目的：睡眠不足致认知障碍，针刺可改善睡眠不足症状，但其改善认知障碍作用及机制不明，本文遵循“临床观察-基础验证”方法，探索针刺对睡眠不足患者及大鼠认知功能的影响。

方法：纳入22例中老年慢性失眠患者，随机分为针刺组（针刺双侧神门、三阴交、太冲穴）和安慰剂组，在治疗前后使用阿森斯失眠量表-5（Athens Insomnia Scale-5，AIS-5）、言语流畅性测验（Verbal Fluency Test，VFT）评价患者睡眠和认知功能变化。将24只大鼠随机分为空白组、睡眠剥夺（sleep deprivation，SD）组、SD＋针刺（SD＋acupoint electroacupuncture，SDA）组以及SD＋针刺非穴位组（SD＋sham acupuncture，SDS）组。记录大鼠的情绪及学习记忆力；检测血清下丘脑-垂体-肾上腺（hypothalamic-pituitary-adrenal，HPA）轴激素［促肾上腺皮质激素（adrenocorticotrophic hormone，ACTH）、促肾上腺皮质激素释放激素（corticotropin releasing hormone，CRH）、肾上腺皮质激素（corticosteroid，CORT）］、氧化应激酶［超氧化物歧化酶（superoxide dismutase，SOD）、丙二醛（malonaldehyde，MDA）］、炎症因子［白细胞介素（interleukin，IL）6、IL-1β、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）］；观察海马角1区（cornu ammonis 1，CA1）神经元及胶质细胞形态和数量。

结果：22例中老年慢性失眠患者经针刺治疗后，AIS-5总分及亚项得分较前降低（P值均＜0.05），VFT得分较前改善（P＝0.022）。针刺对SD大鼠的影响实验结果主要有以下5个方面。（1）行为学方面：与SD组比，SDA组和SDS组睡眠持续时间延长（P值分别为＜0.001和0.001），SDA组进入中央区次数增多（P＝0.027），SDA组和SDS组穿越平台次数显著增加（P值分别为0.002和0.012）。（2）HPA轴激素水平：与SD组比，SDA组CRH水平升高、CORT水平下降、ACTH水平无明显变化（P值分别为0.014、0.020和0.436）；SDS组ACTH水平升高，CRH及CORT水平无明显差异（P值分别为0.017、0.371和0.944）。（3）氧化应激反应：与SD组比，SDA组SOD水平下降（P＝0.018）。（4）炎症反应：与SD组比，SDA组TNF-α、IL-1β及IL-6水平下降（P值分别为0.017、0.006和0.007）。（5）病理表现：与SD组比，SDA组CA1区神经元数量保留增多且胶质细胞减少。

结论：针刺可改善急性睡眠不足所致认知障碍，可能通过HPA轴介导的氧化应激及炎症反应途径起作用。

Objective: Sleep deprivation can lead to cognitive impairment, and acupuncture has been shown to symptoms associated with insufficient sleep; however, effects on cognitive impairment and the underlying mechanisms remain unclear. Following a "clinical observation–basic validation" approach, this study aimed to investigate the impact of acupuncture on cognitive function in both sleep-deprived patients and rats.

Methods: A total of 22 middle-aged and elderly patients with chronic insomnia were enrolled and randomly assigned to either an acupuncture group (receiving bilateral needling at Shenmen, Sanyinjiao, and Taichong acupoints) or a placebo group. Sleep quality and cognitive function were assessed before and after treatment using the Athens Insomnia Scale-5 (AIS-5) and Verbal Fluency Test (VFT). In the animal experiment, 24 rats were randomly divided into four groups: a blank control group, a sleep deprivation (SD) group, a SD＋acupoint electroacupuncture (SDA) group, and an SD＋sham acupuncture (SDS) group. Emotional state and learning and memory performance were recorded in all rats. Serum levels of hypothalamic-pituitary-adrenal (HPA) axis hormones, including adrenocorticotrophic hormone (ACTH), corticotropin releasing hormone (CRH), and corticosteroid (CORT)], as well as oxidative stress enzymes [superoxide dismutase (SOD) and malonaldehyde (MDA)], and proinflammatory cytokines [interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α)] were measured. The morphology and density of neurons and glial cells in the cornu ammonis1 (CA1) of the hippocampus were also examined.

Results: In the 22 middle-aged and elderly patients with chronic insomnia, acupuncture treatment significantly reduced both the total AIS-5 score and individual subscale scores compared to baseline (all P < 0.05), and VFT scores showed meaningful improvement (P = 0.022). The effects of acupuncture on SD rats were observed across five main dimensions. (1) Behavioral outcomes: compared with the SD group, both the SDA and SDS groups exhibited prolonged sleep duration (P < 0.001 and P = 0.001, respectively); the SDA group showed an increased number of entries into the central area of the open field(P = 0.027), and both the SDA and SDS groups demonstrated a significant greater number of platform crossings in the Morris water maze(P = 0.002 and P = 0.012, respectively). (2) HPA axis hormone levels: compared with the SD group, the SDA group showed elevated CRH levels and reduced CORT levels, while ACTH levels remained unchanged (P = 0.014, 0.020, and 0.436, respectively); the SDS group exhibited increased ACTH levels, with no significant difference in CRH or CORT (P = 0.017, 0.371, and 0.944, respectively). (3) Oxidative stress response: compared with the SD group, SOD levels were significantly lower in the SDA group (P = 0.018). (4) Inflammatory response: compared with the SD group, the SDA group showed markedly reduced levels of TNF-α,IL-1β and IL-6 (P = 0.017, 0.006, and 0.007, respectively). (5) Histopathological findings: compared to the SD group, the SDA group demonstrated greater preservation of neurons and a reduction in glial cells in the hippocampal CA1 region.

Conclusion: Acupuncture can ameliorates cognitive impairment induced by acute SD, potentially through pathways involving HPA axis-mediated oxidative stress and inflammatory responses.