肝硬化失眠的发病机制与中西医研究进展

胡玮晔; 柴海生; 祝峻峰; 肖姝雲

doi:10.16766/j.cnki.issn.1674-4152.004261

肝硬化失眠的发病机制与中西医研究进展

doi: 10.16766/j.cnki.issn.1674-4152.004261

1.
上海中医药大学附属岳阳中西医结合医院肝病科, 上海 200473
2.
上海市中医医院失眠科, 上海 201203

基金项目:

国家自然科学基金面上项目 82074386

上海市科技创新行动计划生物医药科技支撑专项项目 23S21900100

上海申康医院发展中心临床三年行动计划 SHDC2020CR3095B

详细信息

通讯作者:
祝峻峰，E-mail: zhujftongling@163.com

中图分类号: R575.2 R242
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- 被引次数: 0
出版历程
- 收稿日期: 2024-12-26
- 网络出版日期: 2026-01-07

The pathogenesis of insomnia in liver cirrhosis and research progress in traditional Chinese and Western medicine

1.
Department of Liver, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200473, China

摘要

摘要: 失眠作为肝硬化常见症状之一，其发生可能与肝硬化相关的临床症状、并发症、药物使用、不良睡眠卫生习惯、环境及心理因素等有关，但对上述因素的潜在发病机制目前尚未明确，可能与下列因素有关，包括褪黑激素、甲状腺激素、生长激素等在内的激素调节障碍；包括糖代谢、胆红素代谢、微量元素代谢、肠道菌群代谢、氨代谢等引起的代谢紊乱；体温改变；不同原发病因所致肝硬化的特异性致病因素；利尿剂、β受体阻滞剂等药物因素及心理因素等。西医在药物干预上多采用降氨药物、镇静剂、褪黑素等，在非药物治疗中则多采用晨光疗法及包括正念在内的认知行为疗法进行干预。在中医方面，通过辨证施治、审证求因、治病求本等优势，充分结合传统中医学对二者病因病机的认识，并进一步总结肝硬化患者失眠的病机及临证特点，在诊疗上立足于“从肝论治”，以口服中药、外治针灸推拿等方法对患者进行整体系统干预，以改善肝硬化患者的失眠症状，并提高生活质量。本文主要从近年来对肝硬化失眠的发病机制研究、西医药物及非药物治疗进展、中医对本病的系统认识及治疗进展等方面进行综述，以期为本病在病理生理机制等方面的进一步基础研究，以及在真实世界中的临床实践及临床研究提供参考。
- 肝硬化 /
- 失眠 /
- 发病机制
Abstract: As one of the common symptoms of liver cirrhosis, the high incidence of insomnia may be associated with clinical symptoms, complications, medication, poor sleep hygiene habits, environmental and psychological factors, etc. Nevertheless, the underlying pathogenic mechanisms remain unclear, may be related to hormonal dysregulation, including melatonin, thyroid hormones, growth hormones, etc.; metabolic disturbances induced by sugar metabolism, bilirubin metabolism, trace element metabolism, intestinal flora metabolism, ammonia metabolism, etc.; changes in body temperature; specific factors related to the different primary etiology; drug effects such as diuretics and β-blockers; and psychology factors, as well as. In Western medicine, pharmacological interventions primarily include ammonia-lowering agents, sedatives, and melatonin, while non-pharmacological approaches involve morning light therapy and cognitive behavioral therapy that incorporate mindfulness. Based on the characteristics of syndrome differentiation, seeking the cause through syndrome analysis, and treating the root cause of the disease, combining the understanding of the etiology and pathogenesis of both liver cirrhosis and insomnia, respectively. Further, it summarizes the pathogenesis and clinical characteristics of insomnia in patients with liver cirrhosis. Aiming to alleviate the insomnia symptoms of patients with liver cirrhosis and enhance their quality of life, traditional Chinese medicine (TCM) rooted in "liver-oriented", treats and diagnoses through oral herbal formulations and external therapies such as acupuncture and massage. This paper reviews recent advances in the pathogenesis of insomnia in liver cirrhosis, progress in Western medical treatments, and systematic TCM perspectives and therapeutic developments for this condition, aiming to provide references for further basic research on pathophysiological mechanisms and real-world clinical practice research.
- Liver cirrhosis /
- Insomnia /
- Pathogenesis

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