调和阴阳法针灸对老年不寐患者睡眠质量及MT、NE、5-HT水平的影响

Effects of acupuncture and moxibustion with the method of regulating Yin and Yang on sleep quality and levels of MT, NE and 5-HT in elderly patients with insomnia

摘要:

目的 探讨调和阴阳法针灸对老年不寐患者睡眠质量及褪黑素（MT）、去甲肾上腺素（NE）、5-羟色胺（5-HT）水平的影响。方法 选取2020年7月—2022年7月河北医科大学第一医院收治的老年不寐患者120例，采用随机数表法分为观察组和对照组，每组60例。对照组采取常规药物治疗，观察组在对照组基础上联合调和阴阳法针灸。比较两组临床疗效，同时评估其中医证候积分和匹兹堡睡眠质量指数（PSQI）评分，测定MT、NE、5-HT、多巴胺（DA）、γ-氨基丁酸（GABA）水平，观察记录不良反应发生情况。结果 观察组总有效率高于对照组（P <0.05）；观察组治疗前后入睡困难、多梦易醒、神疲食少、目赤口苦、舌红少津、脉弦数、舌苔黄评分的差值均高于对照组（P <0.05）。观察组与对照组治疗前及治疗后2、4周的PSQI评分比较，结果 ①不同时间点PSQI评分比较，差异有统计学意义（F =17.894，P =0.000）；②两组PSQI评分比较，差异有统计学意义（F =26.894，P =0.000），观察组PSQI评分较低，相对睡眠质量较好；③观察组与对照组PSQI评分变化趋势比较，差异有统计学意义（F =45.247，P =0.000）。观察组治疗前后睡眠总时间、快速眼动睡眠期、睡眠潜伏期、醒觉时间、睡眠效率的差值均高于对照组（P <0.05）；观察组治疗前后MT、NE、5-HT的差值均高于对照组（P <0.05）；观察组治疗前后DA、GABA的差值均高于对照组（P <0.05）；两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 调和阴阳法针灸治疗老年失眠症疗效显著，不仅能有效改善患者中医症状、睡眠质量及睡眠结构，还能改善血清MT、NE、5-HT、DA、GABA水平，安全性较高。

Abstract:

Objective To explore the effects of acupuncture and moxibustion with the method of regulating Yin and Yang on sleep quality and the levels of melatonin (MT), norepinephrine (NE) and 5-hydroxytryptamine (5-HT) in elderly patients with insomnia.Methods A total of 120 elderly patients with insomnia admitted to our hospital from July 2020 to July 2022 were randomly divided into observation group and control group, with 60 patients in each group. The control group was treated with conventional drugs, and the observation group was treated with acupuncture and moxibustion with the method of regulating Yin and Yang on the basis of the conventional drugs. The clinical efficacy of the two groups was compared, and their TCM syndrome scores and Pittsburgh Sleep Quality Index (PSQI) scores were evaluated. In addition, levels of MT, NE, 5-HT, dopamine (DA) and γ-aminobutyric acid (GABA) were measured, and the incidence of adverse reactions was observed.Results The overall effective rate of the observation group was higher than that of the control group (P < 0.05). The differences of the scores of difficulty falling asleep, dreaminess and being easily awakened, fatigue and poor appetite, conjunctival congestion and bitter taste in the mouth, red tongue and hypoptyalism, taut and rapid pulse, and yellow tongue before and after treatment in the observation group were higher than those in the control group (P < 0.05). The PSQI scores before and 2 and 4 weeks after treatment in the observation and control group were compared, and the results revealed that they were different among time points (F = 17.894, P = 0.000) and between the observation group and the control group (F = 26.894, P = 0.000), with those in the observation group being lower indicating better sleep quality. Besides, there was a difference in the change trends of PSQI scores between the observation group and the control group (F = 45.247, P = 0.000). The differences of total sleep time, duration of rapid eye movement sleep, sleep latency, awakening time, and sleep efficiency before and after treatment in the observation group were higher than those in the control group (P < 0.05). The differences of levels of MT, NE, and 5-HT before and after treatment in the observation group were higher than those in the control group (P < 0.05). The differences of levels of DA and GABA before and after treatment in the observation group were higher than those in the control group (P < 0.05). There was no difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusions The acupuncture and moxibustion with the method of regulating Yin and Yang exhibits pronounced efficacy in treating insomnia among the elderly. It can not only effectively improve the TCM symptoms, sleep quality and sleep structures of patients, but also the serum levels of MT, NE, 5-HT, DA and GABA, with a great safety profile.