| Post-Stroke Insomnia (PSI) is a very common clinical disease, Howerver, The pathogenesis is still unknown. In recent years, the neurotransmitters has been more and more emphasized in vast majority of the study in its pathogenesis. Orexin secreted by the hypothalamus can regulate acetylcholine, serotonin and norepinephrine, which plays an important role in sleep/awakening. Orexin can also regulate brain inflammation, promote neuroprotective factor expression in other ways to protect brain function in stroke pathogenesis. Orexin closely linked with the presence of insomnia after stroke.Objective:To study the serum orexin-A level in PSI and the effects of rTAS and Diazepam therapy and the clinical significance.The First PartMethods:We Selected 47 first episode and drug-naive PSI patients as the study group.35 healthy cases as the control group which matched the study group. We collected all participants' venous blood samples in the morning at 8:00 a.m. and serum orexin-A levels was checked by Elisa.Results:There was significant difference in serum orexin-A level between drug-naive and first episode PSI [(537.36±39.46) pg/ml and normal control group [(341.09±22.94) pg/ml] (P<0.01).The Second PartMethods:We Selected 60 drug-naive and first episode PSI patients who continuous using repetitive transcranial acupuncture stimulation or diazepam (2.5 mg/d), before treatment and after 1months treatment, we measured the orexin-A level of serum, BMI, fasting glucose, triglyceride ester, total cholesterol, low density lipoprotein, high density lipoprotein levels. Treatment response was assessed by PSQI score/SRSS score/Sleep rate before and 1month of treatment.Results:1. After the treatment for 1 month, the two groups PSQI score [rTAS (6.47 ±1.11) VS (14.10 ± 1.37), P<0.01] [DZP (6.03 ± 1.03) VS (14.57 ± 1.14), P<0.01] and SRSS scrore [rTAS (23.73 ± 6.22) VS (41.77 ± 3.85), P<0.01] [DZP (20.73 ± 5.27) VS (43.43 ± 3.07), P<0.01] decreased significantly. Sleep Rate [rTAS (65.60 ± 10.96) VS (39.07 ± 4.97), P<0.01] [DZP (69.87 ± 9.74) VS (38.90 ± 4.57), P<0.01] increased significantly. The diazepam group SRSS rate increased significantly compared with rTAS group [(69.87 ± 9.74) VS (38.90 ± 4.57), P<0.01].2. After 1 month of rTAS treatment, the serum Orexin-A levels of PSI patients decreased significantly [(532.80 ± 46.01) mmol/L VS (369.10 ± 67.04) mmol/L, P <0.01].3. After 1 month of Diazepam treatment, the serum Orexin-A levels of PSI patients decreased significantly [(541.30 ± 32.60) mmol/L VS (338.50 ± 59.60) mmol/L, P<0.01]; but the BMI was significantly increased [(22.67 ± 2.78) VS (25.43 ± 3.97), P<0.01]. Triglycerides [(121.90 ± 21.85) mg/dl VS (137.10 ± 25.44) mg/dl, P<0.05], total cholesterol [(5.23 ± 0.59) mg/dl VS (5.76 ± 1.11) mg/dl, P< 0.05], low-density lipoprotein [(26.00 ± 6.97) mg/dl VS (30.37 ± 8.87) mg/dl, P <0.05] were increased statistically; The high-density lipoprotein [(15.07 ± 3.90) mg/ dl VS (13.07 ± 3.79) mg/dl, P<0.05] statistically decreased.4. After 1 month of Diazepam treatment, Orexin-A levels and LDL changes positively correlated (r= 0.409, P= 0.025).5. After 1 month of rTAS and Diazepam treatment, the BMI of diazepam group significantly increased [(25.43 ± 3.97) VS (21.93 ± 2.12), P<0.01]. High-density lipoprotein significantly decreased [(13.07 ± 3.79) mmol/L VS (15.93 ± 3.53) mg/dl, P<0.01]. Fasting serum glucose [(55.00 ± 6.63) mmol/L VS (50.97 ± 6.75) mg/dl, P<0.05], low-density lipoprotein [(30.37 ± 8.87) mmol/L VS (25.27 ± 6.41) mg/dl, P<0.05] were significantly increased.Conclusion:The serum Orexin-A levels of Post-stroke insomnia patients were significantly increased;The decreased serum Orexin-A levels has no significant relation with the severity, the location of infarction and stroke risk factors;Repetitive transcranial Acupuncture stimulation therapy significantly reduced the serum Orexin A level of PSI patients, moreover, without causing significant changes in BMI, glucose and lipid metabolism.Diazepam has a significant impact on the Orexin-A level and BMI, glucose and lipid metabolism in PSI patients;Increased BMI and the change of the clinical symptom scores were significantly and negatively correlated, suggesting that BMI increased was closely linked with the effect of diazepam in the positive symptoms;BMI increased wasn't significantly correlated with the change of Orexin-A level, we were not sure that the reduce of Orexin-A level was the cause of the weight gain.Repetitive transcranial acupuncture stimulation is useful treatment in the first episode PSI, it can treat positive and negative symptoms without causing abnormal glucose and lipid metabolism. |
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