“脑肠同调”法针刺对缺血性脑卒中患者运动功能及肠道菌群的影响

Effects of"brain-gut coherence"method of acupuncture on motor function and intestinal microflora in the patients with cerebral ischemic stroke

目的:观察“脑肠同调”法针刺治疗缺血性脑卒中的临床疗效,探讨其作用机制。方法:将82例缺血性脑卒中患者随机分为观察组(41例,脱落3例、中止2例)和对照组(41例,脱落4例、剔除2例)。两组均采用常规基础治疗,观察组予“脑肠同调”法针刺治疗,穴取患侧顶颞前斜线,中脘、关元,双侧天枢、足三里、上巨虚、下巨虚;对照组予常规针刺,穴取百会、印堂,双侧风池、足三里,患侧合谷、肩髃、曲池、外关、伏兔、三阴交、太冲。均每次30 min,每日1次,每周治疗5 d,共治疗4周。比较两组患者治疗前后Fugl-Meyer运动功能评定量表(FMA)、Berg平衡量表(BBS)、改良Barthel指数(MBI)评分及胃肠症状积分;检测两组患者治疗前后中性粒细胞计数(NUE)及血清N末端B型利钠肽原(NT-pro BNP)含量;采用16S rRNA基因测序检测两组患者治疗前后肠道菌群组成结构及相对丰度;ELISA法检测两组患者治疗前后血清脂肪酸结合蛋白(i FABP)、D-乳酸(D-LA)、脂多糖(LPS)、脂多糖结合蛋白(LBP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)含量。结果:治疗后,两组患者FMA、BBS、MBI评分均较治疗前升高(P<0.05),胃肠症状积分较治疗前降低(P<0.05);观察组FMA、BBS、MBI评分高于对照组(P<0.05),胃肠症状积分低于对照组(P<0.05)。治疗后,两组患者NEU及血清NT-pro BNP含量较治疗前降低(P<0.05);观察组血清NT-pro BNP含量低于对照组(P<0.05)。治疗后,两组患者Chao1指数、Ace指数、Sobs指数、Shannon指数较治疗前升高(P<0.05),且观察组高于对照组(P<0.05);两组患者拟杆菌科、肠杆菌科、颤螺菌科、链球菌科、梭菌科相对丰度较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。治疗后,两组患者毛螺菌科、瘤胃球菌科、双歧杆菌科、红蝽菌科相对丰度较治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。治疗后,两组患者血清i FABP、D-LA、LPS、LBP、TNF-α、IL-1β、IL-6含量较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。结论:“脑肠同调”法针刺可改善缺血性脑卒中患者运动功能、胃肠道功能,可能与调节肠道菌群组成结构,减轻炎性反应,促进肠道屏障修复有关。

Objective To observe the clinical effect of"brain-gut coherence"method of acupuncture on cerebral ischemic stroke(CIS)and explore its action mechanism.Methods A total of 82 patients with CIS were randomly divided into an observation group(41 cases,3 cases dropped out,2 cases discontinued)and a control group(41 cases,4 cases dropped out,2 cases excluded).The conventional basic treatment was administered in the two groups.Additionally,in the observation group,"brain-gut coherence"method of acupuncture was delivered.The stimulating points included the parietal and temporal anterior oblique line on the affected side,Zhongwan(CV 12),Guanyuan(CV 4),and bilateral Tianshu(ST 25),Zusanli(ST 36),Shangjuxu(ST 37)and Xiajuxu(ST 39).In the control group,the routine acupuncture was operated at Baihui(GV 20),Yintang(GV 24+),bilateral Fengchi(GB 20)and Zusanli(ST 36),and Hegu(LI 4),Jianyu(LI 15),Quchi(LI 11),Waiguan(TE 5),Futu(ST 32),Sanyinjiao(SP 6)and Taichong(LR 3)on the affected side.Acupuncture stimulation lasted 30 min each time,once daily,and for 5 days a week.The intervention for 4 weeks was required.The scores of Fugl-Meyer assessment scale(FMA),Berg balance scale(BBS)and the modified Barthel index(MBI),as well as the score of gastrointestinal symptoms were compared before and after treatment in the two groups.The neutrophil count(NUE)and the content of the serum N-terminal pro-B-type natriuretic peptide(NT-pro BNP)were detected before and after treatment in the two groups.Using 16S rRNA gene sequencing,the structure and relative abundance of intestinal microflora was detected before and after treatment;and with the enzyme linked immunosorbent assay(ELISA)adopted,the levels of intestinal fatty acid-binding protein(iFABP),D-lactate(D-LA),lipopolysaccharide(LPS),lipopolysaccharide binding protein(LBP),tumor necrosis factor-α(TNF-α),interleukin(IL)-1βand IL-6 in the serum were detected before and after treatment in the two groups.Results After treatment,the scores of FMA,BBS and MBI were increased(P<0.05),and the scores of gastrointestinal symptoms were decreased(P<0.05)compared with those before treatment in the two groups.Compared with the control group,the scores of FMA,BBS and MBI were higher(P<0.05)and the score of gastrointestinal symptoms was lower(P<0.05)in the observation group after treatment.NEU and the content of serum NT-pro BNP were reduced in the two groups(P<0.05),and the content of serum NT-pro BNP in the observation group was lower than that of the control group(P<0.05)after treatment.Chao1,Ace,Sobs and Shannon indexes were increased after treatment compared with those before treatment in the two groups(P<0.05);and these indexes in the observation group were higher when compared with the control group(P<0.05).After treatment,the relative abundance of Bacteroidaceae,Enterobacteriaceae,Oscillospiraceae,Streptococcaceae and Sutterellaceae was reduced in comparison with that before treatment in the two groups(P<0.05);and the relative abundance of these microflora was lower in the observation group when compared with the control group(P<0.05).After treatment,the relative abundance of Lachnospiraceae,Ruminococcaceae,Bifidobacteriaceae and Coriobacteriaceae was increased in comparison with that before treatment in the two groups(P<0.05);and the relative abundance of these microflora was elevated in the observation group when compared with the control group(P<0.05).After treatment,the levels of iFABP,D-LA,LPS,LBP,TNF-α,IL-1βand IL-6 were reduced when compared with those before treatment in the two groups(P<0.05),and these levels of the observation group were lower than those of the control group(P<0.05).Conclusion"Brain-gut coherence"method of acupuncture can improve the motor function and gastrointestinal function of the patients with cerebral ischemic stroke,which may be related to modulating the structure of intestinal microflora,alleviating inflammatory reactions and accelerating the intestinal barrier repair.