卒中后失眠患者血清Orexin A水平及经颅重复针刺激治疗的影响
发布时间：2018-08-04 18:06
【摘要】：卒中后失眠(Post Stroke Insomnia, PSI是临床常见的疾病,其发病机理至今未明。近年来脑内相关的神经递质在该病中的作用成为主要的研究热点。Orexin是一种由下丘脑分泌的可以调节ACh、5-HT和NA释放的神经肽,因而在睡眠/觉醒中起重要作用。Orexin也可以通过调节脑内炎症介质、促进神经保护因子表达等途径在脑卒中发病中发挥脑保护作用。Orexin与卒中后失眠存在必然的联系。目的：研究PSI患者血清Orexin-A水平和针灸及药物治疗对其影响及临床意义。第一部分方法：选取47例新入院首发未用药的卒中后失眠患者作为研究组,35名与研究组匹配的健康体检者作为对照组。所有入组对象均于上午8：00空腹采集静脉血,用酶联免疫法测定血清Orexin-A水平。结果：首发未用药的卒中后失眠患者血清Orexin-A水平(537.36±39.46) mmol/L与正常对照组(341.09±22.94) pg/ml比较明显升高(P0.01),差异具有统计学意义。第二部分方法；选择60名首发PSI患者持续分别应用经颅重复针刺激和地西泮(2.5mg/d)治疗,每组各30例。于治疗前和治疗1个月后测定血清Orexin-A水平、BMI、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白、高密度脂蛋白水平。用PSQI评分、SRSS评分、睡眠率于治疗前和治疗后评定其疗效。结果：①治疗1个月后,与治疗前相比,两组PSQI评分[rTAS (6.47±1.11) VS (14.10±1.37), P0.01][DZP (6.03±1.03) VS (14.57±1.14), P0.01]及SRSS评分[rTAS (23.73±6.22) VS (41.77±3.85),P0.01] [DZP (20.73±5.27) VS (43.43±3.07), P0.01]均明显降低,差异具有统计学意义。睡眠率[rTAS (65.60±10.96)VS (39.07±4.97), P0.01] [DZP(69.87±9.74) VS (38.90±4.57),P0.01]明显升高,差异具有统计学意义。治疗后组间比较,地西泮组SRSS评分较治疗组降低[(69.87+9.74)VS(38.90-±：4.57),P0.01],差异具有统计学意义。②经颅重复针刺激持续治疗1个月后的卒中后失眠患者血清Orexin-A水平较治疗前明显降低[(532.80±46.01)mmol/L VS (369.10±67.04)mmol/L, P0.01],差异具有统计学意义。③经地西泮持续治疗1个月后的卒中后失眠患者血清Orexin-A水平较治疗前明显降低[(541.30±32.60) mmol/L VS (338.50±59.60) mmol/L, P0.01],差异具有统计学意义；但BMI较治疗前明显升高[(22.67±2.78)VS(25.43±3.97),P0.0I],差异具有统计学意义。甘油三酯[(121.90±21.85) mg/dl VS (137.10±25.44) mg/dl, P0.05]、总胆固醇[(5.23±0.59) mg/dl VS (5.76±1.11) mg/dl, P0.05]、低密度脂蛋白[(26.00±6.97) mg/dl VS (30.37±8.87) mg/dl,P0.05]均升高,差异具有统计学意义；高密度脂蛋白降低[(15.07±3.90) mg/dl VS (13.07±3.79) mg/dl, P0.05],差异具有统计学意义。④地西泮组治疗1个月后,Orexin-A水平降低与低密度脂蛋白的变化正相关(r=0.409,P=0.025)。⑤治疗1个月后,地西泮组BMI较经颅重复针刺激组明显升高[(25.43±3.97)VS(21.93±2.12),P0.01],高密度脂蛋白降低[(13.07±3.79) mmol/L VS (15.93±3.53) mg/dl, P0.01],差异具有统计学意义；空腹血糖[(55.00±6.63) mmol/L VS (50.97±6.75) mg/dl,低密度脂蛋白[(30.37±8.87) mmol/L VS (25.27±6.41) mg/dl, P0.05]均升高,差异具有统计学意义。结论：①卒中后失眠患者血清Orexin-A水平明显升高；②卒中后失眠患者血清Orexin-A水平升高与病情严重程度、梗死部位、卒中危险因素无关；③经颅重复针刺激治疗明显降低首发卒中后失眠患者血清Orexin A水平,而不引起BMI及糖脂代谢指标明显变化；④地西泮对首发卒中后失眠患者Orexin-A水平及BMI、糖脂代谢指标有显著影响；⑤BMI增加与临床症状分差值显著负相关,推测体重增加与地西泮对临床症状的治疗有着紧密的联系；⑥BMI增加与血清Orexin-A水平变化相关性无统计学意义,尚不能确定血清Orexin-A水平降低为体重增加的原因；⑦经颅重复针刺激对于首发卒中后失眠患者疗效确切,可作为卒中后失眠患者的治疗手段。
[Abstract]:Post Stroke Insomnia (PSI) is a common clinical disease and its pathogenesis is still unknown. In recent years, the role of neurotransmitters related to the brain in this disease has become a major research hotspot,.Orexin is a neuropeptide secreted by the hypothalamus that can regulate ACh, 5-HT, and NA, and thus plays an important role in sleep / awakening. .Orexin can also regulate brain inflammatory mediators and promote the expression of neuroprotective factors in the pathogenesis of cerebral apoplexy. There is an inevitable relationship between.Orexin and insomnia after stroke. Objective: To study the level of Orexin-A in serum of PSI patients and the effect of acupuncture and drug therapy on it and its clinical significance. The first part method: 4 7 cases of insomnia after the first unused stroke were used as the study group, and 35 healthy subjects matched with the study group as the control group. All the subjects were collected at 8:00 a.m. to collect the venous blood, and the serum Orexin-A level was measured by enzyme immunoassay. Results: the level of serum Orexin-A in the first untreated apoplexy insomniacs (53 7.36 + 39.46) mmol/L and normal control group (341.09 + 22.94) pg/ml were significantly increased (P0.01), the difference was statistically significant. The second part method; select 60 first first PSI patients to continue using transcranial repetitive needle stimulation and diazepam (2.5mg/d) treatment, 30 cases in each group. Before and after 1 months of treatment, the serum Orexin-A level was measured. BMI, fasting blood glucose, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein level. PSQI score, SRSS score, and sleep rate were evaluated before and after treatment. Results: (1) 1 months after treatment, two groups of PSQI scores were [rTAS (6.47 + 1.11) VS (14.10 + 1.37), P0.01][DZP (6.03 + 1.03) VS (14.57 + 1.) 14), P0.01] and SRSS scores were [rTAS (23.73 + 6.22) VS (41.77 + 3.85), P0.01] [DZP (20.73 + 5.27) VS (43.43 + 3.07), P0.01] decreased significantly, and the difference was statistically significant. The sleep rate was [rTAS (65.60 + 10.96) VS (39.07 + 4.97), P0.01] [DZP (65.60 + 20.73), obviously increased, and the difference was statistically significant. The SRSS score of diazepam group was lower than that of the treatment group (69.87+9.74) VS (38.90- + 4.57) and P0.01], and the difference was statistically significant. (2) the serum Orexin-A level of patients with insomnia after 1 months of continuous acupuncture stimulation was significantly lower than that before treatment [(532.80 + 46.01) mmol/L VS (369.10 + 67.04) mmol/L, P0.01], and poor The level of serum Orexin-A in patients with insomnia after 1 months of diazepam continuous treatment was significantly lower than that before treatment [(541.30 + 32.60) mmol/L VS (338.50 + 59.60) mmol/L, P0.01], and the difference was statistically significant, but BMI was significantly higher than before treatment [(22.67 + 2.78) VS (25.43 + 3.97), P0.0I], with difference. Statistical significance: triglycerides [(121.90 + 21.85) mg/dl VS (137.10 + 25.44) mg/dl, P0.05], total cholesterol [(5.23 + 0.59) mg/dl VS (5.76 + 1.11) mg/dl, P0.05], low density lipoprotein [(26 + 6.97) mg/dl VS (30.37 + 8.87) mg/dl, P0.05] all rose high, the difference was statistically significant; high density lipoprotein decreased [(15.07 + 3.90)] VS (13.07 + 3.79) mg/dl, P0.05], the difference was statistically significant. 4. After 1 months of diazepam treatment, the decrease of Orexin-A level was positively correlated with the change of low density lipoprotein (r=0.409, P=0.025). (5) after 1 months of treatment, the BMI of diazepam group was significantly higher than that of the craniofacial stimulation group [(25.43 + 3.97) VS (21.93 + 2.12), P0.01], high density lipoprotein Lower [(13.07 + 3.79) mmol/L VS (15.93 + 3.53) mg/dl, P0.01], the difference was statistically significant; fasting blood glucose [(55 + 6.63) mmol/L VS (50.97 + 6.75) mg/dl, low density lipoprotein [(30.37 + 8.87) mmol/L VS (25.27 + 6.41) mg/dl, P0.05] increased, and the difference was statistically significant. The level of -A increased significantly, and the level of serum Orexin-A in the patients with insomnia after stroke was not related to the severity of the disease, the infarct location and the risk of stroke; (3) the level of Orexin A in the serum of the patients with insomnia after the first stroke was obviously reduced, but there was no obvious change in the index of BMI and glycolipid metabolism. 4. The Orexin-A level and BMI, glycolipid metabolism index had significant influence on the patients with insomnia after stroke. The increase of BMI was significantly negatively correlated with the difference of clinical symptoms. It was suggested that the increase of weight and diazepam had a close relationship with the treatment of clinical symptoms; 6. The correlation between the BMI increase and the change of serum Orexin-A level was not statistically significant, and the serum O was not yet determined. The decrease of rexin-A level is the reason for the increase of weight, and the treatment of insomnia patients after stroke can be treated as a therapeutic means for patients with insomnia after stroke.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6
[Abstract]:Post Stroke Insomnia (PSI) is a common clinical disease and its pathogenesis is still unknown. In recent years, the role of neurotransmitters related to the brain in this disease has become a major research hotspot,.Orexin is a neuropeptide secreted by the hypothalamus that can regulate ACh, 5-HT, and NA, and thus plays an important role in sleep / awakening. .Orexin can also regulate brain inflammatory mediators and promote the expression of neuroprotective factors in the pathogenesis of cerebral apoplexy. There is an inevitable relationship between.Orexin and insomnia after stroke. Objective: To study the level of Orexin-A in serum of PSI patients and the effect of acupuncture and drug therapy on it and its clinical significance. The first part method: 4 7 cases of insomnia after the first unused stroke were used as the study group, and 35 healthy subjects matched with the study group as the control group. All the subjects were collected at 8:00 a.m. to collect the venous blood, and the serum Orexin-A level was measured by enzyme immunoassay. Results: the level of serum Orexin-A in the first untreated apoplexy insomniacs (53 7.36 + 39.46) mmol/L and normal control group (341.09 + 22.94) pg/ml were significantly increased (P0.01), the difference was statistically significant. The second part method; select 60 first first PSI patients to continue using transcranial repetitive needle stimulation and diazepam (2.5mg/d) treatment, 30 cases in each group. Before and after 1 months of treatment, the serum Orexin-A level was measured. BMI, fasting blood glucose, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein level. PSQI score, SRSS score, and sleep rate were evaluated before and after treatment. Results: (1) 1 months after treatment, two groups of PSQI scores were [rTAS (6.47 + 1.11) VS (14.10 + 1.37), P0.01][DZP (6.03 + 1.03) VS (14.57 + 1.) 14), P0.01] and SRSS scores were [rTAS (23.73 + 6.22) VS (41.77 + 3.85), P0.01] [DZP (20.73 + 5.27) VS (43.43 + 3.07), P0.01] decreased significantly, and the difference was statistically significant. The sleep rate was [rTAS (65.60 + 10.96) VS (39.07 + 4.97), P0.01] [DZP (65.60 + 20.73), obviously increased, and the difference was statistically significant. The SRSS score of diazepam group was lower than that of the treatment group (69.87+9.74) VS (38.90- + 4.57) and P0.01], and the difference was statistically significant. (2) the serum Orexin-A level of patients with insomnia after 1 months of continuous acupuncture stimulation was significantly lower than that before treatment [(532.80 + 46.01) mmol/L VS (369.10 + 67.04) mmol/L, P0.01], and poor The level of serum Orexin-A in patients with insomnia after 1 months of diazepam continuous treatment was significantly lower than that before treatment [(541.30 + 32.60) mmol/L VS (338.50 + 59.60) mmol/L, P0.01], and the difference was statistically significant, but BMI was significantly higher than before treatment [(22.67 + 2.78) VS (25.43 + 3.97), P0.0I], with difference. Statistical significance: triglycerides [(121.90 + 21.85) mg/dl VS (137.10 + 25.44) mg/dl, P0.05], total cholesterol [(5.23 + 0.59) mg/dl VS (5.76 + 1.11) mg/dl, P0.05], low density lipoprotein [(26 + 6.97) mg/dl VS (30.37 + 8.87) mg/dl, P0.05] all rose high, the difference was statistically significant; high density lipoprotein decreased [(15.07 + 3.90)] VS (13.07 + 3.79) mg/dl, P0.05], the difference was statistically significant. 4. After 1 months of diazepam treatment, the decrease of Orexin-A level was positively correlated with the change of low density lipoprotein (r=0.409, P=0.025). (5) after 1 months of treatment, the BMI of diazepam group was significantly higher than that of the craniofacial stimulation group [(25.43 + 3.97) VS (21.93 + 2.12), P0.01], high density lipoprotein Lower [(13.07 + 3.79) mmol/L VS (15.93 + 3.53) mg/dl, P0.01], the difference was statistically significant; fasting blood glucose [(55 + 6.63) mmol/L VS (50.97 + 6.75) mg/dl, low density lipoprotein [(30.37 + 8.87) mmol/L VS (25.27 + 6.41) mg/dl, P0.05] increased, and the difference was statistically significant. The level of -A increased significantly, and the level of serum Orexin-A in the patients with insomnia after stroke was not related to the severity of the disease, the infarct location and the risk of stroke; (3) the level of Orexin A in the serum of the patients with insomnia after the first stroke was obviously reduced, but there was no obvious change in the index of BMI and glycolipid metabolism. 4. The Orexin-A level and BMI, glycolipid metabolism index had significant influence on the patients with insomnia after stroke. The increase of BMI was significantly negatively correlated with the difference of clinical symptoms. It was suggested that the increase of weight and diazepam had a close relationship with the treatment of clinical symptoms; 6. The correlation between the BMI increase and the change of serum Orexin-A level was not statistically significant, and the serum O was not yet determined. The decrease of rexin-A level is the reason for the increase of weight, and the treatment of insomnia patients after stroke can be treated as a therapeutic means for patients with insomnia after stroke.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6
【相似文献】
相关期刊论文 前10条
1 ;女性失眠患者是男性两倍[J];浙江中医杂志;2003年12期
2 陈世清;邓钧;;90例失眠患者的临床分析[J];兵团医学;2009年02期
3 汪丽静;汪群;龚庆辉;赵溶冰;;60例失眠患者临床治疗体会[J];中国现代药物应用;2013年06期
4 沈扬;樊东升;;失眠患者怎样进行自我调理[J];求医问药;2010年01期
5 孟宪璋;一位失眠患者的精神分析治疗[J];中国临床心理学杂志;2000年02期
6 赵忠顺;失眠患者健康教育的主要内容[J];中国健康教育;2004年12期
7 胡幸福;;失眠患者就医也要对症[J];今日科苑;2004年08期
8 陈娟;曲延芳;;老年失眠患者的护理[J];中国民康医学;2006年02期
9 宋爱秀;李莉;王慧玲;;门诊失眠患者106例临床分析[J];中国冶金工业医学杂志;2007年01期
10 明君;;怎样远离失眠的痛苦?[J];农村.农业.农民(A版);2007年01期
相关会议论文 前10条
1 张鹏;赵忠新;李雁鹏;黄流清;庄建华;尹又;;失眠患者睡眠感知特征及药物、认知行为干预后的变化[A];第十一届全国神经病学学术会议论文汇编[C];2008年
2 黄莉莉;雷飞;杜丽娜;唐向东;;失眠患者中的睡眠呼吸暂停[A];第四届中国睡眠医学论坛论文汇编[C];2011年
3 余小梅;;高电位治疗对失眠患者睡眠质量及心理状态的影响[A];广东省康复医学会、广东社会学会健康研究专业委员会2007年学术年会论文汇编[C];2007年
4 许良;徐建;王惠茹;王翘楚;;失眠患者睡眠与觉醒相关因素临床调查研究[A];2008年中国睡眠研究会第五届学术年会论文摘要汇编[C];2008年
5 于恩彦;吴万震;;老年失眠患者治疗依从性的影响因素初探[A];中国心理卫生协会老年心理卫生专业委员会第八届学术年会论文汇编[C];2006年
6 王传刘;敖文玲;何金彩;林子江;;123例失眠患者一般情况调查以及影响预后[A];2011年浙江省心身医学学术年会论文汇编[C];2011年
7 孙庆利;张燕;樊东升;杨志杰;沈扬;;女性失眠患者相关影响因素的研究[A];2006年中国睡眠研究会第四届学术年会论文摘要汇编[C];2006年
8 李训军;蒋晓江;;失眠患者大脑的神经影像学研究[A];第四届中国睡眠医学论坛论文汇编[C];2011年
9 王传刘;敖文玲;何金彩;林子江;;123例失眠患者一般情况调查以及影响预后[A];2011年浙江省神经病学学术年会论文汇编[C];2011年
10 潘集阳;;关于失眠评估研究标准的建议:美国专家共识[A];中国睡眠研究会第六届学术年会论文汇编[C];2010年
相关重要报纸文章 前10条
1 崔玉艳;一半以上失眠患者存在心理问题[N];卫生与生活报;2007年
2 周向前;四类失眠患者慎用安眠药[N];大众卫生报;2009年
3 张楠;女性失眠患者人数多问题多[N];健康报;2008年
4 北京大学精神卫生研究所教授 于欣 本报记者 李广宇 整理;给失眠患者选择合适的药物[N];医药经济报;2011年
5 施明 （主任医师）（失眠专科）上海市中医文献馆;失眠患者的苦恼和痛苦[N];上海中医药报;2007年
6 记者 任珊珊 通讯员 张玲玲;广州人失眠率居全国之首[N];广州日报;2007年
7 陈俊s，
本文编号：2164678
本文链接：https://www.wllwen.com/zhongyixuelunwen/2164678.html
最近更新
教材专著
