健脾养心安神方联合认知行为疗法治疗老年失眠症的临床疗效及对血清5-羟色胺、食欲素A水平的影响  

Clinical Efficacy of Jianpi Yangxin Anshen Prescription Combined with Cognitive Behavioral Therapy in the Treatment of Senile Insomnia and Its Effect on the Levels of Serum 5-Hydroxytryptamine and Orexin A

作　　者：张珣 刘颖慧 李玲 游晓艳 闫赛强 王朝 成立 ZHANG Xun;LIU Ying-Hui;LI Ling;YOU Xiao-Yan;YAN Sai-Qiang;WANG Chao;CHENG Li(Graduate School of Hebei University of Chinese Medicine,Shijiazhuang 050091 Hebei,China;The Third Hospital of Chengde City,Chengde 067000 Hebei,China;The First Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang 050010 Hebei,China)

机构地区：[1]河北中医学院研究生院,河北石家庄050091 [2]承德市第三医院,河北承德067000 [3]河北中医学院第一附属医院,河北石家庄050010

出　　处：《广州中医药大学学报》2023年第8期1902-1910,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：河北省中医药管理局科研计划项目(编号:2022021)。

摘　　要：【目的】观察健脾养心安神方联合认知行为疗法治疗老年失眠症心脾两虚型患者的临床疗效以及对血清5-羟色胺(5-HT)、食欲素A(Orexin A)水平的影响。【方法】将120例老年慢性失眠症心脾两虚型患者随机分为西药组和联合组,每组各60例。西药组给予右佐匹克隆片口服治疗,联合组给予健脾养心安神方中药颗粒口服联合认知行为疗法治疗,疗程均为8周。观察2组患者治疗前及治疗4周、8周后匹兹堡睡眠质量指数(PSQI)评分、汉密尔顿焦虑量表(HAMA)评分、血清5-HT、Orexin A水平及多导睡眠图(PSG)监测指标的变化情况,并评价2组患者的临床疗效和安全性。【结果】(1)脱落情况:治疗过程中,西药组和联合组各脱落1例,实际入组各59例。(2)疗效方面:治疗8周后,联合组的愈显率和总有效率分别为71.19%(42/59)和93.22%(55/59),西药组分别为38.98%(23/59)和72.88%(43/59),组间比较,联合组的愈显率、总有效率和总体疗效均明显优于西药组(P<0.05)。(3)PSQI评分方面:治疗4周和8周后,2组患者的PSQI各因子评分和总分均较治疗前明显降低(P<0.05),且治疗8周后又均较治疗4周后明显降低(P<0.05);组间比较,联合组在治疗4周后对PSQI的睡眠质量、睡眠效率、睡眠障碍、日间功能障碍评分和总分以及治疗8周后对各因子评分和总分的下降幅度均明显优于西药组(P<0.05)。(4)HAMA评分方面:治疗4周和8周后,2组患者的HAMA评分均较治疗前明显降低(P<0.05),且治疗8周后又较治疗4周后明显降低(P<0.01);组间比较,联合组患者在治疗4周和8周后对HAMA评分的降低幅度均明显优于西药组(P<0.05)。(5)实验室指标方面:治疗4周和8周后,2组患者血清5-HT水平均较治疗前明显升高(P<0.05),血清Orexin A水平均较治疗前明显降低(P<0.05),且治疗8周后,2组患者血清5-HT水平又较治疗4周后明显升高(P<0.01),血清Orexin A水平又较治疗4周后明显降低(P<0.01);组�Objective To investigate the clinical efficacy of Jianpi Yangxin Anshen Prescription combined with cognitive behavioral therapy in the treatment of patients with senile insomnia of heart and spleen deficiency type and to observe its effects on serum 5-hydroxytryptamine(5-HT)and orexin A(Orexin A)levels.Methods A total of 120 patients with chronic senile insomnia of heart and spleen deficiency type were randomly divided into the western medicine group and the combination group,with 60 cases in each group.The western medicine group was given oral use of Dexzopiclone Tablets,and the combination group was given oral use of Jianpi Yangxin Anshen Prescription granules combined with cognitive behavioral therapy.Both groups of patients were treated for 8 weeks.Changes in the Pittsburgh Sleep Quality Index(PSQI)scores,Hamilton Anxiety Scale(HAMA)scores,serum 5-HT and Orexin A levels,and polysomnography(PSG)monitoring indexes in the two groups were observed before treatment and after 4 and 8 weeks of treatment.Moreover,the clinical efficacy and safety of the patients in the two groups were evaluated.Results(1)During the trial,both of the western medicine and the combination group had one case falling off,and each group had 59 cases enrolled eventually.(2)After 8 weeks of treatment,the cured and markedly effective rate and total effective rate of the combination group were 71.19%(42/59)and 93.22%(55/59)respectively,ant those in the western medicine group were 38.98%(23/59)and 72.88%(43/59)respectively.The intergroup comparison showed that the cured and markedly effective rate,total effective rate and overall efficacy of the combination group were significantly superior to those of the western medicine group(P<0.05).(3)After 4 and 8 weeks of treatment,the PSQI item scores and total scores of both groups were significantly decreased compared with those before treatment(P<0.05),and the scores in the two groups after 8 weeks of treatment were significantly lower than those after 4 weeks of treatment(P<0.05).The intergroup compa

关 键 词：老年失眠症 健脾养心安神方 认知行为疗法 多导睡眠图 5-羟色胺 食欲素A 

分 类 号：R256.23[医药卫生—中医内科学]