艾司唑仑治疗失眠症临床疗效及安全性的网状Meta分析

目的 运用网状meta分析探究艾司唑仑、右佐匹克隆、佐匹克隆、米氮平、米氮平联合艾司唑仑在调节失眠症患者匹兹堡睡眠质量指数（PSQI）、睡眠障碍评定量表（SDRS）、睡眠自评量表（SRSS）、阿森斯失眠量表（AIS）、药物不良反应（TESS）的差异。方法 收集截止至2016年11月CNKI、维普、万方、Pubmed数据库中上述药物在治疗失眠症患者的临床试验资料,文章质量评估用Jadad评分,研究结果的分析用Gemtc 14.3、Stata 13、RevMan 5.3软件。结果 纳入13篇研究,Meta分析发现：与艾司唑仑相比,米氮平联合艾司唑仑的PSQI较低[WMD=-6.67,95% CI （-8.38,-4.96）,P<0.000 01];米氮平联合艾司唑仑的AIS较低[WMD=-3.73,95% CI （-4.51,-2.95）,P<0.000 01];佐匹克隆的SDRS较低[WMD=-2.50,95% CI （-3.71,-1.28）,P<0.000 1]。间接网状meta分析显示：SDRS依次为艾司唑仑>右佐匹克隆>佐匹克隆;AIS依次为艾司唑仑>佐匹克隆>米氮平联合艾司唑仑;TESS依次为艾司唑仑>佐匹克隆>右佐匹克隆。结论 艾司唑仑降低失眠患者SDRS、AIS、TESS均不具备明显优势,网状meta分析方法发掘药物疗效与安全性具有一定的参考价值。     

Insomnia and circadian variation of attacks in episodic migraine

OBJECTIVES: To assess the influence of insomnia on the 24-hour temporal pattern of migraine. BACKGROUND: Migraine attacks have been reported to occur in a harmonic (monophasic) or a biphasic 24-hour cyclic manner, and in some studies to have preponderance in the morning hours. The influence of insomnia on the circadian pattern has not been evaluated. METHOD: Based on a previous study of the circadian variation in migraine, an explorative data analysis was made to compare the circadian pattern of insomnia-related migraine attacks to the circadian pattern of migraine attacks not related to insomnia. If the patients reported difficulties in falling asleep and/or maintaining sleep the night prior to the reported attack or the night the attack occurred, the attack was defined as insomnia-related. Relapses were not counted as distinctive attacks. RESULTS: Sixty-eight female migraineurs (mean +/- SD age: 35.5 +/- 7.0) prospectively recorded 1869 migraine attacks. Five hundred-and-thirty-three attacks (29%) were insomnia-related. Insomnia-related attacks had a biphasic temporal pattern with one peak in the morning hours and one peak after noon. They had a preponderance in the morning hours compared to attacks not related to insomnia (t= 3.27, df = 62, P= .002). In 79% of attacks insomnia was experienced prior to the headache. CONCLUSIONS: Episodic morning migraine is associated with insomnia. The cause and consequences of insomnia in migraine is not clarified, but sleep obviously protects against attacks rather than provokes them.     

基于数据挖掘、网络药理学及临床观察探究贾跃进治疗女性失眠症用药规律及机制

目的结合数据挖掘、网络药理学、分子对接方法及临床观察,探究贾跃进临床治疗女性失眠症的用药规律及作用机制。方法首先使用古今医案云平台V2.2.3将贾跃进门诊近5年中药治疗女性失眠症的处方进行药物频次、属性统计以及关联、聚类和复杂网络分析,得出核心组方;再将核心组方运用TCMSP、GEO等数据库得到各药物有效成分的靶点与疾病靶点并取交集,利用CytoscapeV3.8.0及其插件构建疾病-药物-成分-靶点、蛋白互作网络,并进行基因本体论(gene ontology,GO)和京都基因与基因组百科全书(Kyoto encyclopedia of genes and genomes,KEGG)通路富集分析;然后通过分析以上所得的2个网络获取其关键成分及靶点并进行分子对接;最终以核心组方为治疗组,网络药理学预测结果为主要观察指标进行临床研究验证。结果数据挖掘纳入验案221例,方剂258首,涉及中药139味;药性以平、温、微寒为多;药味以甘、辛、苦为主;药物主要归肝、脾经;通过药物关联、聚类和复杂网络分析综合得出11味药物的核心组方。网络药理学共获得核心组方有效成分65种,相关靶点490个,交集靶点142个,关键成分有β-谷甾醇和豆甾醇等,关键靶点聚类有神经递质类及细胞因子类等。GO功能富集分析结果显示,可能与代谢过程、免疫系统过程和信号过程有关;KEGG通路富集分析结果显示,可能与神经活性配体-受体相互作用、血清素能突触、多巴胺能突触等有关;分子对接较好的靶点为蛋白激酶Bα(protein kinase Bα,AKT1)、5-羟色胺受体1A(5-hydroxytryptamine receptor 1A,HTR1A)、多巴胺受体D2(dopamine receptor D2,DRD2)。临床研究显示,核心组方治疗组患者血清中褪黑素(melatonin,MT)水平显著升高,5-羟色胺(5-hydroxytryptamine,5-HT)、多巴胺(dopamine,DA)水平显著降低(P0.05)。结论贾跃进治疗女性失眠症的核心组方包括茯苓、白术、合欢皮、柴胡、香附、白芍、龙骨、当归、牡丹皮、栀子、白茅根,其主要通过多成分、多靶点调控MT、5-HT、DA而实现,对临床相关研究及对女性失眠症的治疗有一定指导意义。     

“更眠安汤”治疗肾阴虚型女性更年期失眠的临床疗效

目的 :观察自拟"更眠安汤"治疗肾阴虚型更年期失眠的临床疗效。方法 :选择2012年6月至2014年3月以失眠为主诉的女性更年期综合征患者36例,给予"更眠安汤"治疗,4周为1个疗程,共服用2个疗程。采用匹兹堡睡眠质量指数量表和中医证候积分评估患者治疗第4周和第8周时的临床疗效,并进行比较。结果 :治疗第4周和第8周时的总有效率分别为86.11%(31/36)和91.67%(33/36),主要睡眠指标较治疗前均有改善,差异有统计学意义(P<0.05);除夜间多梦指标外,治疗第8周时较第4周的其余睡眠指标均更佳,差异有统计学意义(P<0.05)。结论 :"更眠安汤"治疗女性更年期失眠症疗效确切,治疗8周的临床疗效更显著。     

Insomnia and its associated factors in incarcerated adults: A cross‐sectional study

No evidence exists in the literature concerning the prevalence of insomnia and its associated risk factors among prison inmates in Taiwan. The aim of the present study was to determine the prevalence and factors associated with insomnia among inmates in a large prison in Taiwan. A cross‐sectional anonymous questionnaire survey was conducted at a prison. The participants were 1490 male inmates. Participants completed the self‐reported Insomnia Severity Index–Chinese version questionnaire, and the sociodemographic and psychological distress questionnaires for the study. Multivariate logistic regression was used to analyze and compare the differences between inmates with and without insomnia. The prevalence of insomnia was 26.9%. The study determined that anxiety, self‐rated health status, and religious beliefs were independent predictors of insomnia in male inmates. Given the adverse effect of insomnia and its social consequences, it is crucial to develop prevention programs to mitigate insomnia in inmates.     

Sleep problems as a risk factor for fall in community-dwelling older persons

Background: Falls cause serious problems for the elderly. Sleep problems impair the control of postural balance and cause falls, and lack of sleep induces sleepiness, which in turn causes inattentiveness. The present study aims to clarify the relation between sleep disorders and falls among the community-dwelling elderly and to determine whether or not sleep disorder is an independent risk factor for falls.

Methods:

Methods: Of 2274 community-dwelling persons aged 65 and older who participated in the first study in July 1998, 1771 (77.9%) who responded to the questions concerning sleep disorders were the subjects in the present study.

Results:

Results: There were 1521 persons (85.9%) who had not experienced any fall during the past year, 194 (11.0%) who had one or two falls, 27 (1.5%) had three to four falls and 29 (1.6%) had more than five falls. The relation between the history of falls and the sleep problems indicates that the odds ratio for the history of falls was significantly higher if the nocturnal sleep disorder was more intense ( P < 0.001) and the sleep hours during the day were longer ( P < 0.01). In order to determine the independent risk factors for falls, the general linear model analysis was conducted using the significantly different background. The nocturnal sleep problems ( F = 4.05; P = 0.018), the daytime sleep ( F = 4.17; P = 0.016) and nocturnal sleep problems and interaction between (*) daytime sleep ( F = 2.54; P = 0.038) were significant independent explanatory variables as the age ( F = 14.4; P < 0.001), difficulty in walking ( F = 4.30; P = 0.038), history of stroke ( F = 64.1; P < 0.001) and arthralgia ( F = 5.31; P = 0.021).

Conclusion:

Conclusion: The data emphasize that the sleep disorder is closely related to falls.     

女性失眠患者相关影响因素的研究

目的 探讨影响女性失眠的相关危险因素。方法 采用病例一对照研究和流行病学方法调查女性患者的睡眠情况，其中对照组354例，急性失眠组89例及慢性失眠组356例，并采用多元Logistic回归模型分析影响失眠的因素。结果 焦虑（OR=1．978，P=0．024）、抑郁（OR=2．097，P=0．014）与急性失眠显著相关；焦虑（OR=2．592，P=0．000）、抑郁（OR=3．673，P=0．000）、打鼾（OR=1．637，P=0．006）、饮酒（OR=3．105，P=0．046）与慢性失眠显著相关。结论 女性失眠与焦虑、抑郁、打鼾及饮酒有关。     

孕期体操运动对不良症状改善的效果

目的 研究孕期体操运动对不良症状的改善作用,为开展孕期体操提供理论依据。方法 选择北京市5个孕妇学校的孕25～34周孕妇为研究对象,采用专家研发的孕期体操,观察孕期不良症状的改善效果。结果 孕妇通过体操干预,便秘症状改善率为81．2％,失眠改善率为82．8％,腿抽筋症状改善率为89．3％,浮肿症状改善率为53．3％,腰背疼痛感改善率为72．5％,血糖控制改善率为50％,髋关节打开程度改善率为90．6％。结论 孕期体操运动能够有效改善孕期便秘、失眠、腿抽筋、浮肿、腰背疼痛等不良症状,孕妇养生保健体操是安全有效,值得进一步研究和推广的。