基于静息态功能磁共振成像观察加味酸枣仁汤治疗慢性失眠障碍的临床疗效  

Clinical efficacy of Modified Suanzaoren Decoction for chronic insomnia disorder based on restingstate functional magnetic resonance imaging

作　　者：李洁 吕东升 马睿婷[3] 王峥 郭治国 陈丽霞[5] Li Jie;Lyu Dongsheng;Ma Ruiting;Wang Zheng;Guo Zhiguo;Chen Lixia(Clinical Psychology Center,Inner Mongolia Autonomous Region Mental Health Center&the Third Hospital of Inner Mongolia Autonomous Region&Inner Mongolia Autonomous Region Brain Hospital,Huhhot 010010,China;Sleep Medicine Center,Inner Mongolia Autonomous Region Mental Health Center&the Third Hospital of Inner Mongolia Autonomous Region&Inner Mongolia Autonomous Region Brain Hospital,Huhhot 010010,China;Department of Medical Laboratory,Inner Mongolia Autonomous Region Mental Health Center&the Third Hospital of Inner Mongolia Autonomous Region&Inner Mongolia Autonomous Region Brain Hospital,Huhhot 010010,China;Department of Clinical Physics Diagnosis and Treatment,Inner Mongolia Autonomous Region Mental Health Center&the Third Hospital of Inner Mongolia Autonomous Region&Inner Mongolia Autonomous Region Brain Hospital,Huhhot 010010,China;Office of the Party Committee,Inner Mongolia Autonomous Region Mental Health Center,Inner Mongolia Autonomous Region Third Hospital&Inner Mongolia Autonomous Region Brain Hospital,Hohhot 010010,China)

机构地区：[1]内蒙古自治区精神卫生中心,内蒙古自治区第三医院,内蒙古自治区脑科医院临床心理治疗中心,呼和浩特010010 [2]内蒙古自治区精神卫生中心,内蒙古自治区第三医院,内蒙古自治区脑科医院睡眠医学中心,呼和浩特010010 [3]内蒙古自治区精神卫生中心,内蒙古自治区第三医院,内蒙古自治区脑科医院医学检验科,呼和浩特010010 [4]内蒙古自治区精神卫生中心,内蒙古自治区第三医院,内蒙古自治区脑科医院临床物理诊疗部,呼和浩特010010 [5]内蒙古自治区精神卫生中心,内蒙古自治区第三医院,内蒙古自治区脑科医院党委办公室,呼和浩特010010

出　　处：《神经疾病与精神卫生》2024年第5期357-363,共7页Journal of Neuroscience and Mental Health

基　　金：内蒙古自治区自然科学基金项目(2019MS08099);内蒙古自治区精神卫生中心院内项目(2022QNWN0005)。

摘　　要：目的探讨加味酸枣仁汤治疗慢性失眠障碍(CID)患者的临床疗效及静息态功能磁共振(rs-fMRI)的神经影像学机制。方法选取2020年10月—2022年1月于内蒙古自治区精神卫生中心门诊、社区门诊就诊及微信公众号平台招募的39例CID阴虚火旺证患者为研究对象。给予为期4周的加味酸枣仁汤治疗,比较治疗前后患者失眠严重程度指数量表(ISI)、匹兹堡睡眠质量指数量表(PSQI)、汉密尔顿焦虑量表(HAMA)、24项汉密尔顿抑郁量表(HAMD-24)、重复性成套神经心理状态测验(RBANS)得分,多导睡眠监测及rs-fMRI的变化,采用Pearson相关分析检验时间序列均值与PSQI、ISI、HAMA、HAMD减分率的相关性。结果最终纳入27例CID患者,经加味酸枣仁汤治疗后,患者的PSQI总分[(9.85±3.48)比(12.82±2.92)分]、ISI总分[(9.44±5.66)比(17.30±5.45)分]、HAMA总分[(6.67±3.89)比(11.19±4.71)分]、HAMD-24总分[(6.70±4.48)比(11.52±6.44)分]均低于治疗前,差异均有统计学意义(均P<0.05),RBANS总分[(98.72±9.30)分]高于治疗前[(88.92±8.59)分],差异有统计学意义(P<0.05),多导睡眠监测结果与治疗前比较,差异无统计学意义(P>0.05);海马、丘脑、后扣带回及眶部额中回的功能连接发生变化,差异均有统计学意义(均P<0.05),且左侧后扣带回-左侧额中回功能连接降低与HAMD24减分率呈正相关(r=0.422,P=0.028),左侧眶部额中回-左侧前扣带回和旁扣带脑回功能连接降低与HAMD-24减分率呈负相关(r=-0.399,P=0.039)。结论加味酸枣仁汤治疗后,CID患者失眠症状及情绪改善明显,其机制与调节海马、丘脑、后扣带回及眶部额中回等区域的异常功能活动有关。Objective To explore the clinical efficacy of Modified Suanzaoren Decoction for chronic insomnia disorder(CID)patients and the neuroimaging mechanism of resting-state functional magnetic resonance imaging(rs-fMRI).Methods From October 2020 to January 2022,39 CID patients with yin-deficiency and fire-hyperactivity were selected from the Clinic of Inner Mongolia Autonomous Region Mental Health Center,Community Clinic and WeChat Official Account as research objects.Patients were given a 4-week treatment with Modified Suanzaoren Decoction.The scores of the Insomnia Severity Index(ISI),Pittsburgh Sleep Quality Index(PSQI),Hamilton Anxiety Scale(HAMA),24-item Hamilton Depression Scale(HAMD-24),Repeatable Battery for Assessment of Neuropsychological Status(RBANS),as well as polysomnography and rs-fMRI were compared before and after treatment in patients.Pearson correlation was used to analyze the correlation between testing time series mean and PSQI,ISI,HAMA,and HAMD-24 reduction rates.Results Twenty-seven patients with CID were finally included and after treatment with Modified Suanzaoren Decoction,the total PSQI score[(9.85±3.48)vs(12.82±2.92)],ISI score[(9.44±5.66)vs(17.30±5.45)],HAMA score[(6.67±3.89)vs(11.19±4.71)],and HAMD-24 score[(6.70±4.48)vs(11.52±6.44)]of the patients were all lower than before treatment,and the differences were statistically significant(all P<0.05).The total score of RBANS(98.72±9.30)was higher than before treatment(88.92±8.59),and the difference was statistically significant(P<0.05).There was no statistically significant difference in the results of polysomnography after treatment compared to before treatment(P>0.05).The functional connections of the hippocampus,thalamus,posterior cingulate gyrus,and orbital frontal gyrus changed,and the differences were statistically significant(all P<0.05).The decrease in functional connection between the left posterior cingulate gyrus and the left frontal gyrus was positively correlated with the reduction rate of HAMD-24(r=0.422,P=0.028),while

关 键 词：失眠症 加味酸枣仁汤 慢性失眠障碍 临床疗效 静息态功能磁共振 功能连接 

分 类 号：R256.23[医药卫生—中医内科学]