近五年针刺治疗慢性失眠障碍的作用机制研究进展OA

Chronic insomnia disorder(CI)is characterised by difficulty in falling asleep and reduced sleep quality lasting more than 3 months,which seriously affects physical and mental health.By analysing the literature in recent years,it was found that acupuncture treatment for CI has the following mechanisms of action:(1)Modulation of neurotransmitters.Among the monoamine neurotransmitters,acupuncture can reduce the activity of dopamine D1 receptor and the content of norepinephrine(NE),which promotes arousal,and at the same time increase the level of 5-hydroxytryptophan(5-HT)and its receptor,which is essential for sleep,thus improving the sleep-wake cycle.Among the amino acid transmitters,acupuncture can elevate GABA content and lower Glu content,regulating the balance of excitation and inhibition in the nervous system.(2)In the regulation of neuroendocrine hormones,CI is related to the over-activation of the HPA axis and the disruption of the MT secretion rhythm;the over-activation of the HPA axis will increase the concentration of CRH,ACTH and CORT,which will interfere with the sleep-wake cycle,and acupuncture can reduce the content of these hormones and inhibit the over-stress response of the HPA axis;the decrease in the secretion level of MT will lead to the decrease of sleep quality,and acupuncture can increase the content of MT and improve the quality of sleep.(3)Transcription of biological clock proteins.Chronic insomnia patients often exhibit desynchronisation of the central and peripheral clock rhythms,and acupuncture can reshape the synergistic oscillations of the central-peripheral clock and restore the sleep-wake cycle by regulating the core proteins of the biological clock,such as up-regulation of the expression levels of Clock and Bmal1 mRNA,and increasing the expression of Per1,Per2 mRNA,and so on.Despite the potential of acupuncture in treating CI,there are shortcomings in existing studies,such as some of the mechanisms are still unclear,mostly focusing on single-mechanism studies,and small experimental sample sizes.Future studies can explore the mechanism of action of acupuncture for CI in depth,tap into the interactions between multiple targets,increase the sample size of clinical trials,and provide new ideas for the treatment of CI with acupuncture.