耳穴揿针治疗对剖宫产初产妇泌乳功能及TDP-43/Btn1A1/XDH通路的影响

Effects of auricular thumbtack needle on lactation function and TDP-43/Btn1A1/XDH pathway in primiparous women with cesarean section

目的:观察耳穴揿针治疗对剖宫产初产妇母乳喂养及泌乳功能的影响,并从乳脂分泌相关基因角度探讨其作用机制。方法:将100例剖宫产初产妇随机分为观察组(50例,脱落3例)和对照组(50例,剔除2例)。对照组予产科常规护理;观察组在对照组基础上,给予耳穴揿针治疗1次,穴取内分泌、胸、胸椎、神门、交感等,取一侧耳穴,共持续3 d。比较两组初产妇治疗后泌乳启动时间、产后72 h泌乳充足率、产后42 d纯母乳喂养率、母乳喂养评分;实时荧光定量PCR法、Western blot法检测两组初产妇治疗后乳汁反式激活应答DNA结合蛋白(TDP-43)、嗜乳脂蛋白亚家族1成员A1(Btn1A1)、黄嘌呤脱氢酶(XDH)的mRNA及蛋白表达。结果:治疗后,观察组泌乳启动时间早于对照组(P<0.01),母乳喂养评分高于对照组(P<0.01);观察组产后72 h泌乳充足率为63.8%(30/47),高于对照组的41.7%(20/48,P<0.05);观察组产后42 d纯母乳喂养率为72.3%(34/47),高于对照组的47.9%(23/48,P<0.05)。观察组乳汁TDP-43、Btn1A1 mRNA及蛋白表达高于对照组(P<0.01);两组乳汁XDH mRNA及蛋白表达比较差异无统计学意义(P>0.05)。结论:在常规护理基础上,加用耳穴揿针治疗可以提前启动剖宫产初产妇泌乳,提高产后泌乳充足率及产后纯母乳喂养率,其作用机制可能与上调TDP-43、Btn1A1表达有关。

Objective To observe the effects of auricular thumbtack needle on breast feeding and lactation function in primiparous women with cesarean section,and to explore its mechanism of action from the perspective of lactation-related gene expression.Methods One hundred cases of primiparous women with cesarean section were randomly divided into an observation group(50 cases,3 cases dropped off)and a control group(50 cases,2 cases were eliminated).The patients in the control group were treated with routine obstetric care.Based on the treatment of the control group,the patients in the observation group were treated with auricular thumbtack needle at Neifenmi(COis),Xiong(AHio),Xiongzhui(AHin),Shenmen(TF4),and Jiaogan(AHo),etc.,with one side of auricular point selected,only once for a total of 3 d.The lactation initiation time,lactation adequacy rate at postpartum 72 h,exclusive breasfeeding rate at postpartum 42 d,and breastfeeding score after treatment were compared between the two groups.Real-time quantitative PCR and Western blot method were used to detect the mRNA and protein expression levels of TDP-43,BtnlA1 and XDH.Results After treatment,the lactation initiation time in the observation group was earlier than that in the control group(P<0.01),and breastfeeding score in the observation group was higher than that in the control group(P<0.01).The lactation adequacy rate at postpartum 72 h was 63.8%(30/47)in the observation group,which was higher than 41.7%(20/48)in the control group(P<0.05).The exclusive breastfeeding rate at postpartum 42 d was 72.3%(34/47)in the observation group,which was higher than 47.9%(23/48)in the control group(P<0.05).The mRNA and protein expression levels of TDP-43 and Btn1A1 in breast milk in the observation group were higher than those in the control group(P<0.01),while there was no statistically significant diference in mRNA and protein expression of XDH in breast milk between the two groups(P>0.05).Conclusion The auricular thumbtack needle in addition to routine care could promote lactation initiation,improve lactation adequacy rate and exclusive breastfeeding rate in primiparous women with cesarean section,and the action mechanism may be related to up-regulation of TDP-43 and BtnlA1 expression.