脐针治疗腹泻型肠易激综合征疗效及对脑肠肽的影响

Umbilicus acupuncture for treatment of diarrhea-type irritable bowel syndrome:Efficacy and impact on brain-gut peptides

背景肠易激综合征(irritable bowel syndrome,IBS)的发生与脑-肠轴失调相关.脐针具有缓解痉挛,治疗腹泻的作用.我们假设:腹泻型肠易激综合征(diarrhea-type irritable bowel syndrome,IBS-D)存在脑肠肽分泌紊乱,脐针通过调控脑肠肽分泌改善IBS患者症状.目的探讨脐针治疗IBS-D患者的临床疗效及其对血清脑肠肽的影响.方法60例患者符合罗马Ⅳ制定的IBS-D的诊断标准,单盲随机分为2组:脐针组30例,予脐针;益生菌组30例,予地衣芽孢杆菌胶囊治疗,疗程均4周.同时征集30名健康志愿者作基线检测对照.观察2组患者治疗前后的临床症状评分,SF-36量表评分,汉密尔顿抑郁量表(hamilton depression scale,HAMD)及汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)评分,血清5-羟色胺(5-hydroxytryptamine,5-HT),降钙素基因相关肽(calcitonin gene-related peptide,CGRP),P物质(substance P,SP),一氧化氮(nitricoxide,NO),血管活性肠肽(vasoactive intestinal peptide,VIP)含量的变化.试验过程中无一例出现不良反应.结果治疗后脐针组及益生菌组的临床症状评分明显低于治疗前(P=0.000);治疗后脐针组及益生菌组SF-36量表评分明显高于治疗前(P=0.000),HAMD及HAMA评分明显低于治疗前(P=0.000);治疗后脐针组及益生菌组患者血清5-HT,CGRP,SP,NO,VIP含量显著下降(P<0.0001).结论脐针能有效改善IBS-D患者的临床症状及心理精神状态,提高生活质量,其作用机制可能通过降低5-HT,CGRP,SP,NO,VIP水平,调节脑肠肽分泌相关.其治疗效果与益生菌制剂相当.

BACKGROUND Irritable bowel syndrome(IBS)is associated with braingut axis disorder.Umbilicus acupuncture has the effect of relieving cramps and treating diarrhea.We hypothesized that diarrhea-type irritable bowel syndrome(IBS-D)has a disorderd secretion of brain-gut peptides,and umbilicus acupuncture can improve the symptoms of IBS-D patients by regulating brain-gut peptide secretion.AIM To investigate the efficacy of umbilical acupuncture in patients with IBS-D and its effect on serum brain-gut peptides.METHODS Sixty patients who met the Rome IV diagnostic criteria for IBS-D were randomly divided into two groups in a single-blined manner:30 patients who underwent umbilical acupuncture were included in an acupuncture group and 30 patients who were treated with bacillus licheniformin capsules were included in a probiotic group.The course of treatment was 4 weeks.Thirty healthy volunteers served as baseline controls.The changes of clinical symptom scores,SF-36 scale scores,Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)scores,serum brain-gut peptides[5-hydroxytryptamine(5-HT),calcitonin gene-related peptide(CGRP),substance P(SP),nitric oxide(NO),and vasoactive intestinal peptide(VIP)]after treatment were recorded.Adverse reactions were also recorded.RESULTS The clinical symptom scores after treatment in the two groups were significantly lower than those before treatment(P=0.000).SF-36 scores of the two groups were significantly higher,while HAMD and HAMA scores were signficantly lower than those before treatment(P=0.000).After treatment,the levels of 5-HT,CGRP,SP,NO,and VIP in the two groups decreased significantly(P<0.0001).No adverse reactions occurred in either group.CONCLUSION Umbilical acupuncture can significantly improve the clinical symptoms and mental state of patients with IBS-D via mechanisms that may be related to regulating the secretion of 5-HT,CGRP,SP,NO,and VIP.Its therapeutic effect is equal to that of probiotics.