| Object1 Through the clinical trial group with rigid-gentle syndrome differentiation of traditional Chinese medicine(TCM)and the placebo group in the treatment of cardiac neurosis(CN),and evaluate the clinical effectiveness of TCM in the treatment of cardiac neurosis.2 Though using super encephalofluctuograph technology(SET)and analysis of electrophysiological techniques,specificity of neurotransmitters in brain of patients with CN activation level changes,the characteristics of brain electrical activity mapping(BEAM),and the characteristics of heart rate variability(HRV)are observed,which provide the basis for clinical diagnosis,treatment and curative effect evaluation.3 Though analyzing the correlation of psychological social factors,to explore the psychosocial factors of patients with CN characteristic,and to provide the basis for clinical diagnosis and treatment.MethodThe research used a randomized,double blind placebo,and controlled clinical trial of cases in parallel.The clinical 90 cases came from February 2014 to January 2015 in the Department of psychosomatic medicine,China Academy of Chinese Medicine Sciences,Guang' anmen Hospital.The patient group(n=90)was divided into the trial group(n=60)and placebo group(n=30).The healthy group(n=22)was come from healthy volunteers.Patient group lost 3 cases,including 1 case in treatment group and 2 cases in the placebo group.All patients were randomized into trial group and placebo group after are treated with rigid-gentle syndrome differentiation of TCM.The trial group was treated with herbs of TCM combined with cognitive behavioral therapy.The placebo group was treated with the placebo combined with cognitive behavioral therapy.The courses of treatment were 8 weeks.The patient group was examination with EEG detection,evaluation and analysis of HRV and psychosocial factors.Detection of indicators included brain neurotransmitter activation level such as INH,EXC,5-HT,Ach,DA,NE,EEG brain region and topography,short duration of time domain and frequency domain parameters of HRV,as well as the psychological and social factors scales including HAMA,HAMD,the index of TCM five pattern personality inventory,Social Readjustment Rating Scale(SRRS)and symptom checklist(SCL-90).The healthy group only is examination for SET and BEAM.All data entered into the database,using SPSS18.0 software for statistical analysis,to observe the changes of each index.Result1 In the research on clinical effect:The patient group with CN syndromes were divided into the syndrome of the hyperactivity of heart and liver fire(n=15),yin deficiency of liver and heart(n=60),stagnation of liver qi(n=8),and stagnation of liver qi and spleen deficiency(n=7).The mean age was 51.23 ±10.88,and mean duration of disease was 70.67 ±98.07 months.In the improvement of TCM symptom score,the trial group 4 cases were cured,27 cases markedly effective,effective 23 cases,and invalid 5 cases,the total effective rate was 91.53%,placebo group 1 cases were cured,6 cases markedly effective,effective 12 cases,invalid 9 cases,the total effective rate was 67.86%,two groups had significant difference(P<0.05).The trial group and placebo group before and after treatment in both groups were significantly improved,and there was statistically significant difference(P<0.05).The trial group on symptoms improved more significantly than placebo group in the treatment of sixth weeks,eighth weeks,and there was statistically significant difference(P<0.05).In the improvement of anxiety,the trial group than the placebo group improved significantly,there was statistically significant difference(P<0.05),trial group 18 cases were cured,25 cases markedly effective,effective 11 cases,invalid 5 cases,and the total effective rate was 91.53%.The placebo group cured 6 cases,markedly effective in 7 cases,effective 8 cases,invalid 7 cases,and the total effective rate was 75.00%.After the treatment for 8 weeks,the trial group in the improvement of anxiety more significantly than the placebo group,with statistically significant difference(P<0.05).Before and after treatment,the two groups were significantly improved,with a statistically significant difference(P<0.05).In the improvement of depression,the trial group than in the placebo group also improved significantly,with statistically significant difference(P<0.05).Trial group 16 cases were cured,20 cases markedly effective,effective 16 cases,invalid 7 cases,and the total effective rate was 88.14%.The placebo group cured 3 cases,markedly effective in 8 cases,effective 9 cases,invalid in 8 cases,and the total effective rate was 71.43%.After the treatment for 8 weeks,the trial group on depression improved more significantly than the placebo group,with statistically significant difference(P<0.05).2 In the research on brain electrical activity:Including neurotransmitters in the brain regions of patients with CN activation level features:?There was no comparison of whole brain average INH activation level and healthy group was significantly abnormal,but in the areas of the brain activated P3 decreased,with statistically significant difference(P<0.05).The whole brain average EXC levels increased activation in brain regions,F3 and C3,with statistically significant difference(P<0.05).The main component of INH is GABA,in the left parietal activation level is low;the main component of EXC is a strong excitatory neurotransmitter Glu,which shows increased levels of activation in the left frontal lobe and left occipital.Two antagonistic shows the imbalance in the brain,as exciting neurotransmitter activation.?Increased the average activation level of brain 5-HT,F3 in brain regions,with statistically significant difference(P<0.05).The whole brain average DA activation reduced.Antagonistic interaction between 5-HT and DA in the brain is basically balanced state.?The whole brain mean ACh levels decreased in brain regions C3,C4,P3,P4,O1,O2 of activation,with statistically significant difference(P<0.05).The whole brain average NE levels increased activation in brain regions,P3 and O1,with statistically significant difference(P<0.05).It shows the state of imbalance that Antagonistic effect between ACh and NE in the brain.Whole brain neurotransmitters in trial group,the average activation level and the placebo group before and after treatment comparison difference had no statistical difference(P>0.05).The trial group and the placebo group in the whole brain ACh activation levels were compared with healthy people was lower,with statistically significant difference(P<0.01).In the trial group increased ACh activation level trend is higher than that of placebo group,the other neurotransmitter had no significant difference compared with the healthy group(P>0.05).It shows that the rigid and gentle syndrome differentiation and treatment of CN after 8 weeks to improve the level of neurotransmitters in the brain activation.Patients with CN in EEG changes,as follows:the power of ?????1 brain area value of healthy group was not statistically significant(P>0.05).Brain power of a 2 value in the FP1,FP2,T5 compared with the healthy control group decreased,with statistically significant difference(P<0.05).Brain power of a 3 value in the FP1,FP2,T,O1 area than the health group power decreased,with statistically significant difference(P<0.05).Brain ? power value in the T5 area than healthy control group,with statistically significant difference(P<0.05).In the case of the patient with CN of the syndrome yin deficiency of heart and liver,the neurotransmitters in the brain activation level showed abnormal features:the average activation level of the whole brain 5-HT,NE,EXC compared with the healthy group,with statistically significant difference(P<0.05).INH,ACh average activation level lower than healthy control group,with statistically significant difference(P<0.01).After 8 weeks of treatment,the trial group EXC activation level was significantly lower than placebo group;the two groups have statistical significance(P<0.05).The trial group and the placebo group respectively,and the healthy control group were compared,the results showed that in the trial group ACh in the whole brain activation levels of healthy people group significantly decreased,with statistically significant difference(P<0.05).More than the neurotransmitter no significant difference with healthy group(P>0.05),showed that the trial group by the neurotransmitter after treatment only ACh has not returned to normal levels,more neurotransmitters were restored to the normal level.The placebo group of the whole brain ACh activation levels of healthy people group significantly decreased,with statistically significant difference(P<0.05).The whole brain NE and EXC activation levels of healthy group was significantly increased,with statistically significant difference(P<0.05),and the other neurotransmitter had no significant difference compared with the healthy group(P>0.05).The placebo group after treatment showed that the neurotransmitter ACh,NE and EXC were not restored to the normal level,any differences with healthy group.In EEG brain regions,the characteristic on the syndrome of yin deficiency of heart and liver is that power brain region of ?,?,?1,?2 and ? values than healthy group was not statistically significant(P>0.05).Brain regions of a 3 power values than the healthy group power value decreased in FP1,FP2,T3,T5,01,with statistically significant differences(P<0.05).3 In the research on electrophysiological:short term heart rate variability in patients with cardiac neurosis(5min)time domain indexes of SDNN,RMSSD compared with the norm,the SDNN index is often Ming mode significantly,with significant statistical difference(P<0.01);RMSSD index had no significant difference compared with the norm,(P>0.05).The trial group and the placebo group before and after treatment in time domain indexes of SDNN,RMSSD had no significant difference(P>0.05),while the trial group before and after treatment SDNN index increased significantly,with statistical difference(P<0.05),SDNN index before and after the treatment,the placebo group did not change significantly(P<0.05);There was no significant difference in RMSSD index before and after the trial group and the placebo group were treated(P>0.05).It is show that the sympathetic nerve activity was significantly enhanced,sympathetic nerve activity in trial group decreased significantly after treatment.Patients with CN frequency domain indexes of TP,LF,HF,LFnorm,HFnorm,LF/HF compared with the norm,TP norm,LF/HF index is significantly lower,with significant statistical difference(P<0.01).It is show that the overall low level of cardiac neurosis patients with autonomic nerve;the trial group and the placebo group before and after treatment in the two groups before and after treatment the difference had no statistical difference(P>0.05).TP index of the placebo group before and after treatment increased significantly,with statistical difference(P<0.05).There was no significant difference in other indexes(P>0.05).After treatment,the trial group,the placebo group and the norm was no significant difference(P>0.05).HFnorm index was significantly lower than the norm,with statistical difference(P<0.05).It is show that the trial group after treatment,the level of TP was significantly higher than that before treatment,basically reached the normal level,while the placebo group after treatment,the level of TP was significantly higher than that before treatment,but the HFnorm level was still low level of norm,namely the low tension of vagus nerve.4 In the research on correlation analysis of the psychological and social factors:through SRRS change units of patients with CN in nearly two years,shows the total score accounted for 62.22%below 150 points,the score between 150?300 points accounted for 27.78%,accounting for 10%of the score more than 300 points in the.It is show that the patients with cardiac neurosis in 37.78%more than half of the probability may be ill in the next year.The total score of SCL-90 and each factor score is show that the scale of anxiety,hostility and additional factor index of more than 2,there is positive significance.A comparative analysis of five-kind personality scale and norm,results show that the Taiyang,Taiyin dimension than the norm,with statistically significant difference(P<0.05);Yinyangheping and Shaoyin dimension reduced than norm,statistically significant differences(P<0.05).The five dimensions of the five-kind personality and syndrome type,gender,age,course of disease,SRRS,EEG,SCL-90,HAMA,HAMD were related to factor analysis,results show that Taiyang dimension and SRRS,HAMA was positively correlated.Shaoyang dimensions and SRRS,duration of the disease was positively correlated.Conclusion1 Through the treatment of CN patients with TCM rigid and gentle syndrome differentiation,after 8 weeks of treatment,that can significantly improve the cardiac neurosis symptoms of anxiety and depression and clinical physical emotional disorder.2 There are cerebral electrophysiological changes in CN patients.The level of activation in the brain neurotransmitter,reduce the activation of ACh,P3 region appeared synergistic effects of ACh decreased and NE increased in the most obvious,may be one of the material basis of patients with cardiac neurosis brain function change.In the changes of BEAM,manifested as forward generalization trend may be the a wave of rhythm abnormalities.In the case of yin deficiency of heart and liver,activate the elevated levels of activation levels in the brain 5-HT,NE,EXC and INH,decrease the ACh may be one of the features.After 8 weeks of treatment,EXC in the brain activation level decreasing trend may be one of the material bases for the effectiveness,and provide reference for clinical diagnosis,treatment and curative effect evaluation and prognosis.3 There are decrease of HRV in CN patients.The manifested as increased sympathetic nervous activity and characteristics of autonomic nervous dysfunction.After 8 weeks of treatment,it could increase HRV of patient with CN.4 The access of CN relates to the psychosocial factors closely.Five-kind personality characteristics of patients for the Taiyang and Taiyin dimension are high,while Yinyangheping and Shaoyin dimension are relatively low.The person who is Taiyang and Shaoyang dimension personality make a big influence on their life events. |
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