【摘要】 目的:观察温针透灸法治疗原发性失眠(primary insomnia,PI)的临床疗效及其对脑递质的影响。方法:选取66例PI患者随机分为温针透灸组和常规针刺组，每组33例。温针透灸组采用针刺结合透灸治疗，常规针刺组采用针刺结合特定电磁波理疗仪治疗。两组均每天治疗1次，每周治疗5次，连续治疗4周。比较两组患者治疗前后的匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、失眠严重程度指数(insomnia severity index,ISI)、中医症状量表评分以及脑递质[γ-氨基丁酸(γ-aminobutyric acid,GABA)、5-羟色胺(5-hydroxytryptamine,5-HT)、去甲肾上腺素(norepinephrine,NE)、多巴胺(dopamine,DA)、谷氨酸(glutamic acid,Glu)、乙酰胆碱(acetylcholine,ACh)]相对功率，并比较两组临床疗效。结果:(1)温针透灸组有效率为93.75%(30/32)，常规针刺组有效率为87.10%(27/31)，两组有效率比较，差异有统计学意义(P<0.05)。(2)治疗后，两组患者PSQI总分、ISI评分及中医症状总分均低于本组治疗前;治疗4周后，温针透灸组PSQI总分为(6.34±0.24)分、ISI评分为(4.75±1.22)分、中医症状总分为(5.84±1.17)分，均低于同期常规针刺组(P<0.05)。(3)治疗后，两组患者脑递质GABA、5-HT相对功率均显著升高;治疗4周后，温针透灸组GABA相对功率为(23.30±4.51 )、5-HT相对功率为(281.71±28.56)，均高于同期常规针刺组(P<0.05)。(4)治疗后，两组患者脑递质NE、DA、Glu、Ach相对功率均显著低于治疗前;治疗4周后，温针透灸组NE相对功率为(152.65±14.10)、DA为(105.23±12.73)、Glu为(40.50±9.83)、Ach为(237.16±18.83)，均低于同期常规针刺组(P<0.05)。(5)治疗期间两组患者均未发生晕针、晕灸等不良反应。结论:温针透灸法治疗PI临床疗效显著，能显著改善PI患者睡眠质量，并调节脑递质水平。更多还原

【Abstract】 Objective: To observe the clinical efficacy of warm needle Toujiu(moxibustion of deep heat penetration) therapy for primary insomnia(PI) and its effect on brain neurotransmitters. Methods: Sixty-six PI patients were randomly divided into a warm needle Toujiu(moxibustion of deep heat penetration) group and a conventional acupuncture group,with 33 patients in each group. The warm needle Toujiu(moxibustion of deep heat penetration) group received acupuncture combined with moxibustion therapy,while the conventional acupuncture group received acupuncture combined with a specific electromagnetic therapy device. Both groups were treated once daily,five times per week,for four consecutive weeks. The Pittsburgh sleep quality index(PSQI),insomnia severity index(ISI),Traditional Chinese Medicine symptom scale scores,and the relative power of brain neurotransmitters [γ-aminobutyric acid(GABA),5-hydroxytryptamine(5-HT),norepinephrine(NE),dopamine(DA),glutamic acid(Glu),acetylcholine(ACh) ] were compared before and after treatment,and the clinical efficacy between the two groups was evaluated. Results:(1) The effective rate of warm needle Toujiu(moxibustion of deep heat penetration group was 93. 75%(30/32),and the effective rate of the conventional acupuncture group was 87. 10%(27/31). The comparison of the effective rates between the two groups showed a statistically significant difference(P <0. 05).(2) After treatment,the PSQI total score,ISI score,and total TCM symptom score of patients in both groups were lower than those before treatment in each group; after 4 weeks of treatment,the warm needle Toujiu(moxibustion of deep heat penetration group had a PSQI total score of(6. 34 ± 0. 24),ISI score of(4. 75 ± 1. 22),and total TCM symptom score of(5. 84 ± 1. 17),all lower than those of the conventional acupuncture group at the same period(P < 0. 05).(3) After treatment,the relative power of neurotransmitters GABA and 5-HT in both groups increased significantly; after 4 weeks of treatment,the warm needle Toujiu(moxibustion of deep heat penetration) group had a GABA relative power of(23. 30 ± 4. 51) and 5-HT relative power of(281. 71 ± 28. 56),both higher than the conventional acupuncture group at the same period(P < 0. 05).(4) After treatment,the relative power of neurotransmitters NE,DA,Glu,and Ach in both groups was significantly lower than before treatment; after 4 weeks of treatment,the warm needle Toujiu(moxibustion of deep heat penetration group had an NE relative power of(152. 65 ± 14. 10),DA of(105. 23 ± 12. 73),Glu of(40. 50 ± 9.83),and Ach of(237. 16 ± 18. 83),all lower than the conventional acupuncture group at the same period(P < 0. 05).(5) During the treatment,no adverse reactions such as fainting from needles or moxibustion occurred in either group. Conclusion: warm needle Toujiu(moxibustion of deep heat penetration) has significant clinical efficacy in the treatment of primary insomnia(PI),can significantly improve the sleep quality of PI patients,and regulate neurotransmitter levels.更多还原