V A,Torres M J,Druesne-Pecollo N,et al.Sex-specific associations of different anthropometric indices with acute and chronic insomnia[J].Eur J Public Health,2017,27(6):1026-1031.
[11] 李超群,李秀玉.加味小柴胡汤联合米氮平治疗成人慢性失眠36例[J].环球中医药,2016,9(4):476-478.
[12] 苏锡明,夏振西,王海霞,等.米氮平对老年失眠伴抑郁症的疗效及安全性观察[J].中国临床保健杂志,2015,18(5):524-525.
[13] 蔡喆.小剂量米氮平与劳拉西泮治疗慢性失眠症的临床分析[J].实用药物与临床,2013,16(9):821-823.
[14] 孟宪慧,于峥,董洪坦,等.疏肝泻火养血安神法治疗广泛性焦虑症伴失眠的临床观察[J].中国中医基础医学杂志,2016,22(8):1068-1070.
[15] 郑舒月,王媛媛,彭浩轩,等.中医药治疗肝郁化火型失眠的研究进展[J].医学综述,2017,23(13):2662-2665,2670.
[16] 白桦,李理,刘法.疏肝汤治疗肝郁化火型失眠症60例临床观察[J].中医药导报,2015,21(12):41-43.
[17] 刘俊梅.加味疏肝汤治疗失眠症的疗效及对生活质量相关激素水平的影响[J].陕西中医,2016,37(4):420-422.
[18] 孙晓卉,张量.柴胡药理作用的研究进展[J].中国医药导报,2017,14(10):52-55.
[19] 李岩.白芍及其化学成分的药理研究进展[J].职业与健康,2015,31(15):2153-2156.
[20] 赵玉娇,高耀,周玉枝,等.白术在神经精神系统疾病中的药理作用及机制研究进展[J].中草药,2017,48(21):4546-4551.
[21] 赵金龙,林勇,严韬,等.九味镇心颗粒对失眠患者下丘脑-垂体-甲状腺轴激素水平的影响[J].中华中医药学刊,2015,33(1):212-214.
[22] 谢柯,曾艳.养血清脑颗粒联合西药治疗中青年亚急性失眠疗效及对下丘脑-垂体-甲状腺轴激素水平的影响[J].现代中西医结合杂志,2017,26(18):2001-2003.
[23] 左卫星,张志飞,刘志民,等.参与下丘脑-垂体-甲状腺轴负反馈调控的分子元件研究进展[J].生物技术进展,2017,7(6):601-607.
[2] 岳莉莉,左文秀,汪辉耀,等.度洛西汀和米氮平治疗老年抑郁症的临床比较[J].国际精神病学杂志,2015,42(6):37-40.
[3] 蒋国卿,孙晓峰,张文静,等.自拟镇静安神汤辅助米氮平治疗焦虑抑郁状态伴顽固性失眠30例临床观察[J].疑难病杂志,2015,14(7):682-685.
[4] 王丽,王彩娟,芮绵,等.清心镇肝汤对肝郁化火型失眠症患者睡眠质量及血清5-HT、DA及GABA水平的影响[J].中医药信息,2017,34(6):64-69.
[5] Lawrenson J G,Hull C C,Downie L E.The effect of blue-light blocking spectacle lenses on visual performance,macular health and the sleep-wake cycle:a systematic review of the literature[J].Ophthalmic Physiol Opt,2017,37(6):644-654.
[6] 中华医学会神经病学分会睡眠障碍学组.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.
[7] 中华医学会神经病学分会神经心理学与行为神经病学组.综合医院焦虑、抑郁与躯体化症状诊断治疗的专家共识[J].中华神经科杂志,2016,49(12):908-917.
[8] Sobreira-Neto M A,Pena-Pereira M A,Sobreira E S T,et al.High frequency of sleep disorders in Parkinson’s disease and its relationship with quality of life[J].Eur Neurol,2017,78(5-6):330-337.
[9] Johansson M,Jansson-Fr?jmark M,Norell-Clarke A,et al.The role of psychiatric and somatic conditions in incidence and persistence of insomnia:a longitudinal,community study[J].Sleep Health,2016,2(3):229-238.
[10] Andreeva V A,Torres M J,Druesne-Pecollo N,et al.Sex-specific associations of different anthropometric indices with acute and chronic insomnia[J].Eur J Public Health,2017,27(6):1026-1031.
[11] 李超群,李秀玉.加味小柴胡汤联合米氮平治疗成人慢性失眠36例[J].环球中医药,2016,9(4):476-478.
[12] 苏锡明,夏振西,王海霞,等.米氮平对老年失眠伴抑郁症的疗效及安全性观察[J].中国临床保健杂志,2015,18(5):524-525.
[13] 蔡喆.小剂量米氮平与劳拉西泮治疗慢性失眠症的临床分析[J].实用药物与临床,2013,16(9):821-823.
[14] 孟宪慧,于峥,董洪坦,等.疏肝泻火养血安神法治疗广泛性焦虑症伴失眠的临床观察[J].中国中医基础医学杂志,2016,22(8):1068-1070.
[15] 郑舒月,王媛媛,彭浩轩,等.中医药治疗肝郁化火型失眠的研究进展[J].医学综述,2017,23(13):2662-2665,2670.
[16] 白桦,李理,刘法.疏肝汤治疗肝郁化火型失眠症60例临床观察[J].中医药导报,2015,21(12):41-43.
[17] 刘俊梅.加味疏肝汤治疗失眠症的疗效及对生活质量相关激素水平的影响[J].陕西中医,2016,37(4):420-422.
[18] 孙晓卉,张量.柴胡药理作用的研究进展[J].中国医药导报,2017,14(10):52-55.
[19] 李岩.白芍及其化学成分的药理研究进展[J].职业与健康,2015,31(15):2153-2156.
[20] 赵玉娇,高耀,周玉枝,等.白术在神经精神系统疾病中的药理作用及机制研究进展[J].中草药,2017,48(21):4546-4551.
[21] 赵金龙,林勇,严韬,等.九味镇心颗粒对失眠患者下丘脑-垂体-甲状腺轴激素水平的影响[J].中华中医药学刊,2015,33(1):212-214.
[22] 谢柯,曾艳.养血清脑颗粒联合西药治疗中青年亚急性失眠疗效及对下丘脑-垂体-甲状腺轴激素水平的影响[J].现代中西医结合杂志,2017,26(18):2001-2003.
[23] 左卫星,张志飞,刘志民,等.参与下丘脑-垂体-甲状腺轴负反馈调控的分子元件研究进展[J].生物技术进展,2017,7(6):601-607.