调神针法对慢性乙型肝炎患者腹泻型IBS(肝郁脾虚证)疗效及血浆SP、VIP的影响

Tiaoshen acupuncture for diarrhea type IBS in patients with chronic hepatitis B(liver stagnation and spleen deficiency syndrome): Curative effect and influence on plasma SP and VIP

目的:研究调神针法对慢性乙型肝炎患者腹泻型肠易激综合征(irritable bowel syndrome,IBS)(肝郁脾虚证)疗效及血浆P物质(substance P,SP)、血管活性肠肽(vasoactive intestinal peptide,VIP)的影响.方法:将108例入组病例随机分到治疗组及对照组,各为54例.治疗组给予真刺头针胃区(双)和头针肠区(双),假刺天枢(双)、足三里(双)、太冲(双)治疗;对照组给予真刺天枢(双)、足三里(双)、太冲(双),假刺头针胃区(双)和头针肠区(双)治疗.疗程均为4 wk.观察中医证候积分、中医证候疗效及血浆SP、VIP水平.结果:共有96例(治疗组49例)患者完成4wk的研究.临床证候疗效方面治疗组总有效率优于对照组[89.80%(44/49)vs65.96%(31/47),P<0.05].疗程结束后治疗组、对照组中医证候积分均较治疗开始前明显降低[(26.4±3.6)vs(8.5±1.8);(25.3±2.5)v s(15.6±2.7)],差异均有统计学意义(P<0.05).治疗后治疗组中医证候积分下降幅度比对照组大[(8.5±1.8)vs(15.6±2.7)],差异均有统计学意义(P<0.05).疗程结束后治疗组、对照组血浆SP、VIP水平均较治疗开始前明显降低:两组SP:[(43.68±15.15)vs(22.08±11.47);(45.24±15.07)vs(34.52±14.76)];两组VIP:[(38.44±13.57)vs(16.31±13.72);(37.13±10.19)vs(25.47±12.75)],差异均有统计学意义(P<0.05).治疗后治疗组SP、VIP水平下降幅度均较对照组大[(22.02±11.47)vs(33.52±14.76);(16.31±13.72)vs(25.47±12.75)],差异均有统计学意义(P<0.05).本研究中治疗组、对照组均未发现不良反应病例及血清学转换患者.结论:调神针法可显著提高慢性乙型肝炎患者腹泻型IBS(肝郁脾虚证)疗效,且优于传统针灸疗法;调神针法可通过影响血浆SP、VIP含量进而通过调节脑-肠轴改善慢性乙型肝炎患者腹泻型IBS(肝郁脾虚证)临床症状.

AIM： To assess the curative efficacy of Tiaoshenacupuncture for diarrhea type irritable bowel syndrome（IBS） in chronic hepatitis B（CHB） patients（liver stagnation and spleen deficiency syndrome） and its impact on serum levels of substance P（SP） and vasoactive intestinal peptide（VIP）. METHODS： One hundred and eight patients were randomly assigned to two groups（a treatment group and a control group） to receive both acupuncture and sham acupuncture treatment for 4 wk. The treatment group received acupuncture at gastric area and intestinal area of scalp acupuncture, and sham acupuncture at Tianshu, Zusanli, and Taichong. The control group were acupunctured at Tianshu, Zusanli, and Taichong, and shamacupunctured at gastric area and intestinal area of scalp acupuncture. Traditional Chinese medicine（TCM） syndrome curative efficacy, TCM syndrome scores and serum levels of SP and VIP were evaluated before and after therapy. RESULTS： A total of 96 patients（including 49 in the treatment group） completed the four-week study. Clinical curative effect in the treatment group was significantly better than that in the control group [89.80%（44/49） vs 65.96%（31/47）, P〈0.05]. Compared with pretreatment values, TCM syndromes of both groups after treatment were decreased significantly [（26.4 ± 3.6） vs（8.5 ± 1.8）;（25.3 ± 2.5） vs（15.6 ± 2.7）], while the treatment group showed a more significant decrease compared with the control group [（8.5 ± 1.8） vs（15.6 ± 2.7）, P〈0.05]. After treatment, serum levels of SP and VIP in the two groupsdecreased significantly [SP：（43.68 ± 15.15） vs（22.08 ± 11.47）; VIP：（45.24 ± 15.07） vs（34.52 ± 14.76）], and the decrease was more significant in the treatment group [SP：（38.44 ± 13.57） vs（16.31 ± 13.72）; VIP：（37.13 ± 10.19） vs（25.47 ± 12.75）, P〈0.05]. There were no adverse reactions or seroconversion in the study.CONCLUSION： Tiaoshen acupuncture has a better clinical efficacy in CHB patients with diarrhea type IBS（liver stagnation and spleen deficiency syndrome） than traditional acupuncture treatment. Tiaoshen acupuncture may alleviate syndromes of CHB patients with diarrhea type IBS by altering serum levels of SP and VIP and thereby modulating intestinebrain responses.