The Study Of Magnetic Resonance Imaging Of Chronic Primary Insomnia And The Clinical Efficacy Of Traditional Chinese Medicine In The Treatment Of Insomnia

Objectives1.Observe the clinical features of chronic primary insomnia;2.Resting-state functional connectivity analysis was used to examine the temporal correlation between the bilateral dorsolateral gyrus,insula,anterior cingulate gyrus,hippocampus,amygdala and whole-brain regions in 10 chronic primary insomnia patients and 10 age-and sex-matched healthy controls in order to explore the possible mechanism of chronic primary insomnia and the possible effect of abnormal emotion-related brain regions function in chronic primary insomnia;3.To observe the efficacy and safety of nourishing kidney,harmonizing liver and spleen and tranquilizing mind to treat insomnia.Methods1.Detailed medical history inquiry and using the Pittsburgh Sleep Quality Index Scale(PSQI),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and Insomnia Severity Index(ISI)to assess all subjects;2,Using the Siemens Tim verio 3.0T superconducting magnetic resonance scanner(Siemens,Germany)to scan the normal structure of brain and simultaneously scan the resting brain function data to exclude brain structural abnormalities and/or brain irregular function data;3.Using SPM8 software package of Matlab system for resting state brain function network data preprocessing;4.Use WFU_PickAtlas tool and xjview software to perform functional connectivity analysis,and then statistical analysis;5.A prospective cohort study method was used to form a cohort.The treatment group was given Chinese medicine of nourishing kidney,harmonizing liver and spleen and tranquilizing mind,2 times per day for 4 weeks,combined with sleep hygiene education,and control group was given sleep hygiene education.The clinical efficacy was compared between two groups,including total effective rate,Pittsburgh Sleep Quality Index(PSQI)factor and traditional Chinese medicine(TCM)syndromes.And adverse reactions were also recorded.Results1.These study concludes 10 cases in the chronic primary insomnia group and 10 cases in the healthy control group.The results of the scale test showed that the PSQI score,HAMD score,HAMA score and ISI score of the chronic primary insomnia group were higher than the healthy control group(P<0.001);2.The bilateral dorsolateral superior frontal gyrus,insula,anterior cingulate gyrus,hippocampus and amygdala were used as seed points.Compared with the healthy control group,the abnormal functional connectivity areas of the chronic primary insomnia group were as follows:2.1The left dorsolateral superior frontal gyrus was used as the seed point.Compared with the healthy control group,the left dorsolateral superior frontal gyrus of the chronic primary insomnia group had enhanced functional connection with the right right superior frontal gyrus and right superior temporal gyrus.The functional connection with the right midbrain,the left caudate nucleus,the left paracentral lobule,the right precentral gyrus,the right cerebellum and the left cerebellum were weakened.The right dorsolateral superior frontal gyrus had enhanced functional connection with the right cerebellum and the right middle frontal gyrus.The functional connection with the right occipital lobe,the left thalamus,the right caudate nucleus,and the left precentral gyrus was weakened;2.2Taking the bilateral insula as the seed point,compared with the healthy control group,the left insula of the chronic primary insomnia group had enhanced functional connection with the right superior temporal gyrus,the right inferior frontal gyrus and the right cerebellum.The functional connection with the the bilateral precentral gyrus was weakened.The right insula had enhanced functional connection with the right superior temporal gyrus,the left middle cingulate gyrus and right postcentral gyrus.The functional connection with the left precentral gyrus was weakened;2.3The bilateral anterior cingulate gyrus was used as the seed point.Compared with the healthy control group,the left anterior cingulate gyrus had enhanced functional connection with the bilateral middle occipital gyrus,bilateral surprior occipital gyrus,bilateral superior temporal gyrus,left middle temporal gyrus and left cuneus.The functional connection with the left cerebellum,right cerebellum,left middle frontal gyrus,left posterior cingulate gyrus,right caudate nucleus and right pons was weakened.The right anterior cingulate gyrus had enhanced functional connection with the left surprior occipital gyrus,bilateral superior temporal gyrus and left inferior frontal gyrus.The functional connection with the left precentral gyrus,right cerebellum,bilateral pons,posterior cingulate gyrus and left middle frontal gyrus was weakened;2.4 The bilateral hippocampus was used as the seed point.Compared with the healthy control group,the left hippocampus of the chronic primary insomnia group had enhanced functional connection with the the right cerebellum and opercular part of right inferior frontal gyrus and right cerebellum.The functional connection with the posterior cingulate gyrus,left precentral gyrus was weakened.The right hippocampus had enhanced functional connection with the bilateral insula and bilateral cuneus.The functional connection with the left inferior frontal gyrus,right middle frontal gyrus,bilateral inferior temporal gyrus,bilateral cerebellum,right precentral gyrus,right postcentral gyrus,posterior cingulate gyrus,lateral occipital gyrus and right fusiform gyrus was weakened;2.5The bilateral amygdala was used as the seed point.Compared with the healthy control group,the left amygdala had enhanced functional connection with the occipital lobe and right surprior frontal gyrus.The functional connection with the bilateral precentral gyrus,left middle temporal gyrus and right cerebellum was weakened.The right amygdala had enhanced functional connection with the left middle frontal gyrus,left cerebellum and right cuneus;The functional connection with the right pons,right cerebellum,left middle temporal gyrus of temporal pole,posterior cingulate gyrus and left precentral gyrus;3.Clinical efficacy:3.1Total effective rate:The total effective rate(84.21%)of treatment group was significantly better than that of control group(7.14%,P<0.001);3.2PSQI Factor:Five factors of treatment group(sleep latency,sleep quality,sleep duration,sleep efficiency,sleep disturbances)were significantly better than control group(P<0.001).When treatment had been finished,cases of 0 point were significantly better than baseline(P<0.05)by comparing 3 factors(sleep quality,sleep efficiency,sleep disturbances)between these two groups.Cases of 0 point and 1 point were significantly better than baseline(P<0.05)in factors(sleep quality,sleep efficiency,sleep latency).Treatment group had a better sleep efficiency and sleep quality than control group;3.3TCM syndromes:Total effective rate of fire due to yin deficiency syndrome(92.11%)in treatment group was significantly better than control group(21.43%,P<0.001).Total effective rate of disharmony between liver and spleen syndrome(84.21%)in treatment group was significantly better than control group(28.57%,P<0.001);3.4Safety:During treatment,no obvious adverse reactions occurred in two groups.Conclusions1.Chronic primary insomnia patients have the basic characteristics of sleep disorders and emotional disorders.Anxiety and depression are the main emotional disorders associated with Chronic primary insomnia patients.Emotional disorders often interact with sleep disorders,leading to prolonged insomnia and cure difficulties;2.Patients with chronic primary insomnia have different degrees of functional connectivity abnormalities in the bilateral dorsolateral gyrus,insula,anterior cingulate gyrus,hippocampus,and amygdala.These brain regions are involved in emotional loop processing regulation.Abnormal functional connections with other brain regions can explain the clinical features of patients with chronic primary insomnia to some extent,including difficulty falling asleep,early awakening,vulnerability to environmental factors,daytime dysfunction and long-term adverse mood,indicating emotional loop correlation brain dysfunction may be a potential neurobiological mechanism for the development of chronic primary insomnia and prolonged refractory;3.The method of nourishing kidney,harmonizing liver and spleen and tranquilizing mind can improve overall sleep condition.