加味酸枣仁汤对阴虚火旺型慢性失眠患者认知功能的影响
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R256.23

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宁波市品牌学科基金资助(PPXK2018-07)


Effect of Modified Suanzaoren Tang on Cognitive Function in Patients with Chronic Insomnia of Yin Deficiency with Effulgent Fire Type
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    摘要:

    目的:观察加味酸枣仁汤治疗阴虚火旺型慢性失眠患者认知功能的临床疗效并探讨其可能的作用机理。方法:共纳入符合标准的病例70 例,按随机数字表法分为西药组和中药组,最终纳入统计的病例67 例,西药组33 例,中药组34 例。西药组予艾司唑仑片治疗,中药组予加味酸枣仁汤治疗。2 组均治疗8 周。观察2 组睡眠的客观指标及认知功能评价指标。结果:①Pearson 相关性分析显示,患者蒙特利尔认知评估量表(MoCA) 评分与睡眠总时间、熟睡时间、快速眼球运动(REM) 睡眠时间呈正相关,与觉醒时间、初入睡时间、浅睡时间呈负相关。②治疗后,西药组睡眠总时间、浅睡时间较前增加,REM 睡眠时间、觉醒时间、初入睡时间较前缩短,差异有统计学意义(P<0.05);熟睡时间治疗前后比较,差异无统计学意义(P>0.05);中药组睡眠总时间、熟睡时间较前增加,初入睡时间较前缩短,差异均有统计学意义(P<0.05);浅睡时间、REM 睡眠时间、觉醒时间治疗前后比较,差异均无统计学意义(P>0.05);西药组和中药组治疗后客观睡眠各项数据指标比较,差异均无统计学意义(P>0.05)。③治疗后,西药组MoCA 评分较治疗前显著下降,差异有统计学意义(P<0.01);中药组治疗后MoCA 评分有所提高,差异有统计学意义(P<0.05);治疗后,2 组MoCA 评分比较,差异有统计学意义(P<0.05)。④2 组治疗前后简易精神状态检查表(MMSE) 评分比较,差异均无统计学意义(P>0.05);治疗后,2 组MMSE 评分比较,差异均无统计学意义(P>0.05)。结论:慢性失眠以轻度认知功能障碍为主要表现,认知功能受损与睡眠时间减少、睡眠结构破坏、睡眠片段化相关;加味酸枣仁汤能改善慢性失眠患者轻度的认知功能,有可能扭转当前慢性失眠患者接受苯二氮䓬类治疗后认知功能进一步恶化的困局。其机制可能是与增加患者的熟睡时间,改善睡眠结构有关。

    Abstract:

    Abstract: Objective: To observe the clinical effect of modified Suanzaoren tang on cognitive function in patients with chronic insomnia of yin deficiency with effulgent fire type and its possible mechanism. Methods: In accordance with the inclusion criteria,a total of 70 cases were included and divided into the western medicine group and the Chinese medicine group according to the random number table method. Finally, 67 cases were included, including 33 cases in the western medicine group and 34 cases in the Chinese medicine group. The western medicine group was treated with estazolam tablets, and the Chinese medicine group was treated with modified Suanzaoren tang. Both groups were treated for eight weeks. The objective indexes of sleep and the evaluation indexes of cognitive function in the two groups were observed. Results: ① According to the Pearson correlation, the scores of Montreal Cognitive Assessment(MoCA) were positively correlated with the total sleep time, the deep sleep time and rapid eye movement(REM) sleep time, and negatively correlated with the awakening time, the time of first falling asleep and the light sleep time. ② After treatment, in the western medicine group, the total sleep time and the light sleep time were prolonged, and the REM sleep time, the awakening time and the time of first falling asleep were shortened,the difference being significant(P<0.05);there was no significant difference being found in the comparison of the deep sleep time before and after treatment(P>0.05). After treatment,in the Chinese medicine group,the total sleep time and the deep sleep time were prolonged,and the time of first falling asleep were shortened,the difference being significant(P<0.05);there was no significant difference being found in the comparison of the light sleep time,the REM sleep time and the awakening time before and after treatment(P>0.05). After treatment,there was no significant difference being found in the comparison of each index between the two groups(P> 0.05).③After treatment,the MoCA score in the western medicine group was significantly decreased when compared with that before treatment, the difference being significant(P<0.01); the MoCA score in the Chinese medicine group was increased,the difference being significant(P<0.05);there was significant difference being found in the comparison of the MoCA scores between the two groups(P<0.05). ④Before and after treatment, there was no significant difference being found in the comparison of Mini- mental State Examination(MMSE) scores between the two groups(P>0.05). After treatment,there was no significant difference being found in the comparison of MMSE scores between the two groups(P> 0.05). Conclusion:Mild cognitive dysfunction is the main manifestation of chronic insomnia,and the cognitive impairment is related to sleep time reduction,sleep structure damage,and sleep fragmentation. Modified Suanzaoren tang can improve mild cognitive function of patients with chronic insomnia,and may reverse the plight of deterioration of cognitive function of the patients after receiving benzodiazepines treatment. The mechanism may be related to the increase of the deep sleep time and the improvement of the sleep structure.

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吴王芳,张永华.加味酸枣仁汤对阴虚火旺型慢性失眠患者认知功能的影响[J].新中医,2020,52(19):31-35

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  • 在线发布日期: 2020-10-12
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