基于代谢组学的电针与伊托必利治疗功能性消化不良的比较研究

Metabonomic Based Comparison Study on Functional Dyspepsia Treated with Electro-acupuncture and Itopride

目的:采用基于核磁共振(1H nuclear magnetic resonance,NMR)技术的代谢组学方法比较针刺阳明经穴与伊托必利对功能性消化不良(Functional Dyspepsia,FD)患者血浆代谢物的影响,从代谢组学角度探讨针灸治疗FD的原理及其与西药作用机制的差异。方法:16例FD女性患者分为电针治疗组和西药治疗组,同时设立健康正常对照组10例。电针组采用足阳明胃经的冲阳、丰隆、足三里、梁丘进行治疗,西药组服用伊托必利,连续治疗4个疗程。运用NDI(Nepean Dyspepsia Index)量表评价临床疗效;分别获取治疗前1天、治疗1个疗程和治疗4个疗程后所有受试者的空腹血浆样本,采用1HNMR检测,运用主成分分析和正交偏最小二乘判别分析等模式识别方法分析所得数据。结果:NDI量表显示电针及西药治疗FD均有效,但针灸在提高患者生活质量方面优于西药组。代谢组学结果表明,电针或西药治疗1个疗程均可以使患者血浆代谢水平向正常组恢复,但治疗4个疗程后针灸组主要使患者体内乳酸、葡萄糖和乙酰乙酸的含量提高,西药组则主要表现为降低胆碱、亮氨酸/异亮氨酸的水平。两种治疗方式对患者血浆内大分子的影响基本一致。结论:代谢组学研究结果提示,循经取穴治疗功能性消化不良的机制与伊托必利不同,这可能是针灸与西药治疗功能性消化不良在疗效上出现差异的机理所在。

Objective：To compare the different mechanism between electreo-acupuncture（EA）and Itopride in treating Functional Dyspepsia（FD）based on 1H nuclear magnetic resonance（NMR） metabonomic technique.Methods：16 functional dyspepsia female patients were divided into EA group and Itopride group,the NDI（Nepean Dyspepsia Index） scale was used to evaluate the clinical efficacy.Plasma were obtained and detected by NMR,Data from NMR spectrometer were then subjected to principal components analysis（PCA） and OSC-PLS-DA（orthogonal signal correction and partial least squares discriminant analysis）.Results：NDI scale displayed both EA and western medicine were efficacy.However,EA was better than Itopride in improving the patient life quality.Metabolomics results showed that both EA and the western medicine may make metabolic level in patients close to the normal group after 5 d treatment.After 20 d treatment,patients in EA group had higher level of lactic acid,glucose and acetoacetate,western group was mainly manifested in the lower level of choline,leucine / isoleucine.The macromolecules in both groups were almost the same.Conclusion：The metabonomics study suggests that in treating FD,acupuncture and Itopride have different mechanisms,which may be the basis of their discrepancies in clinic efficacy.