不同频率提插针刺手法对功能性消化不良上腹痛综合征疗效及血清胃运动相关激素影响的研究

Study on the Effects of Lifting-inserting Acupuncture Manipulations with Different Frequencies on the Epigastric Pain Syndrome and Serum Gastric Motion-related Hormones in Functional Dyspepsia Patients

[目的]观察不同频率提插针刺手法对功能性消化不良上腹痛综合征疗效及血清胃运动相关激素的影响。[方法]选取2018年2月至2019年12月于浙江中医药大学附属第一医院和天津市南开医院针灸科门诊就诊的功能性消化不良上腹痛综合征患者114例,随机平行分为3组,即60次/min、120次/min和180次/min提插手法组。每组患者分别给予不同频率提插针刺手法治疗2个疗程。在治疗前、治疗后及随访期(治疗结束后8周)对各组的临床疗效进行评价,指标包括中国版尼平消化不良指数评分、健康相关生活质量评分,同时对患者治疗前后抑郁自评量表和焦虑自评量表评分,以及血清胃动素、胃泌素、胃促生长素的水平进行比较。[结果]3种不同频率提插针刺手法治疗2个疗程后,患者尼平消化不良指数评分、健康相关生活质量评分、抑郁自评量表和焦虑自评量表评分较治疗前均显著改善(P<0.05),并且治疗结束后8周针刺治疗效果依然显著(P<0.05)。同时2个疗程后,患者血清中胃动素、胃促生长素水平均有不同程度升高(P<0.05),而胃泌素水平显著下降(P<0.05)。组间比较发现,120次/min、180次/min提插手法组临床治疗效果及其对血清胃动素、胃促生长素水平的调节效应总体优于60次/min提插手法组(P<0.05)。3组患者治疗期间均未出现明显不良事件。[结论]在固定选穴的基础上,相比于低频刺激手法(60次/min提插手法),中高频刺激手法(120、180次/min提插手法)治疗功能性消化不良上腹痛综合征疗效更佳,其作用机制可能与针刺调节血清胃动素、胃促生长素水平有关。

[Objective]To investigate the effects of lifting-inserting acupuncture manipulations with different frequencies on the epigastric pain syndrome(EPS)and serum gastric motion-related hormones in functional dyspepsia(FD)patients.[Methods]One hundred and fourteen FD patients with EPS from February 2018 to December 2019 treated in Outpatient Department of Acupuncture at the First Affiliated Hospital of Zhejiang Chinese Medical University and Tianjin Nankai Hospital,were randomly allocated into 3 lifting-inserting acupuncture manipulation groups,separately with frequency of 60 times/min,120 times/min or 180 times/min.All groups were received acupuncture treatment for 2 courses.The outcomes of the study included dyspeptic symptoms(evaluated by Nepean Dyspepsia Symptom Index before,after treatment and at follow-up time point),quality of life(evaluated by Nepean Dyspepsia Life Quality Index and 36-Item Short Form Health Survey before,after treatment and at follow-up time point),mental status(evaluated by self-rating depression scale and self-rating anxiety scale before and after treatment),level of serum gastrin,motilin and ghrelin.[Results]After treatment and at follow-up time point,the dyspeptic symptoms relieved and the quality of life in all the groups was improved compared with before treatment(P<0.05),and the mental status in all the groups after treatment were also improved compared with before treatment(P<0.05).And after treatment,the serum motilin and ghrelin concentration in all the groups increased compared with before treatment(P<0.05),but the serum gastrin concentration decreased(P<0.05).The clinical effects of groups with frequency of 120 or 180 times/min were better than the group with frequency of 60 times/min.The modulatory effects of acupuncture manipulation groups separately with frequencies of 120 times/min or 180 times/min on the level of motilin and ghrelin were better than the group with frequency of 60 times/min(P<0.05).No significant adverse safety events occurred in the 3 groups during treatment.[Conclusion]Acupuncture manipulation with medium and high frequency stimulation(lifting-inserting manipulation with frequency of 120 or 180 times/min)could improve EPS in FD patients better than low frequency stimulation(lifting-inserting manipulation with frequency of 60 times/min).The possible mechanism may be that the manipulation with strong stimulus could regulate the level of serum motilin and ghrelin better.