针刺对便秘型肠易激综合征患者血浆5-HT、NPY和CGRP的影响
Influence of Acupuncture on Plasma 5-HT， NPY and CGRP in Patients with Constipation-predominant Irritable Bowel Syndrome
-
摘要: 目的 观察针刺对便秘型肠易激综合征（IBS-C）患者血浆中5-羟色胺（5-HT）、神经肽Y（NPY）和降钙素基因相关肽（CGRP）水平的影响，从脑-肠轴的角度阐述针刺治疗IBS-C的效应机制。方法 60例IBS-C患者随机分为针刺组和西药组。针刺组30例，予针刺治疗，取天枢、足三里、上巨虚、太冲、三阴交、印堂、百会，每日1次，每周5次，4周为1个疗程；西药组30例，予口服乳果糖口服溶液，15 mL每次，每日3次，4周为1个疗程。观察2组治疗前后临床症状改善情况。同时采集2组患者治疗前后及30名健康志愿者外周静脉血，采用Elisa法检测患者血浆中的5-HT、CGRP和NPY的水平，探讨针刺对IBS-C患者血浆5-HT、NPY和CGRP的影响。结果 ①针刺及西药均能显著改善IBS-C患者的临床症状（P<0.01），针刺组疗效均优于西药组（P<0.01）。②2组IBS-C患者血浆5-HT、NPY和CGRP水平均明显高于健康志愿者，差异有统计学意义（P<0.01）。治疗后2组IBS-C患者血浆5-HT、NPY和CGRP水平均下降，针刺组患者血浆5-HT、NPY和CGRP水平较治疗前有显著差异（P<0.01）；西药组患者血浆5-HT、NPY水平较治疗前也有显著差异（P<0.01），CGRP水平与治疗前比较无统计学意义（P>0.05）。2组治疗后组间比较血浆5-HT、NPY无统计学差异（P>0.05），血浆CGRP有统计学差异（P<0.01），针刺组下降趋势优于西药组。结论 ①针刺可显著改善IBS-C患者的临床症状，疗效均优于西药组。②IBS-C患者血浆5-HT、NPY和CGRP水平均升高，说明脑肠肽水平异常与IBS-C症状密切相关。③针刺能明显降低患者血浆5-HT、NPY和CGRP水平，缓解腹痛与腹部不适程度，表明针刺对IBS-C患者血浆脑肠肽水平的良性调控作用可能是其治疗本病的效应机制之一。Abstract: OBJECTIVE To explore the acupuncture treatment mechanism of constipation-predominant irritable bowel syndrome(IBS-C) from the perspective of brain-gut axis， by observing the plasma 5HT， CGRP and NPY level before and after the treatment. METHODS 60 patients with IBS-C were randomly divided into two groups. 30 cases in the acupuncture group(AG) were treated by acupuncture five times a week， with such acupoints as Tianshu， Zusanli， Shangjuxu， Taichong， Sanyinjiao， Yintang， Baihui being selected. The other 30 cases in the medicine group(MG) were treated with lactulose oral solution， 15 ml per time for three times a day. After 4 weeks treatment， enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma 5HT， NPY and CGRP level of 30 healthy volunteers and the two treatment groups and observe the improvement of clinical symptoms. RESULTS ①Both groups could significantly improve the clinical symptoms in patients with IBS-C (P<0.01)，while the curative effect in the AG was superior to that in the MG (P<0.01). ②The levels of 5-HT， NPY and CGRP in patients with IBS-C of two treatment groups were significantly higher than those in healthy volunteers， and the difference was statistically significant (P<0.01). The plasma 5-HT， NPY and CGRP levels all went down in both groups after treatment， and the differences of 5-HT， NPY and CGRP levels were significant when compared to the levels before treatment in AG(P<0.01). The differences of 5-HT，NPY levels were also significant when compared to the levels before treatment in MG(P<0.01)， while there was no significant difference on CGRP(P<0.01). There were no significant differences of 5-HT and NPY levels between these two groups after treatment (P>0.05)， but the difference of CGRP was highly statistically significant(P<0.01). The downward trend of 5-HT，NPY and CGRP level was better in the AG. CONCLUSION ①Acupuncture treatment can significantly improve the clinical symptoms in patients with IBS-C， and the theraputic effect is superior to that in the MG. ②The increase of 5-HT， NPY and CGRP level in patients with IBS-C after treatment suggests a close relationship between the abnormal level of brain-gut peptide and IBS syndrome. ③Acupuncture treatment can decrease the plasma levels of 5-HT， NPY and CGRP， alleviate the degree of abdominal pain and discomfort， which indicates that benign regulation of brain-gut peptide level in patients with IBS-C by acupuncture may be one of the effective mechanisms in treatmenting this disease.
-
Keywords:
- acupuncture /
- IBS-C /
- 5-HT /
- NPY /
- CGRP
-
-
[1] 胡品津．从脑-肠互动的高度认识肠易激综合征[J]．中华消化杂志，2003， 23（5）：261-262． [2] Hu PJ. From the height of brain-gut interaction to understand irritable bowel syndrome[J]. Chin J Dig， 2003， 23(5): 261-262. [3] 中华医学会消化病学分会胃肠动力学组.肠易激综合征诊断和治疗的共识意见[J]. 中华消化杂志，2008，28(1):38-40. [4] Gastrointestinal Dynamics Group， Gastroenterology Branch of Chinese Medical Association. Consensus on the dignosis and treatment of irritable bowel syndrome[J]. Chin J Dig， 2008，28(1):38-40. [5] 中药新药临床指导研究原则[M]．北京：中国医药科技出版社，2002：139-143． [6] Guidance Principal of Clinical Study on Traditional Chinese Medicine[M]. Beijing: Chinese medical science and technology press， 2002:139-143. [7] Okumura T. Brain-gut interaction in the pathophysiology of IBS[J]. Nihon Shokakibyo Gakkai Zasshi， 2014， 111(7):1334-1344. [8] 詹丽杏，许国铭，李兆申，等．肠易激综合征患者活动期和缓解期血浆5-HT、5-HIAA的变化[J]．第二军医大学学报，2003， 24（2）：152-154． [9] Zhan LX， Xu GM， Li ZS，et al. Plasma 5-HT，5-HIAA changes in patients with irritable bowel syndrome at active stage and remission stage[J]. Acad J Second Mil Med Univ， 2003， 24(2): 152-154. [10] 杨倩，邱贝，马赟，等．便秘型肠易激综合征大鼠肠组织中5-HT的实验研究[J]．中医临床研究，2014， 30（30）：35-37． [11] Yang Q， Qiu B， Ma Y， et al. Experimental study of 5-HT in intestinal tissues of rats with constipation predominant irritable bowel syndrome[J]. Clin J Chin Med， 2014， 30(30): 35-37. [12] Husum H， Van Kammen D， Termeer E， et al. Topiramate normalizes hippocampal NPY-LI in flinders sensitive line 'depressed' rats and upregulates NPY， galanin， and CRH-LI in the hypothalamus: implications for mood-stabilizing and weight loss-inducing effects[J]. Neuropsychopharmacology， 2003， 28(7): 1292-1299. [13] 王巍峰，杨云生，孙刚，等．肠易激综合征大鼠模型脊髓后角神经递质表达的改变[J]．胃肠病学和肝病学杂志，2006， 15（4）：405-408． [14] Wang WF， Yang YS， Sun G， et al. Expressions of several neurotransmitters on the posterior horn of spinal cord in the rat model of irritable bowel syndrome[J]. Chin J Gastroenterol Hepatoli， 2006， 15(4): 405-408. [15] 裴丽霞，孙建华，夏晨，等．针灸治疗腹泻型肠易激综合征肝郁脾虚证临床研究[J]．南京中医药大学学报，2012， 28（1）：27-29． [16] Pei LX， Sun JH， Xia C， et al. Clinical evaluation of acupunture in treating IBS-D belonging to liver depression and spleen defeciency syndrome[J]. J Nanjing Univ Tradit Chin Med， 2012， 28(1): 27-29. [17] 邱学梅，陈少宗．针灸治疗肠易激综合征的取穴组方规律与经验分析[J]．针灸临床杂志，2013， 29（5）：48-50． [18] Qiu XM， Chen SZ. Analysis of acupoints selection and formula rules of irritable bowel syndrome treated by acupuncture and moxibustion[J]. J Clin Acupunct Moxib， 2013， 29(5): 48-50. [19] 灵枢经[M]．北京：人民卫生出版社，1963：123． [20] Classic of Miraculous Pivot[M]. Beijing: People's medical publishing house， 1963:123. [21] 杨继渊．针灸大成[M]．北京：中国中医药出版社，2011：272． [22] Yang JZ. Compendium of Acupuncture and Moxibustion[M]. Beijing: Chinese press of traditional Chinese medicine， 2011:272.
计量
- 文章访问数: 1047
- HTML全文浏览量: 6
- PDF下载量: 1228
下载:
