摘要
目的观察针刺治疗苯二氮卓类药物依赖性失眠症患者的临床疗效及对其影响因素的Logistic分析。方法选取2018年4月—2021年6月在首都医科大学附属复兴医院针灸骨伤科门诊、首都医科大学附属北京中医医院心身医学科、首都医科大学附属复兴医院月坛社区卫生服务中心中医科、北京大学第六医院中西医结合科诊治的64例苯二氮卓类药物(Benzodiazepines,BZDs)依赖性失眠症患者,按随机数字表法分为对照组和治疗组,每组各32例。两组患者均接受BZDs递减治疗,对照组给予安慰针刺干预,治疗组给予针刺干预。观察比较两组患者的临床疗效、不良反应情况,治疗前后失眠严重程度(Insomnia severity index,ISI)、苯二氮卓类药物戒断症(Benzodiazepine withdrawal symptom questionnaire,BWSQ)评分,采用单/多Logistic分析针刺治疗苯二氮卓类药物依赖性失眠症疗效的影响因素。结果治疗后治疗组临床总有效率为75.00%(24/32),对照组为38.71%(12/31),差异有统计学意义(P<0.05)。治疗后两组患者ISI评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组ISI评分均明显低于对照组,差异有统计学意义(P<0.05)。重复测量线性混合效应模型显示,ISI总分时间与组别的交互作用存在显著差异(P<0.001),治疗组患者的ISI总分下降速度快于对照组。治疗后两组患者BWSQ评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组BWSQ评分较对照组明显降低,差异有统计学意义(P<0.05)。两组患者各有1例针刺不良事件,均为轻度,未进行纠正治疗,转归为不良事件消失。单因素Logisitic回归分析结果显示,既往史、服用BZDs时间以及干预方式与针刺治疗苯二氮卓类药物依赖性失眠症的疗效有显著相关性(P≤0.05)。多因素Logisitic回归分析结果显示,干预方式(针刺)、服用BZDs时间(≤0.5年)以及治疗前服用BZDs剂量(≤4 mg地西泮)与针刺治疗苯二氮卓类药物依赖性失眠症的疗效有显著相关性(P≤0.05)。结论针刺可显著改善苯二氮卓类药物依赖性失眠症患者的失眠程度;干预方式(针刺)、服用BZDs时间(≤0.5年)以及治疗前服用BZDs剂量(≤4 mg地西泮)是针刺治疗苯二氮卓类药物依赖性失眠症疗效的影响因素。
Objective To observe the clinical efficacy of acupuncture in the treatment of benzodiazepine(BZD)-dependent insomnia and to analyze its influencing factors using logistic regression.Methods A total of 64 patients with BZD-dependent insomnia treated between April 2018 and June 2021 at the Acupuncture-Moxibustion and Traditional Chinese orthopedics department of Fu Xing Hospital affiliated to Capital Medical University,the Psychosomatic Medicine Department of Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University,the Traditional Chinese Medicine Department of Yuetan Community Health Service Center of Fu Xing Hospital,and the Integrated Traditional Chinese and Western Medicine Department of Peking University Sixth Hospital were enrolled.Patients were randomly assigned using a random number table into a treatment group and a control group,with 32 patients in each group.Both groups underwent gradual BZD tapering.The control group received placebo acupuncture,while the treatment group received true acupuncture.Clinical efficacy and adverse events were compared between the groups.Insomnia Severity Index(ISI)and benzodiazepine withdrawal symptom questionnaire(BWSQ)scores were assessed before and after treatment.Univariate and multivariate logistic regression analyses were used to explore factors influencing the efficacy of acupuncture in treating BZD-dependent insomnia.Results After treatment,the total effective rate in the treatment group was 75.00%(24/32),significantly higher than 38.71%(12/31)in the control group(P<0.05).ISI scores in both groups decreased significantly after treatment(P<0.05),with the treatment group showing significantly lower scores than the control group(P<0.05).A linear mixed-effects model for repeated measures showed a significant interaction between time and group for ISI scores(P<0.001),indicating that ISI scores in the treatment group declined more rapidly.BWSQ scores also decreased significantly in both groups(P<0.05),with a significantly greater reduction in the treatment group compared to the control group(P<0.05).One mild acupuncture-related adverse event occurred in each group,and both resolved spontaneously without intervention.Univariate logistic regression analysis showed that past medical history,duration of BZD use,and intervention method were significantly associated with acupuncture treatment efficacy of BZD-dependent insomnia(P≤0.05).Multivariate logistic regression analysis indicated that the intervention method(acupuncture),duration of BZD use(≤0.5 years),and pre-treatment BZD dosage(≤4 mg diazepam equivalent)were significantly associated with treatment outcomes(P≤0.05).Conclusion Acupuncture can significantly alleviate insomnia in patients with BZD dependence.The intervention method(acupuncture),a shorter duration of BZD use(≤0.5 years),and a lower pre-treatment BZD dosage(≤4 mg diazepam)are key factors influencing acupuncture treatment efficacy of BZD-dependent insomnia.
作者
范竹青
高义崧
陈於虹
陈颖
FAN Zhu-qing;GAO Yi-song;CHEN Yu-hong;CHEN Ying(Department of Acupuncture-Moxibustion and Traditional Chinese Orthopedics,Fu Xing Hospital,Capital Medical University,Beijing 100038)
出处
《世界中西医结合杂志》
2025年第6期1193-1199,共7页
World Journal of Integrated Traditional and Western Medicine
基金
首都卫生发展科研专项项目(首发2018-3-7021)。
