针刺联合小儿推拿对抽动障碍患儿肠道菌群的影响

Effect of acupuncture combined with infantile tuina on intestinal flora in children with tic disorders

目的:观察针刺联合小儿推拿治疗抽动障碍(TD)患儿的疗效及对肠道菌群的影响,探讨其作用机制。方法:招募15例TD患儿作为观察组,10例健康儿童作为健康对照组。观察组接受调和脾胃针刺联合小儿推拿治疗,先于中脘、天枢、关元、合谷、足三里等穴针刺,再予摩腹等推拿手法,均每日1次,每周6次,2周为一疗程,共治疗2个疗程。健康对照组不予任何干预。治疗前及治疗1、2个疗程后,比较观察组耶鲁综合抽动严重程度量表(YGTSS)、中医证候评分。采用16S rRNA测序技术检测健康对照组及治疗前后观察组肠道菌群。结果:治疗1、2个疗程后,观察组YGTSS、中医证候评分较治疗前降低(P<0.01,P<0.05)。观察组治疗前较健康对照组操作分类单元(OTU)数量减少,Chao1、Sobs、Ace、Shannon指数降低(P<0.05,P<0.01);与治疗前比较,观察组治疗后OTU数量增加,Chao1、Sobs、Ace、Shannon指数升高(P<0.01,P<0.05)。与健康对照组比较,观察组治疗前厚壁菌门相对丰度降低(P<0.001),拟杆菌门、拟杆菌属、多枝梭菌属相对丰度升高(P<0.001,P<0.05)。与治疗前比较,观察组治疗后拟杆菌门相对丰度降低(P<0.001),放线菌门、双歧杆菌属、阿托波菌属相对丰度升高(P<0.05,P<0.01)。结论:以调和脾胃为治则的针刺联合小儿推拿治疗可有效改善儿童TD症状,其机制可能为通过调节肠道菌群多样性,增加有益菌,维持肠道微生态平衡,发挥改善神经精神障碍作用。

Objective To observe the effect of acupuncture combined with infantile tuina on intestinal flora and its efficacy in children with tic disorders(TD),and to explore its mechanism.Methods A total of 15 children with TD were recruited as an observation group and 10 healthy children as a healthy control group.Regulating spleen and stomach acupuncture combined with infantile tuina were received in the observation group.First,acupuncture was applied to Zhongwan(CV 12),Tianshu(ST 25),Guanyuan(CV 4),Hegu(LI 4),Zusanli(ST 36),etc.,and then abdominal massage and other tuina techniques were applied,once a day,6 times a week,2 weeks as a course of treatment,a total of 2 courses of treatment were required.No intervention was given in the healthy control group.In the observation group,Yale global tic severity scale(YGTSS)score and TCM syndrome score were compared before treatment and after 1 and 2 courses of treatment.16S rRNA sequencing technology was used to detect the intestinal flora in the healthy control group and before and after treatment in the observation group.Results After 1 and 2 courses of treatment,the scores of YGTSS and TCM syndrome in the observation group were lower than those before treatment(P<0.01,P<0.05).Compared with the healthy control group,the number of operational taxonomic units(OTU)and indexes of Chao1,Sobs,Ace and Shannon were decreased in the observation group before treatment(P<0.05,P<0.01).Compared with before treatment,the number of OTU and indexes of Chao1,Sobs,Ace and Shannon were increased in the observation group after treatment(P<0.01,P<0.05).Compared with the healthy control group,the relative abundance of Firmicutes in the observation group before treatment was decreased(P<0.001),while the relative abundance of Bacteroidetes,Bacteroides and Erysipelatoclostridium was increased(P<0.001,P<0.05).Compared with before treatment,the relative abundance of Bacteroidetes in the observation group was decreased(P 0.001)after treatment,while the relative abundance of Actinobacteria,Bifidobacterium and Atopobium was increased(P<0.05,P<0.01).Conclusion Acupuncture combined with infantile tuina based on the principle of regulating spleen and stomach could effectively improve TD symptoms in children,which may be related to regulating the diversity of intestinal flora,increasing beneficial bacteria,maintaining intestinal microecological balance,and playing a role in improving neurological disorders.