180例失眠患者中医证型分布及其与多导睡眠图的相关性分析  

Distribution of Traditional Chinese Medicine Syndrome Types in 180 Patients with Insomnia and Its Correlation with Polysomnography

作　　者：邵珺 张振贤[1] 史佳宁[1] 蒋天君 SHAO Jun;ZHANG Zhenxian;SHI Jianing;JIANG Tianjun(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200437)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海市200437

出　　处：《中医杂志》2023年第4期377-386,共10页Journal of Traditional Chinese Medicine

基　　金：上海市进一步加快中医药事业发展三年行动计划[ZY(2018-2020)-FWTX-6011];上海市中医药事业发展三年行动计划[ZY(2018-2020)-ZWB-1001]。

摘　　要：目的 分析失眠患者的中医证型分布规律并比较不同证型失眠患者的多导睡眠图特征与临床特点。方法 调查180例失眠患者的一般情况、中医证型,分析患者多导睡眠图特征,并进行匹兹堡睡眠质量指数、失眠严重指数、汉密尔顿焦虑量表和汉密尔顿抑郁量表评价。比较不同中医证型患者睡眠情况的差异,并分析影响失眠主要中医证型的相关因素。结果 中医证型分布统计结果,心脾两虚证占比为49.44%(89/180),不同性别的失眠患者均以心脾两虚证为主要中医证型。不同证型患者的年龄、体重指数、睡眠潜伏期、觉醒次数差异有统计学意义(P<0.05)。失眠患者普遍存在焦虑抑郁症状,不同证型的匹兹堡睡眠质量指数、汉密尔顿焦虑量表、汉密尔顿抑郁量表、失眠严重指数总分比较差异无统计学意义(P>0.05)。经Spearman相关性分析发现,在服用苯二氮?类受体激动剂的失眠患者中,年龄与总睡眠时间呈负相关(r=-0.386,P<0.01),与入睡后觉醒时间呈正相关(r=0.356,P<0.01)。二元Logistic回归分析结果显示,觉醒次数与心脾两虚型失眠显著相关(OR=1.080,P=0.009),心脾两虚型失眠患者的觉醒次数增加风险是非心脾两虚型失眠患者的1.08倍。结论 心脾两虚是失眠的主要中医证型,不同证型失眠患者的睡眠结构存在差异,其中觉醒次数与心脾两虚型失眠显著相关,觉醒次数增加可能是失眠心脾两虚证候的特征表现。Objective To analyze the distribution of traditional Chinese medicine(TCM) syndrome types of insomnia patients,and compare the polysomnographic features and clinical characteristics of insomnia with different syndrome types.Methods A total of 180 patients with insomnia were investigated on their general condition,TCM syndrome types,polysomnographic features,Pittsburgh sleep quality index(PSQI),insomnia severity index(ISI),Hamilton anxiety scale(HAMA) and Hamilton depression scale(HAMD).The difference between sleep conditions of different TCM syndrome types were compared,and the relevant factors affecting the main TCM syndrome types of insomnia were analyzed.Results In terms of the distribution of TCM syndrome types,the heart and spleen deficiency syndrome was the main pattern irrespective of the gender,totally accounting for 49.44%(89/180).There were significant differences in age,body mass index,sleep latency and number of awakenings among different syndrome types(P<0.05).Anxiety and depression were common in patients with insomnia,and there was no significant differences in the scores of PSQI,HAMA,HAMD,and ISI among different syndrome types(P>0.05).According to Spearman correlation analysis,in insomnia patients taking benzodiazepine agonists,age was negatively correlated with total sleep time(TST)(r=-0.386,P<0.01),and positively correlated with wakefulness after sleep onset(WASO)(r=0.356,P<0.01).Binary logistic regression analysis showed that the number of awakenings was significantly correlated to insomnia with the heart and spleen deficiency(OR=1.080,P=0.009).The increased risk of the number of awakenings of patients with heart and spleen deficiency was 1.08 times that of the patients without(P<0.01).Conclusion The deficiency of both heart and spleen is the main TCM syndrome type of insomnia.The sleep structure varies among the different types of insomnia patients.The number of awakenings is significantly correlated to the deficiency of both heart and spleen,and its increase may be the featured manifestation

关 键 词：失眠 心脾两虚 多导睡眠图 横断面研究 

分 类 号：R256.23[医药卫生—中医内科学]