Study on the mechanism of regulating the hypothalamic cortical hormone releasing hormone/corticotropin releasing hormone type I receptor pathway by vibro-annular abdominal massage under the brain-intestine interaction in the treatment of insomnia.
Study on the mechanism of regulating the hypothalamic cortical hormone releasing hormone/corticotropin releasing hormone type I receptor pathway by vibro-annular abdominal massage under the brain-intestine interaction in the treatment of insomnia.
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DOI：
10.1097/md.0000000000025854
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发表时间：
2021-05-14
期刊：
影响因子：
1.6
通讯作者：
Zhang H
中科院分区：
文献类型：
--
作者：
Zhang Y;Cong D;Liu P;Zhi X;Shi C;Zhao J;Zhang H
失眠是一种与不同神经系统应激反应和内分泌紊乱有关的常见病。此前有报道称，腹部振动和圆环按摩疗法可以显著改善失眠患者的症状，增强神经元的活动。此外，静息状态脑测试的功能MRI（静息状态脑功能磁共振成像[Rs_fMRI]）证实，腹部按摩治疗后下丘脑与海马旁回之间的功能连接可明显增强。已证实脑-肠相互作用可能参与失眠的治疗，但缺乏研究阐明脑-肠相互作用治疗失眠的可能机制。本研究的目的是探讨下丘脑与肠道相互作用在腹部按摩治疗失眠中的关系。将进行单盲随机对照试验。本研究将招募60名慢性失眠症志愿者和30名健康志愿者。60名失眠志愿者将被随机分为药物组和按摩组，30名健康志愿者将被分配到健康组。治疗组手法以腹部揉揉和振动按摩为主，每天1次，30分钟/次，5天为一个疗程，共进行4个干预疗程。药物组患者给予健脾丸口服，每日2次，早晚各1粒。疗程为5天，共4个疗程。采用匹兹堡睡眠指数量表（PSQI）、高觉醒量表（HAS）、汉密尔顿抑郁量表（HAMD）、疲劳量表-14量表（FS-14）、韦氏成人记忆量表（WAIS）与按摩组和药物组进行比较，观察睡眠质量。Rs-fMRI将观察脑内各种BOLD信号，比较Reho、fALFF、FC的值。利用MRS技术观察下丘脑中GABA和5-羟色胺的含量。检测血清中皮质激素释放激素（CRH）、促肾上腺皮质激素（ACTH）、COR、GABA、NE、PGE2、5-HT的含量。取各组血清进行1H核磁共振（1HNMR）代谢组学研究，分析3组间各种常见代谢物、差异代谢物、潜在代谢生物标志物及代谢途径。最后，结合脑功能成像和脑频谱，探讨腹部振动和环按摩的潜在机制。本研究结果将有可能为阐明揉腹环治疗失眠症脑肠相互作用的多种机制提供依据。
Insomnia is a common disease associated with different nervous system stress response and endocrine disorders. It has been reported previously that abdominal vibration and ring massage therapy can significantly improve the symptoms of insomnia patients, enhance the activity of neurons. In addition, functional MRI (resting state brain functional magnetic resonance imaging [Rs_fMRI]) of the resting state brain test has proved that the functional connection between hypothalamus and parahippocampal gyrus could be significantly enhanced after abdominal massage treatment. It has been confirmed that there is possible involvement of brain–gut interaction effect in the treatment of insomnia, but there is a lack of research to elucidate the possible mechanisms of brain–gut interaction in the treatment of insomnia. The purpose of this study is to investigate the relationship between the hypothalamus and intestinal interaction in the treatment of insomnia by abdominal massage. A single blind randomized controlled trial will be conducted. Sixty chronic insomnia volunteers and 30 healthy volunteers will be recruited for this study. Sixty insomnia volunteers will be randomly divided into a drug group and a massage group, and 30 healthy volunteers will be assigned to the healthy group. The manipulation of the treatment group will be mainly carried out through abdominal rubbing and vibration massage, once a day, 30 min/time, 5 days for a course of treatment, and a total of 4 intervention courses will be carried out. Patients in the drug group will be given orally spleen-invigorating bolus, twice a day, 1 pill in the morning and 1 pill in the evening. The course of treatment will be carried for 5 days, and a total of 4 courses of treatment will be administered. The massage group will be compared with the healthy group and the drug group by Pittsburgh Sleep Index scale (PSQI), Hyperarousal scale (HAS), Hamilton Depression scale (HAMD), Fatigue scale-14 (FS-14), and Wechsler Adult Memory scale (WAIS) scales using to observe the sleep quality. Rs-fMRI will be used to observe various BOLD signals in the brain and compare the values of Reho, fALFF, and FC. MRS technology will be used to observe the contents of GABA and 5-HT in the hypothalamus. Additionally, the contents of cortical hormone releasing hormone (CRH), adrenocorticotropic hormone (ACTH), COR, GABA, NE, PGE2, and 5-HT in the serum will be also detected. The serum of each group will be taken for 1H nuclear magnetic resonance (1HNMR) metabolomics study to analyze the various common metabolites, differential metabolites, potential metabolic biomarkers, and metabolic pathways among the 3 groups. Finally, in combination with the brain functional imaging and brain spectrum, the potential mechanism of abdominal vibration and ring massage will be discussed. The results of this study will be used to possibly elaborate the various mechanisms of brain and intestine interaction in the treatment of insomnia by employing abdomen ring rubbing.