桂枝甘草龙骨牡蛎汤加减治疗阴虚火旺型更年期失眠疗效及对患者睡眠质量、神经递质的影响
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摘要
目的:探讨更年期失眠患者应用桂枝甘草龙骨牡蛎汤加减治疗的临床效果。方法:选取2016年1月至2018年6月本院收治的134例女性更年期失眠患者,使用随机数字表法将其随机分成观察组与对照组,各67例。对照组口服右佐匹克隆,观察组在此基础上联合桂枝甘草龙骨牡蛎汤加减治疗。所有患者均治疗4周。对比两组临床效果,治疗前后睡眠质量[匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)]评分,神经递质[谷氨酸(glutamic acid,Glu),γ-氨基丁酸(γ-aminobutyric acid,GABA),5-羟色胺(5-hydroxytryptamine,5-HT),多巴胺(dopamine,DA)]水平变化,不良反应发生情况。结果:观察组总有效率为92.5%(62/67),明显高于对照组的80.6%(54/67)(P<0.05)。两组治疗后PSQI中入睡时间、睡眠效率、睡眠质量等6个维度评分(除催眠药物维度外)及总分较本组治疗前均明显下降(P<0.05),且观察组治疗后PSQI中各维度(入睡时间、睡眠效率、催眠药物等)评分及总分较对照组同期均明显降低(P<0.05)。与本组治疗前对比,两组治疗后血清Glu,DA浓度均明显减少(P<0.05),血清GABA,5-HT含量均明显升高(P<0.05);且观察组改善更明显(P<0.05)。观察组不良反应率与对照组比较差异无统计学意义。结论:阴虚火旺型更年期失眠应用桂枝甘草龙骨牡蛎汤加减治疗能明显提高患者睡眠质量,改善失眠症状,纠正神经递质代谢紊乱,疗效确切,患者耐受性较好。
Objective: To explore the clinical efficiency of modified Guizhi Gancao Longgu Muli Tang in treating menopausal insomnia. Method: A total of 134 female cases with menopausal insomnia in our hospital from January 2016 to June 2018 were selected as research objectives and randomly divided into observation group( 67 cases) and control group( 67 cases). Oral zopiclone was provided to control group,and modified Guizhi Gancao Longgu Muli Tang combined with oral zopiclone was provided to observation group. All cases were treated for 4 weeks. The two groups’ clinical effects, sleep quality [pittsburgh sleep quality index( PSQI) score ],neurotransmitter [glutamate( Glu),γ-aminobutyric acid( GABA),5-hydroxytryptamine( 5-HT),dopamine( DA) ]levels before and after treatment,as well as adverse reactions were compared. Result: Observation group’s overall effective rate was 92. 5%( 62/67),which was significantly higher than 80. 6%( 54/67) of control group( P < 0. 05). Both groups’ scores and total scores of the six dimensions including sleep time,sleep efficiency and sleep quality in PSQI( except for the hypnotic drug dimension) after treatment were significantly lower than those before treatment( P < 0. 05),and observation group’s scores and total scores of each dimension( like sleeping time,sleep efficiency,hypnotic drugs) in PSQI after treatment were significantly lower than those in control group( P < 0. 05). Compared with those before treatment,both groups’ serum Glu,DA levels decreases significantly( P < 0. 05),while serum GABA,5-HT levels increased significantly( P < 0. 05),and observation group showed more significant improvement( P < 0. 05). Observation group’s adverse reaction rate was lower than that of control group,with no statistically significant difference. Conclusion: Modified Guizhi Gancao Longgu Muli Tang can improve sleep quality,alleviate symptoms of insomnia,and correct neurotransmitter metabolic disorder for patients with menopausal insomnia,with an exact curative effect and a higher tolerance of patients.
Objective: To explore the clinical efficiency of modified Guizhi Gancao Longgu Muli Tang in treating menopausal insomnia. Method: A total of 134 female cases with menopausal insomnia in our hospital from January 2016 to June 2018 were selected as research objectives and randomly divided into observation group( 67 cases) and control group( 67 cases). Oral zopiclone was provided to control group,and modified Guizhi Gancao Longgu Muli Tang combined with oral zopiclone was provided to observation group. All cases were treated for 4 weeks. The two groups’ clinical effects, sleep quality [pittsburgh sleep quality index( PSQI) score ],neurotransmitter [glutamate( Glu),γ-aminobutyric acid( GABA),5-hydroxytryptamine( 5-HT),dopamine( DA) ]levels before and after treatment,as well as adverse reactions were compared. Result: Observation group’s overall effective rate was 92. 5%( 62/67),which was significantly higher than 80. 6%( 54/67) of control group( P < 0. 05). Both groups’ scores and total scores of the six dimensions including sleep time,sleep efficiency and sleep quality in PSQI( except for the hypnotic drug dimension) after treatment were significantly lower than those before treatment( P < 0. 05),and observation group’s scores and total scores of each dimension( like sleeping time,sleep efficiency,hypnotic drugs) in PSQI after treatment were significantly lower than those in control group( P < 0. 05). Compared with those before treatment,both groups’ serum Glu,DA levels decreases significantly( P < 0. 05),while serum GABA,5-HT levels increased significantly( P < 0. 05),and observation group showed more significant improvement( P < 0. 05). Observation group’s adverse reaction rate was lower than that of control group,with no statistically significant difference. Conclusion: Modified Guizhi Gancao Longgu Muli Tang can improve sleep quality,alleviate symptoms of insomnia,and correct neurotransmitter metabolic disorder for patients with menopausal insomnia,with an exact curative effect and a higher tolerance of patients.
引文
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[3]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):67-68,75.
[4]邓斌,王磊,郑淑英,等.东莞市成人慢性病发病危险因素调查分析[J].国外医学:医学地理分册,2016,37(3):225-229.
[5]马堃,陈燕霞.中西医治疗围绝经期综合征策略的探讨[J].中国中药杂志,2015,40(20):3899-3906.
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[7]李淼,白正勇.经方辨治更年期失眠探析[J].实用中医内科杂志,2011,25(3):17-18.
[8]GUO T,JIA M,JIN Y,et al.Acupuncture for perimenopausal insomnia:a systematic review and metaanalysis protocol[J].Medicine:Baltimore,2018,97(24):e11083.
[9]彭思菡,林潮荣,吕梦亮,等.桂枝甘草龙骨牡蛎汤配合耳穴对更年期失眠患者生存质量的影响[J].中国民族民间医药,2017,26(24):92-94.
[10]赵晋莹,王环,张欣露,等.中医药治疗更年期失眠症[J].长春中医药大学学报,2016,32(5):962-963.
[11]曹泽毅.中华妇产科学[M].3版.北京:人民卫生出版社,2014:2713.
[12]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.
[13]中华中医药学会发布.中医内科常见病诊疗指南·中医病证部分[M].北京:中国中医药出版社,2008:50-53.
[14]王蔚文,孙明.临床疾病诊断与疗效判断标准[M].北京:科学技术文献出版社,2010:1470.
[15]Buysse D J,Reynolds C F,Monk T H,et al.The Pittsburgh Sleep Quality Index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28(2):193-213.
[16]Ciano C,King T S,Wright R R,et al.Longitudinal study of insomnia symptoms among women during perimenopause[J].J Obstet Gynecol Neonatal Nurs,2017,46(6):804-813.
[17]中华医学会神经病学分会,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(2017版)[J].中华神经科杂志,2018,51(5):324-335.
[18]曾令烽,蒙昌荣,李滋平,等.中医药辅助治疗围绝经期失眠研究的Meta分析[J].中国实验方剂学杂志,2015,21(18):195-201.
[19]魏士雄,徐波,刘琼,等.探讨女性更年期失眠的中医发病机制及防治[J].时珍国医国药,2018,29(3):653-655.
[20]路桃影,李艳,夏萍,等.匹兹堡睡眠质量指数的信度及效度分析[J].重庆医学,2014,43(3):260-263.
[21]孟方,龚卫娟,廖月霞,等.耳揿针联合耳尖放血对围绝经期失眠患者睡眠质量、神经内分泌水平的影响[J].中国针灸,2018,38(6):575-579.
[22]郭晓,郭蓉娟,邢佳,等.宁心安神方调控失眠大鼠Glu/GABA-Gln代谢环路失衡的机制研究[J].北京中医药大学学报,2017,40(5):413-419.
[23]吴建丽,王天琪,王永亮,等.电项针对失眠大鼠脑干单胺类神经递质含量的影响[J].长春中医药大学学报,2017,33(3):358-361.
[24]张飞燕,李晶晶,周莹,等.安神类中药及其有效成分对神经递质镇静催眠机制的研究进展[J].中国中药杂志,2016,41(23):4320-4327.
[2]Hirose A,Terauchi M,Akiyoshi M,et al.Subjective insomnia is associated with low sleep efficiency and fatigue in middle-aged women[J].Climacteric,2016,19(4):369-374.
[3]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):67-68,75.
[4]邓斌,王磊,郑淑英,等.东莞市成人慢性病发病危险因素调查分析[J].国外医学:医学地理分册,2016,37(3):225-229.
[5]马堃,陈燕霞.中西医治疗围绝经期综合征策略的探讨[J].中国中药杂志,2015,40(20):3899-3906.
[6]李世勇,陈少玫.围绝经期妇女失眠症的中医药研究进展[J].现代中医药,2014,34(1):99-103.
[7]李淼,白正勇.经方辨治更年期失眠探析[J].实用中医内科杂志,2011,25(3):17-18.
[8]GUO T,JIA M,JIN Y,et al.Acupuncture for perimenopausal insomnia:a systematic review and metaanalysis protocol[J].Medicine:Baltimore,2018,97(24):e11083.
[9]彭思菡,林潮荣,吕梦亮,等.桂枝甘草龙骨牡蛎汤配合耳穴对更年期失眠患者生存质量的影响[J].中国民族民间医药,2017,26(24):92-94.
[10]赵晋莹,王环,张欣露,等.中医药治疗更年期失眠症[J].长春中医药大学学报,2016,32(5):962-963.
[11]曹泽毅.中华妇产科学[M].3版.北京:人民卫生出版社,2014:2713.
[12]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.
[13]中华中医药学会发布.中医内科常见病诊疗指南·中医病证部分[M].北京:中国中医药出版社,2008:50-53.
[14]王蔚文,孙明.临床疾病诊断与疗效判断标准[M].北京:科学技术文献出版社,2010:1470.
[15]Buysse D J,Reynolds C F,Monk T H,et al.The Pittsburgh Sleep Quality Index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28(2):193-213.
[16]Ciano C,King T S,Wright R R,et al.Longitudinal study of insomnia symptoms among women during perimenopause[J].J Obstet Gynecol Neonatal Nurs,2017,46(6):804-813.
[17]中华医学会神经病学分会,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(2017版)[J].中华神经科杂志,2018,51(5):324-335.
[18]曾令烽,蒙昌荣,李滋平,等.中医药辅助治疗围绝经期失眠研究的Meta分析[J].中国实验方剂学杂志,2015,21(18):195-201.
[19]魏士雄,徐波,刘琼,等.探讨女性更年期失眠的中医发病机制及防治[J].时珍国医国药,2018,29(3):653-655.
[20]路桃影,李艳,夏萍,等.匹兹堡睡眠质量指数的信度及效度分析[J].重庆医学,2014,43(3):260-263.
[21]孟方,龚卫娟,廖月霞,等.耳揿针联合耳尖放血对围绝经期失眠患者睡眠质量、神经内分泌水平的影响[J].中国针灸,2018,38(6):575-579.
[22]郭晓,郭蓉娟,邢佳,等.宁心安神方调控失眠大鼠Glu/GABA-Gln代谢环路失衡的机制研究[J].北京中医药大学学报,2017,40(5):413-419.
[23]吴建丽,王天琪,王永亮,等.电项针对失眠大鼠脑干单胺类神经递质含量的影响[J].长春中医药大学学报,2017,33(3):358-361.
[24]张飞燕,李晶晶,周莹,等.安神类中药及其有效成分对神经递质镇静催眠机制的研究进展[J].中国中药杂志,2016,41(23):4320-4327.