脑卒中后失眠患者血清神经递质水平与推拿疗效的关系-东南大学学报医学版

脑卒中后失眠患者血清神经递质水平与推拿疗效的关系

单位：1. 中国中医科学院西苑医院脑病科, 北京 100091;
2. 苏州市中医医院脑病科, 江苏苏州 215000;
3. 中国中医科学院西苑医院普外科, 北京 100091

分类号：R256.23

出版年·卷·期（页码）：2026·45·第二期（296-302）

摘要：

目的:探讨脑卒中后失眠(PSI)患者血清神经递质水平与推拿疗效的关系。方法:选取2024年2月至2025年1月本院收治的236例PSI患者,所有患者均行推拿治疗。治疗两周后,统计PSI患者的推拿疗效,并依据推拿疗效分为疗效良好组(n=205)和疗效不佳组(n=31)。比较疗效良好组和疗效不佳组临床资料及血清神经递质水平。Logistic回归分析影响PSI患者推拿疗效的相关因素。绘制受试者工作特征(ROC)曲线,分析血清神经递质水平对PSI患者推拿疗效的预测效能。结果:治疗后PSI患者疗效不佳率为13.16%。疗效不佳组合并高血脂症占比及血清去甲肾上腺素(NE)、5-羟色胺(5-HT)、多巴胺(DA)水平高于疗效良好组(P＜0.05)。Logistic分析结果显示,NE(OR=4.076,95%CI 1.850~9.158)、5-HT(OR=3.117,95%CI 1.401~6.935)、DA(OR=3.347,95%CI 1.504~7.446)均为是影响PSI患者推拿疗效的危险因素(P＜0.05)。ROC曲线分析结果显示,血清NE、5-HT、DA及三者联合对PSI患者推拿疗效预测的曲线下面积(AUC)分别为0.789(95%CI 0.731~0.839)、0.787(95%CI 0.729~0.838)、0.815(95%CI 0.759~0.862)、0.898(95%CI 0.852~0.933)。结论:PSI患者血清神经递质水平与推拿疗效相关,且血清NE、5-HT及DA三者联合对PSI患者推拿疗效的预测效能较高。

Objective: To explore the correlation between the level of serum neurotransmitter and the therapeutic effect of massage in patients with post-stroke insomnia(PSI). Methods: A total of 236 patients with PSI admitted to our hospital from February 2024 to January 2025 were selected, all patients were treated with massage. After two weeks of treatment, the massage effect of PSI patients was counted. According to the curative effect of massage, the patients were divided into good curative effect group(n=205) and poor curative effect group(n=31). The clinical data and serum neurotransmitter levels of the good curative effect and the poor curative effect group were compared. Logistic regression analysis was used to analyze the related factors affecting the massage efficacy of PSI patients. Receiver operating characteristic(ROC) curve was made to analyze the predictive efficacy of serum neurotransmitter level on massage efficacy of patients with PSI. Results: After treatment, the ineffective rate of PSI patients was 13.16%. The proportion of hyperlipidemia, serum levels of norepinephrine(NE), 5-hydroxytryptamine(5-HT) and dopamine(DA) in the poor curative effect group were higher than those in the good curative effect group(P<0.05). Logistic regression analysis showed that NE(OR=4.076, 95%CI 1.850-9.158), 5-HT(OR=3.117, 95%CI 1.401-6.935), DA(OR=3.347, 95%CI 1.504-7.446) were all risk factors affecting the therapeutic effect of massage for patients with PSI(P<0.05). The ROC curve analysis showed that the area under the curve(AUC) of serum NE, 5-HT, DA and their combination in predicting the therapeutic effect of massage for patients with PSI were 0.789(95%CI 0.731-0.839), 0.787(95%CI 0.729-0.838), 0.815(95%CI 0.759-0.862) and 0.898(95%CI 0.852-0.933), respectively. Conclusion: The levels of serum neurotransmitter in patients with PSI is related to the therapeutic effect of massage, and the combination of serum NE, 5-HT and DA has a high predictive effect on the therapeutic effect of massage in patients with PSI.

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