电针改善功能性消化不良胃动力、自主神经功能及心理状态

Electroacupuncture improves gastric motility,autonomic nerve activity and psychological state in patients with functional dyspepsia

目的:评价电针刺激内关和足三里对功能性消化不良的治疗价值,并探讨其可能所包含的机制.方法:符合罗马Ⅱ诊断标准的功能性消化不良患者40例,随机分为治疗组和对照组,每组20例.治疗组用电针刺激内关和足三里,对照组口服多潘立酮;观察2组治疗前后患者的消化不良症状、焦虑抑郁评分、心率变异性和胃电图,并且抽血检测神经肽Y和胃动素的水平.结果:治疗组和对照组治疗后,消化不良症状均明显改善(P<0.05).治疗组患者的焦虑抑郁状态明显改善.电针治疗后与治疗前相比,HF显著增加(0.08±0.02vs0.02±0.01,P<0.05),LF/HF显著降低(0.87±0.14vs1.35±0.15,P=0.02);而药物治疗前后,HF和LF/HF均无明显改变.治疗组和对照组治疗后,胃电图主频和正常慢波百分比均明显改善(P<0.05).电针治疗后神经肽Y的含量明显增加(88.80±7.16vs68.82±7.15,P<0.05),而胃动素的含量亦明显增加(163.20±11.52vs145.22±11.15,P<0.05).而经过药物治疗后,胃动素的含量增加,但神经肽Y的含量无明显改变.结论:电针刺激内关和足三里对功能性消化不良的治疗作用可能与神经肽Y和胃动素的调节有关.

AIM： To evaluate the therapeutic value of electroacupuncture at acupoints, and to explore the possible mechanism involved. METHODS： Forty patients with functional dyspepsia （FD） who fulfilled the Rome II criteria were randomly assigned to the treatment group （n = 20） and control group （n = 20）. The treat- ment group was treated with electroacupuncture at acupoints （Neiguan and Zusanli）, while patients in control group took Cisapride orally. The dyspepsia symptoms, self-rating anxiety and depress scale （SADS）, electrogastrogram and heart rate variability were recorded before and after treatment. Blood samples were also taken to detect NPY and Motilin levels. RESULTS： The dyspepsia symptom scores were significantly improved at the end of treatment both in treatment group and control group （P 〈 0.05）. Through the acupuncture treatment, the depression-anxiety state was significantly improved. The HF was markedly increased and LF/HF was decreased in the treatment group （0.08 ± 0.02 vs 0.02 ± 0.01, 0.87 ± 0.14 vs 1.35 ± 0.15, both P 〈 0.05） after treatment, but there was little change in the control group. Gastro- electric frequency and the normal percentage of gastric slow waves in treatment group and control group were improved more significantly than before （P 〈 0.05）. The plasma levels of NPY and motilin were increased after the electroacupuncture treatment （88.80 ± 7.16 vs 68.82 ± 7.15, 163.20 ± 11.52 vs 145.22 ± 11.15, both P 〈 0.05）. Plasma level of motilin was increased after the Cisapride treatment, but no change occurred to NPY in the control group. CONCLUSION： Electroacupuncture at acupoints （Neiguan and Zusanli） is capable of improving dyspepsia symptoms, depression state, and gastric motility, and relieving anxiety and increasing vagal activity. These may be associated with the modulation of NPY and motility.