电针辅以养血滋阴法对功能性便秘患者肠道神经递质、短链脂肪酸的影响

Effects of Electroacupuncture Combined with Nourishing Blood and Enriching Yin on Intestinal Neurotransmitters and Short Chain Fatty Acids in Patients with Functional Constipation

目的研究电针辅以养血滋阴法对功能性便秘患者肠道神经递质、短链脂肪酸的影响。方法选取2018年2月至2019年2月在秦皇岛市中医医院接受治疗的162例功能性便秘患者作为研究对象,根据治疗方法不同分为养血滋阴组(采用养血滋阴法治疗)和养血滋阴联合电针组(采用电针辅以养血滋阴法治疗),每组81例。比较两组排便情况(排便频率和排便时间),肠道神经递质(P物质、一氧化氮)及胃肠激素(胃泌素、胃动素)水平,短链脂肪酸水平(短链脂肪酸含量、短链脂肪酸浓度),中医证候评分(脘腹胀满评分、欲便不畅评分)、临床疗效及并发症。结果治疗前,两组排便频率、排便时间、P物质、一氧化氮、短链脂肪酸含量、短链脂肪酸浓度、胃泌素、胃动素、脘腹胀满、欲便不畅评分比较差异均无统计学意义(P>0.05)。治疗后,两组排便频率、短链脂肪酸含量以及P物质、胃泌素、胃动素水平均高于治疗前,排便时间、一氧化氮水平、短链脂肪酸浓度、脘腹胀满和欲便不畅评分均低于治疗前(P<0.05),且养血滋阴联合电针组排便频率、短链脂肪酸含量以及P物质、胃泌素、胃动素水平均高于养血滋阴组[(6.14±0.90)次/周比(4.16±1.19)次/周、(52.17±13.14)mg/g比(35.21±11.24)mg/g、(41.37±9.26)ng/L比(26.28±6.24)ng/L、(42.15±10.57)ng/L比(32.15±7.45)ng/L、(294.71±51.42)ng/L比(216.47±35.42)ng/L](P<0.01),排便时间、一氧化氮水平、短链脂肪酸浓度、脘腹胀满和欲便不畅评分低于养血滋阴组[(14.11±2.12)min比(23.46±6.23)min、(72.41±15.01)mmol/L比(94.36±18.29)mmol/L、(40.10±12.14)mg/L比(64.26±18.10)mg/L、(20.10±7.12)分比(29.44±10.42)分、(24.15±8.24)分比(32.14±10.21)分](P<0.01)。养血滋阴联合电针组治疗总有效率高于养血滋阴组[96.29%(78/81)比87.65%(71/81)](χ^(2)=4.098,P=0.043)。养血滋阴联合电针组的并发症发生率低于养血滋阴组[4.93%(4/81)比14.81%(12/81)](P<0.05)。结论电针辅以养血滋阴法治疗可提高功能性便秘患者排便频率、缩短排便时间,改善肠道神经递质、短链脂肪酸水平,缓解临床症状,且并发症少,疗效较好。

Objective To study the effect of the electroacupuncture supplemented by blood nourishing method on intestinal neurotransmitter and short chain fatty acids in patients with functional constipation.Methods A total of 162 functional constipation patients who were treated in Qinhuangdao Hospital of Traditional Chinese Medicine(TCM)from Feb.2018 to Feb.2019 were included.According to the treatment methods,they were divided into a blood nourishing yin enriching group(treated by blood nourishing yin enriching method)and a blood nourishing yin enriching combined with electroacupuncture group(treated by blood nourishing yin enriching method),with 81 cases in each group.The defecation status(defecation frequency and defecation time),intestinal neurotransmitter(P substance,nitric oxide)and gastrointestinal hormone(gastrin,motilin)level,short chain fatty acid level(short chain fatty acid,short chain fatty acid concentration),TCM syndrome score(abdominal fullness and distension score,"desire to defecate but poor defecation"score),complications and clinical curative effect of the two groups were compared.Results Before treatment,there were no significant differences in the scores of defecation frequency,defecation time,substance P,nitric oxide,short chain fatty acid content,short chain fatty acid concentration,gastrin,motilin,abdominal distension,and"desire to defecate but poor defecation"score(P>0.05).After treatment,the defecation frequency,short chain fatty acid content and substance P,gastrin and motilin levels of both groups were higher than before treatment;defecation time,nitric oxide level,short chain fatty acid concentration,abdominal distension and"desire to defecate but poor defecation"score of both groups were lower than before treatment(P<0.05);the defecation frequency,short chain fatty acid content,gastrin and motilin levels of the blood nourishing yin enriching combined with electroacupuncture group were higher than those of the blood nourishing yin enriching group[(6.14±0.90)times/week vs(4.16±1.19)times/week,(52.17±13.14)mg/g vs(35.21±11.424)mg/g,(41.37±9.26)ng/L vs(26.28±6.24)ng/L,(42.15±10.57)ng/L vs(32.15±7.45)ng/L,(294.71±51.42)ng/L vs(216.47±35.42)ng/L](P<0.01),while the defecation time,nitric oxide level,short chain fatty acid concentration,abdominal distension and"desire to defecate but poor defecation"score were lower than those of the blood nourishing yin enriching group[(14.11±2.12)min vs(23.46±6.23)min,(72.41±15.01)mmol/L vs(94.36±18.29)mmol/L,(40.10±12.14)mg/L vs(64.26±18.10)mg/L,20.10±7.12 vs 29.44±10.42,24.15±8.24 vs 32.14±10.21](P<0.01).The total effective rate of the blood nourishing yin enriching combined with electroacupuncture was higher than that of the blood nourishing yin enriching group[96.29%(78/81)vs 87.65%(71/81)](χ^(2)=4.098,P=0.043).The complication incidence in the blood nourishing yin enriching group combined with electroacupuncture group was lower than that in the blood nourishing yin enriching group[4.93%(4/81)vs 14.81%(12/81)](P<0.05).Conclusion Electroacupuncture supplemented by blood nourishing and yin enriching method can improve defecation frequency,shorten defecation time,improve intestinal neurotransmitter and short chain fatty acid level,relieve clinical symptoms,with few complications and good curative effect.