摘要
目的观察“疏肝调神”针法联合丙戊酸镁缓释片治疗肝气郁结证双相情感障碍失眠的临床效果。方法选择2020年12月至2022年1月在衢州市第三医院诊治的双相情感障碍失眠患者186例为研究对象,采用前瞻性研究方法,按照随机数字表法分成两组,每组93例。对照组口服丙戊酸镁缓释片治疗,观察组给予“疏肝调神”针法联合丙戊酸镁缓释片治疗。两组疗程8周,观察两组临床疗效、倍克-拉范森躁狂量表(BRMS)评分、匹兹堡睡眠质量指数(PSQI)评分,血清白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)、脑源性神经营养因子(BDNF)、胶质源性神经营养因子(GDNF)水平,应用生活质量量表(SF-36)评价生活质量,并比较治疗过程中两组间不良反应情况。结果观察组总有效率为92.47%(86/93),高于对照组的78.49%(73/93)(χ^(2)=7.32,P=0.007)。治疗后,观察组BRMS、PSQI评分均低于对照组[(22.35±5.10)分比(30.09±5.42)分,(15.37±4.46)分比(20.63±4.09)分,t=-10.03、-8.38,均P<0.001]。治疗后,观察组WCST、CPT、HVLT-R评分均高于对照组[(49.29±6.85)分比(47.48±7.14)分,(3.59±0.66)分比(2.81±0.73)分,(26.07±5.13)分比(24.64±5.08)分,t=1.76,7.64、1.91,均P<0.05]。治疗后,观察组血清TNF-α、IL-1β均低于对照组[(60.26±10.31)ng/L比(79.35±9.82)ng/L,(49.27±8.33)g/L比(75.61±9.12)g/L,t=-12.93、-20.56,均P<0.001],BDNF、GDNF水平均高于对照组[(60.08±10.31)μg/L比(56.96±11.45)μg/L,(53.09±7.01)ng/L比(48.65±8.47)ng/L,t=-11.42、8.02,均P<0.001]。治疗后,观察组生活质量各项评分均高于对照组(t=4.03~5.37,均P<0.001)。观察组不良反应总发生率为7.52%(7/93),对照组为8.60%(8/93),差异无统计学意义(χ^(2)=0.07,P=0.788)。结论“疏肝调神”针法联合丙戊酸镁缓释片治疗肝气郁结证双相情感障碍合并失眠效果显著,能够减轻患者躁狂症状,改善睡眠质量及生活质量,下调血清TNF-α、IL-1β水平,提高BDNF、GDNF水平。
Objective To investigate the clinical efficacy of"Shugan Tiaoshen"needling combined with magnesium valproate sustained-release tablets in the treatment of insomnia in patients with bipolar disorder with liver qi stagnation syndrome.Methods A total of 186 patients with bipolar disorder and insomnia who were diagnosed and treated at the Third Hospital of Quzhou from December 2020 to January 2022 were included in this study.These patients were randomly divided into a control group and an observation group(n=93 per group)using a prospective study method.The control group was orally treated with magnesium valproate sustained-release tablets,while the observation group was treated with"Shugan Tiaoshen"needling combined with magnesium valproate sustained-release tablets.Two groups were treated for 8 weeks.Clinical efficacy,Bech-Rafaelsdn Mania Rating Scale score,Pittsburgh Sleep Quality Index score,and serum interleukin-1β,tumor necrosis factor-alpha,brain-derived neurotrophic factor,and glial derived neurotrophic factor levels were compared between the two groups.The Short-Form 36 Health Survey was used to evaluate quality of life.The adverse reaction was compared between the two groups.Results The total effective rate in the observation group was 92.47%(86/93),which was significantly higher than 78.49%(73/93)in the control group(χ^(2)=7.32,P=0.007).After treatment,the Bech-Rafaelsdn Mania Rating Scale score and Pittsburgh Sleep Quality Index score in the observation group were significantly higher than those in the control group[(22.35±5.10)points vs.(30.09±5.42)points,(15.37±4.46)points vs.(20.63±4.09)points,t=-10.03,-8.38,both P<0.001].After treatment,Wsiconsin card sorting test score,Continuous Performance Task score,and Hopkins Verbal Learning Test-Revised score in the observation group were significantly higher than those in the control group[(49.29±6.85)points vs.(47.48±7.14)points,(3.59±0.66)points vs.(2.81±0.73)points,(26.07±5.13)points vs.(24.64±5.08)points,t=1.76,7.64,1.91,all P<0.05].After treatment,serum tumor necrosis factor-alpha and interleukin-1βlevels in the observation group were significantly lower than those in the control group[(60.26±10.31)ng/L vs.(79.35±9.82)ng/L,(49.27±8.33)g/L vs.(75.61±9.12)g/L,t=-12.93,-20.56,both P<0.001].Brain derived neurotrophic factor and glial derived neurotrophic factor levels in the observation group were significantly lower than those in the control group[(60.08±10.31)μg/L vs.(56.96±11.45)μg/L,(53.09±7.01)ng/L vs.(48.65±8.47)ng/L,t=-11.42,8.02,both P<0.001].After treatment,the quality of life scores in each dimension in the observation group were significantly higher than those in the control group(t=4.03-5.37,all P<0.001).The total incidence of adverse reactions in the observation group was 7.52%(7/93),while that in the control group was 8.60%(8/93),and there was no significant difference in total incidence of adverse reactions between the two groups(χ^(2)=0.07,P=0.788).Conclusion"Shugan Tiaoshen"needling combined with magnesium valproate sustained-release tablets has an obvious therapeutic effect on bipolar disorder combined with insomnia in patients with bipolar disorder.The combined therapy can reduce manic symptoms,improve sleep quality and quality of life,down-regulate serum tumor necrosis factor-alpha and interleukin-1βlevels,and increase brain-derived neurotrophic factor and glial derived neurotrophic factor levels.
作者
王艳
Yan Wang(Women's Ward,Department of Psychiatry,The Third Hospital of Quzhou,Quzhou 324000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2023年第10期1511-1517,共7页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省衢州市科技攻关项目(2022K146)。
关键词
双相情感障碍
睡眠障碍
内源性
疏肝调神
肝气郁结证
生活质量
丙戊酸镁
Bipolar disorder
Sleep disorders,intrinsic
Shu Gan Tiao Shen Needling Method
Liver qi stagnation
Quality of life
Magnesium valproate
