【摘要】：卒中后失眠(Post Stroke Insomnia, PSI是臨床常見的疾病,其發(fā)病機(jī)理至今未明。近年來腦內(nèi)相關(guān)的神經(jīng)遞質(zhì)在該病中的作用成為主要的研究熱點。Orexin是一種由下丘腦分泌的可以調(diào)節(jié)ACh、5-HT和NA釋放的神經(jīng)肽,因而在睡眠/覺醒中起重要作用。Orexin也可以通過調(diào)節(jié)腦內(nèi)炎癥介質(zhì)、促進(jìn)神經(jīng)保護(hù)因子表達(dá)等途徑在腦卒中發(fā)病中發(fā)揮腦保護(hù)作用。Orexin與卒中后失眠存在必然的聯(lián)系。目的：研究PSI患者血清Orexin-A水平和針灸及藥物治療對其影響及臨床意義。第一部分方法：選取47例新入院首發(fā)未用藥的卒中后失眠患者作為研究組,35名與研究組匹配的健康體檢者作為對照組。所有入組對象均于上午8：00空腹采集靜脈血,用酶聯(lián)免疫法測定血清Orexin-A水平。結(jié)果：首發(fā)未用藥的卒中后失眠患者血清Orexin-A水平(537.36±39.46) mmol/L與正常對照組(341.09±22.94) pg/ml比較明顯升高(P0.01),差異具有統(tǒng)計學(xué)意義。第二部分方法；選擇60名首發(fā)PSI患者持續(xù)分別應(yīng)用經(jīng)顱重復(fù)針刺激和地西泮(2.5mg/d)治療,每組各30例。于治療前和治療1個月后測定血清Orexin-A水平、BMI、空腹血糖、甘油三酯、總膽固醇、低密度脂蛋白、高密度脂蛋白水平。用PSQI評分、SRSS評分、睡眠率于治療前和治療后評定其療效。結(jié)果：①治療1個月后,與治療前相比,兩組PSQI評分[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評分[rTAS (23.73±6.22) VS (41.77±3.85),P0.01] [DZP (20.73±5.27) VS (43.43±3.07), P0.01]均明顯降低,差異具有統(tǒng)計學(xué)意義。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]明顯升高,差異具有統(tǒng)計學(xué)意義。治療后組間比較,地西泮組SRSS評分較治療組降低[(69.87+9.74)VS(38.90-±：4.57),P0.01],差異具有統(tǒng)計學(xué)意義。②經(jīng)顱重復(fù)針刺激持續(xù)治療1個月后的卒中后失眠患者血清Orexin-A水平較治療前明顯降低[(532.80±46.01)mmol/L VS (369.10±67.04)mmol/L, P0.01],差異具有統(tǒng)計學(xué)意義。③經(jīng)地西泮持續(xù)治療1個月后的卒中后失眠患者血清Orexin-A水平較治療前明顯降低[(541.30±32.60) mmol/L VS (338.50±59.60) mmol/L, P0.01],差異具有統(tǒng)計學(xué)意義；但BMI較治療前明顯升高[(22.67±2.78)VS(25.43±3.97),P0.0I],差異具有統(tǒng)計學(xué)意義。甘油三酯[(121.90±21.85) mg/dl VS (137.10±25.44) mg/dl, P0.05]、總膽固醇[(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,差異具有統(tǒng)計學(xué)意義；高密度脂蛋白降低[(15.07±3.90) mg/dl VS (13.07±3.79) mg/dl, P0.05],差異具有統(tǒng)計學(xué)意義。④地西泮組治療1個月后,Orexin-A水平降低與低密度脂蛋白的變化正相關(guān)(r=0.409,P=0.025)。⑤治療1個月后,地西泮組BMI較經(jīng)顱重復(fù)針刺激組明顯升高[(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],差異具有統(tǒng)計學(xué)意義；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,差異具有統(tǒng)計學(xué)意義。結(jié)論：①卒中后失眠患者血清Orexin-A水平明顯升高；②卒中后失眠患者血清Orexin-A水平升高與病情嚴(yán)重程度、梗死部位、卒中危險因素?zé)o關(guān)；③經(jīng)顱重復(fù)針刺激治療明顯降低首發(fā)卒中后失眠患者血清Orexin A水平,而不引起B(yǎng)MI及糖脂代謝指標(biāo)明顯變化；④地西泮對首發(fā)卒中后失眠患者Orexin-A水平及BMI、糖脂代謝指標(biāo)有顯著影響；⑤BMI增加與臨床癥狀分差值顯著負(fù)相關(guān),推測體重增加與地西泮對臨床癥狀的治療有著緊密的聯(lián)系；⑥BMI增加與血清Orexin-A水平變化相關(guān)性無統(tǒng)計學(xué)意義,尚不能確定血清Orexin-A水平降低為體重增加的原因；⑦經(jīng)顱重復(fù)針刺激對于首發(fā)卒中后失眠患者療效確切,可作為卒中后失眠患者的治療手段。
[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.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R246.6

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