Clinical Study of Electro-acupuncture Treatment with Different Intensities for Functional Constipation Patients

Functional constipation （FC） is a common functional bowel disorder disease that affects life quality of a large number of people. This study aimed to explore the impact of different intensities of electro-acupuncture （EA） treatment for FC patients. Totally, 111 patients with FC meeting the Rome III criteria were randomly assigned to different intensities of EA groups （low and high intensity of EA groups） and medicine-controlled （MC） group. In EA groups, patients were treated with EA at quchi （Llll） and shangjuxu （ST37） bilaterally for 4 weeks, 5 times/week in the first 2 weeks, and 3 times/week in the last 2 weeks. In MC group, 5 mg mosapride citrate was administered orally 3 times/day for 4 weeks. Spontaneous bowel movement frequency each day was recorded using a consti- pation diary. Self-rating anxiety scale （SAS） and self-rating depression scale （SDS） were used to assess the patients＇ psychological state. Cortisol （CORT）, substance P （SP）, and vasoactive intestinal polypep- tide （VIP） were evaluated at baseline and at the end of 4 weeks after treatment. As compared with the baseline, there was statistically significant increase in stool frequency every week （P〈0.01）, but there was no statistically significant difference among the three groups. As compared with the baseline, after 4 weeks of EA therapy, the scores of SDS and serum levels of CORT were decreased significantly in low intensity of EA group （P〈0.01）, and the serum levels of SP and VIP were increased significantly （P〈0.05）; the scores of SAS and SDS and serum levels of CORT were decreased significantly in high intensity of EA group （P〈0.05）, and the serum levels of SP and VIP were increased significantly （P〈0.05）; the serum levels of CORT and VIP were increased significantly in MC group （P〈0.05）. As compared with MC group, after 4 weeks of treatment, the serum levels of SP were signifcicantly in- creased in low intensity of EA group （P〈0.01）. Low and high intensities of EA could increase the stool frequency, improve the FC patient＇s anxiety and depression, reduce the serum levels of CORT, and in- crease the serum levels of SP and VIP effectively. It is concluded that both low and high intensities of EA are effective for FC patients, but there is no significant difference between the low and high intensi- ties of EA.

Effects of electroacupuncture at Chize(LU 5) versus Shangjuxu(ST 37) in rats with ulcerative colitis

Objective： To compare the effects between electroacupuncture （EA） at Chize （LU 5, the He-Sea point of the Lung Meridian） and Shangjuxu （ST 37, the lower He-Sea point of the large intestine） in rats with ulcerative colitis （UC） on the variations of mesenteric microcirculation and vasoactive intestinal peptide （VIP） in the colon, lung, and hypothalamus. The relative specificity of acupoints was also explored. Methods： A total of 28 male Wistar rats were randomized into a normal group, a model group, a Chize （LU 5） group and a Shangjuxu （ST 37） group, 7 rats in each group. The UC model was established by enema with acetic acid. Since the third day after modeling, rats in the Chize （LU 5） group and Shangjuxu （ST 37） group respectively received EA at Chize （LU 5） and Shangjuxu （ST 37）, 1S min each time for successive 7 d. The variations of mesenteric microvascular calibers and blood flow status were observed by a microcirculation microscopic tester; VIP in the colon, lung and hypothalamus was measured by radioimmunoassay. Results： Compared with the normal group, the mesenteric microvascular calibers were significantly expanded in the model group （P〈0.05）; there was no significant difference between the model group and Chize （LU 5） group （P〉0.05）; compared with the model group and Chize （LU 5） group, the calibers were obviously shrunk in Shangjuxu （ST 37） group （P〈0.05）. The four groups showed no significant inter-group differences in comparing blood flow status （P〉0.05）. The colonic VIP levels in the model group and Chize （LU 5） group were significantly higher than that in the normal group （P〈0.01, P〈0.05）; the VIP level in Shangjuxu （ST 37） group was markedly lower than that in the model group （P〈0.01）. There were no significant differences among the four groups in comparing VIP level in lung and hypothalamus （P〉0.05）. Conclusion： The effects of Chize （LU 5） and Shangjuxu （ST 37） were different in treating UC. Shangjuxu （ST 37） showed a more significant efficacy in down-regulating VIP in the colon and regulating mesenteric microcirculation, while the effects of Chize （LU 5） were not obvious.

Effects of Electroacupuncture at Shangjuxu (ST 37) on Interleukin-1β and Interleukin-4 in the Ulcerative Colitis Model Rats

Objective： To probe into the mechanisms of electroacupuncture （EA） at Shangjuxu （ST 37） for treatment of the ulcerative colitis （UC）. Methods： Forty male Wistar rats were randomly divided into 4 groups： a normal group, a model group, a Shangjuxu group and a non-acupoint group, 10 rats in each group. The UC rat model was made with enema of trinitro-benzenesulfonic acid （TNBSA）, and the changes of interleuldn-1β （IL-1β） and interleukin-4 （IL-4） contents after EA at Shangjuxu （ST 37） were observed. Results： EA at Shangjuxu （ST 37） could significantly decrease the IL-1β content and increase the IL-4 content in the colic tissues of the UC rats with significant differences as compared with the model group and the non-acupoint group （P〈0.05 or P〈0.01）. Conclusion： The mechanisms of EA at Shangjuxu （ST 37） for treatment of the UC rats is possibly related with the decrease of IL-1β, a inflammation-promoting cytokine, and the increase of IL-4, a anti-inflammatory cytokine.

溃疡性结肠炎患者大肠经原穴与下合穴红外光谱的比较研究

目的:探讨穴位红外光谱对溃疡性结肠炎的诊断价值。方法:使用PHE 201型高灵敏度红外光谱分析仪检测34名溃疡性结肠炎患者大肠经原穴合谷与大肠经下合穴上巨虚的红外光谱。结果:在59个检查波长中,溃疡性结肠炎患者右侧合谷穴共有28个波长的红外辐射强度与正常人有显著差异(P<0.05或P<0.01),左侧有13个波长的红外辐射强度与正常人有显著差异(P<0.05)。右侧上巨虚穴共有16个波长的红外辐射强度与正常人有显著差异(P<0.05或P<0.01),左侧有17个波长的红外辐射强度与正常人有显著差异(P<0.05或P<0.01)。患者左右合谷有18个波长的辐射强度有显著差异(P<0.05或P<0.01),正常人左右合谷7个波长上有显著差异(P<0.05)。患者左右上巨虚共有4个波长的辐射强度有显著差异(P<0.05或P<0.01),而正常人左右上巨虚有1个波长的辐射强度有显著差异(P<0.01)。结论:上巨虚与合谷穴均能在红外辐射光谱上反映出肠道病变,而合谷穴似乎更明显一些。

基于r-fMRI技术观察电针曲池、上巨虚对功能性肠病患者大脑的即刻效应

目的以静息态功能性磁共振成像(r-f MRI)技术观察电针曲池、上巨虚穴对功能性肠病患者大脑功能活动模式的改变,为探索曲池、上巨虚穴治疗功能性肠病发挥效应的中枢机制提供影像学依据。方法选择功能性便秘患者20例为便秘组,功能性腹泻患者20例为腹泻组。便秘组采用电针上巨虚治疗,腹泻组采用电针曲池治疗,次日两组均取相关非经非穴点进行电针治疗。采集两组电针前后的静息态功能磁共振数据,以功能连接为观察指标,以右侧岛叶为种子点,运用MATLAB、DPARSF和REST等软件得到两组与种子点存在功能连接的脑区图像,进而分析两组自身经电针刺激前后脑功能连接的差异。结果电针刺激功能性便秘患者上巨虚穴可正激活左侧小脑后叶小脑山坡、左侧枕叶舌回、左侧枕叶枕中回、右侧枕叶、右侧顶叶缘上回、右侧穹窿回扣带回、左侧顶叶楔前叶;负激活右侧额叶Sub-Gyral、右侧岛叶、左侧岛叶。电针功能性腹泻患者曲池穴有显著差异的脑区为左侧小脑后叶山顶和左侧边缘叶后扣带回。结论电针曲池、上巨虚穴可引起功能性肠病患者大脑部分内脏高敏相关脑区功能连接的变化,提示针刺对功能性肠病患者的改善效应可能与此有关。

电针天枢不同配穴对溃疡性结肠炎大鼠结肠黏膜保护作用的研究

目的:通过观察电针天枢加不同配穴对溃疡性结肠炎(UC)结肠黏膜的保护作用,筛选治疗UC活动期较佳的腧穴处方。方法:Wistar大鼠60只,随机分为正常对照组、模型组、电针天枢组、电针天枢+中脘组、电针天枢+上巨虚组、电针天枢+中脘+上巨虚组,每组10只。观察各组大鼠的结肠黏膜损伤指数、血清一氧化氮(NO)、超氧化物歧化酶(SOD)和丙二醛(MDA)变化。结果:模型组溃疡溃疡较大,充血、水肿明显,黏膜损伤指数较高,各电针治疗组均可明显降低黏膜损伤指数;与正常对照组相比,模型组MDA、NO明显增加,SOD明显减低,均有非常显著性差异(P<0.01);各电针治疗组均可明显降低MDA、NO,提高SOD的含量,但各组间存在差异,以天枢+中脘+上巨虚组效果明显。结论:电针天枢加不同配穴对UC大鼠结肠黏膜有明显的保护作用,以天枢、中脘、上巨虚三穴配伍疗效最优。

电针足三里、上巨虚对腹部术后胃肠功能的影响

目的:观察电针足三里、上巨虚对腹部术后患者胃肠功能恢复情况的影响。方法:将120例腹部术后患者随机分为4组,每组各30例。对照Ⅰ组(空白组)术后给予常规处理,另外三组均加用特殊处理。对照Ⅱ组加用新斯的明足三里、上巨虚穴位注射,对照Ⅲ组普通针刺足三里、上巨虚,治疗组电针足三里、上巨虚。结果:治疗组、对照Ⅲ组胃肠功能恢复时间较短,与另外两组相比有显著差异(P<0.01),治疗组与对照Ⅲ组间无显著差异(P>0.05)。但电针刺激强度规范,容易控制刺激量,且节省人力。结论:电针足三里、上巨虚可促进腹部术后患者胃肠功能恢复,减少并发症。

电针上巨虚对溃疡性结肠炎模型大鼠白细胞介素-1β和白细胞介素-4的影响

目的观察电针上巨虚对溃疡性结肠炎(UC)模型大鼠白细胞介素-1β(IL-1β)和白细胞介素-4(IL-4)的影响,探讨电针上巨虚治疗UC的部分作用机制。方法40只雄性Wistar大鼠随机分为正常组、模型组、上巨虚组、非穴组4组,每组10只。以三硝基苯磺酸灌肠诱导建立UC大鼠模型,观察电针上巨虚后UC模型大鼠IL-1β及IL-4含量的变化。结果电针上巨虚能使UC模型大鼠结肠组织IL-1β含量明显降低,IL-4含量明显增高,与模型组及非穴组比较,差异有显著性意义(P<0.05或P<0.01)。结论电针上巨虚对UC模型大鼠的作用机制可能与降低促炎细胞因子IL-1β水平和提高抗炎细胞因子IL-4水平有关。

电针不同部位单穴对大鼠胃运动双向调节效应特征的研究

目的探讨不同部位穴位对胃运动异常大鼠的双向调节效应特征。方法通过在大鼠胃内安置球囊的方法记录胃内压,观察电针天枢、大肠俞、曲池、上巨虚对胃运动异常模型大鼠胃内压的影响。结果在正常生理状态及胃运动增强和胃运动抑制的病理状态下,电针曲池、上巨虚均以促进胃运动为主(P<0.05);而电针天枢均以抑制胃运动为主(P<0.01);电针大肠俞只有在正常及心得安所造成的胃运动兴奋状态下,以抑制胃运动为主(P<0.05);其他状态无明显方向倾向。结论腹部和四肢单穴对胃运动的调节很可能具有定向效应的特征,穴位的双向调节作用并不一定是同一穴位对不同病理状态下内脏器官的双向调节。

电针大肠合穴下合穴配穴治疗功能性肠病双向调节效应的临床研究

目的:通过运用电针刺激大肠合穴下合穴配穴(曲池、上巨虚),观察针刺对于2种不同状态(便秘、腹泻)的功能性肠病的临床疗效,为探求针刺治疗的双向调节作用机制,扩大针灸主治范围,探索针灸配穴组合疗效提供有效的临床依据。方法:选取2013年8月至2015年12月湖南中医药大学第一附属医院收治的符合相应纳入标准的功能性肠病患者132例(便秘型72例、腹泻型60例),将2型患者各自分为2个电针组,2个药物组,分别为便秘电针组(36例)、便秘药物组(36例)、腹泻电针组(30例)、腹泻药物组(30例)。2电针组均采用针刺双侧曲池、上巨虚后,采用20 Hz电流、连续波刺激30 min。治疗期为4周,共完成16次治疗,第1~2周治疗5次/周,第3~4周治疗3次/周。腹泻药物组口服盐酸洛哌丁胺胶囊,2 mg/次,3次/d,连服4周。便秘药物组口服枸橼酸莫沙必利片,5 mg/次,3次/d,连服4周。各组于治疗前、治疗第2周末、治疗完成后(第4周末)、治疗结束后1个月随访时,分别记录患者周排便次数和大便性状,评估其治疗期间及随访期的心理状态(SAS、SDS),并对数据进行统计与分析。结果:经治疗后,2电针组的周排便次数、大便性状、SAS、SDS均得到有效改善。组内比较中,治疗前后比较差异有显著统计学意义(P<0.01)。随访4周与治疗4周比较,差异无统计学意义(P>0.05),但与治疗前比较,差异有显著统计学意义(P<0.01)。组间比较中,2电针组的临床疗效与同型的药物组比较,其差异均无统计学意义(P>0.05)。结论:电针大肠合穴下合穴配穴能够治疗不同状态(便秘、腹泻)下的功能性肠病,并能产生稳定的、具有一定持续性的双向调节效应。

针刺上巨虚穴对大脑中动脉血流动力学影响的研究

目的:探讨针刺上巨虚穴对大脑中动脉(MCA)血流动力学的影响,为临床应用上巨虚穴治疗脑血管病提供依据。方法:对10名青年健康志愿者(男性6名,女性4名)通过经颅多普勒超声(TCD)连续观测针刺双侧上巨虚穴在进针前10 min、进针得气后、行针时(留针15 min)、出针时(留针30 min)并分别施以行针手法15 s钟后、出针后10 min等5个时间点的大脑中动脉的血流动力学变化。结果:同进针前10 min比较,进针时、行针时VM、VD有统计学意义(P<0.05);出针时、出针后10 min VM有显著的统计学意义(P<0.01);同进针前10 min比较Vs、PI、RI均无统计学意义(P>0.05)。结论:针刺上巨虚穴有可能增加MCA的血流量,对MCA的平均血流速度的影响具有非常显著的后遗效应,提示针刺该穴具有一定的延迟治疗作用。针刺上巨虚穴对MCA血管的收缩和舒张无显著影响。

电针足三里对十二指肠溃疡大鼠肠黏膜保护作用的影响

为探讨针刺治疗十二指肠溃疡的腧穴的相对特异性及其机理 ,将 97只大鼠随机分为正常组 ( 2 0只 ) ,模型组( 19只 ) ,足三里组 ( 19只 ) ,上巨虚组 ( 19只 ) ,下巨虚组 ( 2 0只 ) ,除正常组外 ,其余各组大鼠以盐酸半胱胺诱发十二指肠溃疡 ,并分别针刺相应穴位 ,10日后观察各组大鼠的十二指肠溃疡面积、溃疡指数、以及十二指肠黏液厚度。结果 :电针足三里、上巨虚、下巨虚三穴均可不同程度缩小溃疡面积、降低溃疡指数及促进肠道黏液的分泌。其中以足三里穴的效果最好 ,上巨虚与下巨虚相当。

天枢、上巨虚作为基础腧穴治疗胃肠疾病的研究进展

分析总结天枢、上巨虚作为基础腧穴治疗胃肠疾病的临床与基础研究进展,探索合募配穴的临床价值,从而为合募配穴的临床应用提供依据。基于现有文献,天枢与上巨虚作为基础腧穴应用广泛,二者共同作为基础腧穴主要应用于功能性肠病与炎症性肠病的治疗,而在慢性胃炎、功能性消化不良等其他常见消化疾病中应用较少。临床常用的治疗方法为针刺、艾灸、中药穴位贴敷。基于动物实验的疗效机制表明,天枢、上巨虚及其他配穴干预,可调节大鼠兴奋性、抑制性神经递质并改善大鼠体内炎症介质水平,改善功能性便秘症状;抑制中枢敏化,从而缓解大鼠肠易激症状;抑制胃内压和胃运动以减轻功能性腹泻症状;通过降低大鼠延髓孤束核内神经元和星形胶质细胞的阳性免疫产物的高表达水平,并抑制Toll样受体4(TLR4)/髓样分化因子88(MyD88)/核因子κB(NF-κB)信号通路并减少炎症介质的释放以保护溃疡性结肠炎大鼠结肠黏膜组织。在不同胃肠疾病治疗中,天枢、上巨虚所配伍的腧穴有所差异,因此应基于现有证据与临床经验选择最佳腧穴配伍,从而提升临床疗效。

Effect of electric acupoint stimulation on gastrointestinal hormones and motility among geriatric postoperative patients with gastrointestinal tumors

OBJECTIVE:To evaluate the effects of electric acupoint stimulation on gastrointestinal hormones and motility among geriatric postoperative patients with gastrointestinal tumors,and to explore an efficient and noninvasive method for postoperative recovery of bowel functions.METHODS:Forty patients were randomly and evenly assigned into a regular nursing care group(RNC) and an acupoint electric stimulation group(AES).Patients in the RNC group received regular nursing care and patients in the AES group received regular nursing care plus electric stimulation of acupoints.The serum levels of gastrin(GAS),motilin(MOT),and cholecystokinin(CCK),and an electrogastrogram(EGG) of all the patients were evaluated on the first,third,and fifth day after surgery.The time to first flatus after surgery and the number of patients with side effects such as abdominal pain,abdominal distention,and diarrhea were recorded.RESULTS:There were significant differences between the two groups in GAS,MOT,EGG,time to first flatus,abdominal pain,abdominal distention,and diarrhea(P < 0.05).CONCLUSION:Electric stimulation on acupoints could increase levels of GAS and MOT,promote the recovery of gastrointestinal functions,and decrease complications among postoperative senile patients with gastrointestinal tumors.

电针对溃疡性结肠炎大鼠肠黏膜维生素D受体表达的影响

目的:观察电针天枢、上巨虚穴对结肠炎大鼠肠黏膜中维生素D受体(VDR)表达的影响,探讨电针治疗溃疡性结肠炎(UC)的可能机制。方法:按照随机数字表法将雄性Wistar大鼠分为对照组、模型组和电针组,每组8只。采用三硝基苯磺酸(TNBS)灌肠的方法来诱导溃疡性结肠炎制备大鼠模型,同时采用大鼠疾病活动指数(DAI)评分和组织学活动度评分(HAI)来评估结肠炎症程度。电针组大鼠经TNBS造模成功后次日取天枢、上巨虚穴进行电针治疗,共14 d。于第15天处死大鼠后收集结肠组织,分别采用免疫组化和实时荧光定量PCR法(qRT-PCR)检测肠黏膜VDR的表达水平,采用分光光度法测定结肠组织髓过氧化物酶(MPO)活性。结果:与模型组比较,电针组HAI明显下降(P=0.005)。与对照组比较,模型组和电针组结肠组织中MPO活性均明显增加。与模型组比较,电针组结肠组织中MPO活性下降(P<0.001)。与对照组比较,模型组、电针组大鼠肠黏膜中VDR mRNA及蛋白表达降低(P<0.01)。与模型组比较,电针组大鼠肠黏膜VDR m RNA及蛋白表达升高(P<0.05)。蛋白免疫组化提示VDR主要在上皮细胞中表达。VDR蛋白表达水平与MPO活性成负相关(P<0.05)。结论:电针天枢、上巨虚两穴可能通过上调肠黏膜VDR表达来缓解大鼠UC症状。

Effectiveness of acupuncture in postoperative ileus: a systematic review and Meta-analysis

OBJECTIVE: To conduct a systematic review and Meta-analysis of the effectiveness of acupuncture and common acupoint selection for postoperative ileus(POI).METHODS: Randomized controlled trials(RCTs)comparing acupuncture and non-acupuncture treatment were identified from the databases Pub Med, Cochrane, EBSCO(Academic Source Premier and MEDLINE), Ovid(including EvidenceBased Medicine Reviews), China National Knowledge Infrastructure, and Wanfang Data. The data from eligible studies were extracted and a Meta-analysis performed using a fixed-effects model.Results were expressed as relative risk(RR) for dichotomous data, and 95% CI(confidence intervals)were calculated. Each trial was evaluated using the CONSORT(Consolidated Standards of Reporting Trials) and STRICTA(STandards for Reporting Interventions in Controlled Trials of Acupuncture) guide-lines. The quality of the study was assessed using the Grading of Recommendations, Assessment, Development and Evaluation(GRADE) approach.RESULTS: Of the 69 studies screened, eight RCTs were included for review. Among these, four RCTs(with a total of 123 patients in the intervention groups and 124 patients in the control groups) met the criteria for Meta-analysis. The Meta-analysis results indicated that acupuncture combined with usual care showed a significantly higher total effective rate than the control condition(usual care)(RR1.09, 95% CI 1.01, 1.18; P = 0.02). Zusanli(ST 36) and Shangjuxu(ST 37) were the most common acupoints selected. However, the quality of the studies was generally low, as they did not emphasize the use of blinding.CONCLUSION: The results suggested that acupuncture might be effective in improving POI; however,a definite conclusion could not be drawn because of the low quality of trials. Further large-scale,high-quality randomized clinical trials are needed to validate these findings and to develop a standardized method of treatment. We hope that the present results will lead to improved research, resulting in better patient care worldwide.

电针对功能性便秘小鼠肠道神经元自噬水平的影响

目的:基于肠道神经元自噬探讨电针大肠合募配穴治疗功能性便秘(FC)的作用机制。方法:将40只SPF级昆明小鼠随机分为对照组、模型组、针刺组、3-甲基腺嘌呤(3-MA)组以及3-MA+针刺组5组,每组8只。除对照组外,其余4组小鼠采用复方地芬诺酯混悬液灌胃14 d制备FC模型。造模成功后,针刺组、3-MA+针刺组电针双侧“天枢”“上巨虚”,予疏密波,频率3 Hz/15 Hz,电流强度1 mA,每次30 min,每日1次,5 d为一疗程,疗程之间休息2 d,共治疗2个疗程。3-MA组及3-MA+针刺组于电针前30 min予3-MA溶液腹腔注射(15 mg/kg),每日1次。分别于干预前后观察各组小鼠首粒黑便排出时间和6 h排便情况。干预后计算各组小鼠小肠推进率;HE染色法观察小鼠结肠组织形态;透射电镜观察小鼠肠道神经元自噬情况;免疫组化法检测小鼠结肠肌层神经元微管相关蛋白1轻链3(LC3)、Beclin-1、神经元核抗原蛋白(NeuN)表达。结果:干预前,与对照组比较,模型组、针刺组、3-MA组及3-MA+针刺组小鼠首粒黑便排出时间延长(P<0.01,P<0.05),6 h排便粒数减少(P<0.01),6 h粪便湿重降低(P<0.01,P<0.05),6 h粪便含水率下降(P<0.05,P<0.01)。干预后,与对照组比较,模型组小鼠首粒黑便排出时间延长(P<0.05),6 h排便粒数减少(P<0.01),6 h粪便湿重降低(P<0.01),6 h粪便含水率下降(P<0.01);与模型组比较,针刺组首粒黑便排出时间缩短(P<0.01),6 h排便粒数增多(P<0.01),6 h粪便湿重增加(P<0.01),6 h粪便含水率升高(P<0.01);与针刺组比较,3-MA+针刺组小鼠首粒黑便排出时间延长(P<0.01),6 h排便粒数减少(P<0.01),6 h粪便湿重降低(P<0.01),6 h粪便含水率下降(P<0.01)。各组小鼠结肠组织各层结构均正常、完整。与对照组比较,模型组小鼠小肠推进率及结肠肌层神经元LC3、Beclin-1、NeuN平均吸光度值降低(P<0.01),自噬小体减少;与模型组比较,针刺组小肠推进率及结肠肌层神经元LC3、Beclin-1、NeuN平均吸光度值升高(P<0.01,P<0.05),自噬小体增多;与针刺组比较,3-MA+针刺组小肠推进率及结肠肌层神经元LC3、Beclin-1、NeuN平均吸光度值降低(P<0.05,P<0.01)。结论:电针可促进肠道神经元自噬,增加神经元数量,从而增加FC模型小鼠肠道运动,改善便秘症状。

艾灸“天枢”“上巨虚”对克罗恩病大鼠肠道菌群及血清炎症因子的影响

目的:观察艾灸“天枢”“上巨虚”对克罗恩病(CD)大鼠肠道炎症损伤的影响,从肠道菌群角度探讨艾灸对CD大鼠结肠的保护作用。方法:以2,4,6三硝基苯磺酸灌肠制备CD大鼠模型。实验设正常组、模型组、艾灸组和药物组。艾灸组予艾灸双侧“天枢”和“上巨虚”,药物组予美沙拉嗪灌胃。记录大鼠体质量、粪便隐血情况并评估疾病活动指数(DAI);HE染色观察结肠病理损伤;ELISA法检测血清肿瘤坏死因子-α(TNF-α)、组胺、缓激肽水平;16S rDNA测序技术检测并分析肠道菌群组成结构的改变;冗余分析(RDA)对肠道菌群与血清炎症因子进行相关性分析。结果:与正常组比较,模型组大鼠疾病症状明显,DAI评分显著升高(P<0.05),结肠黏膜存在明显的炎症损伤,血清TNF-α、组胺、缓激肽水平显著升高(P<0.05);与模型组比较,艾灸组与药物组大鼠疾病症状缓解,DAI评分显著下降(P<0.05),结肠黏膜炎症损伤减轻,血清TNF-α、组胺、缓激肽水平显著降低(P<0.05)。16S rDNA测序显示,与正常组比较,模型组大鼠菌群丰富度和多样性减少,菌群组成结构差异较大;与模型组比较,艾灸组、药物组菌群丰富度和多样性较高,菌群结构趋于正常组。此外,考拉杆菌属、Allobaculum属、厌氧杆菌属与血清炎症因子之间呈正相关。结论:艾灸“天枢”“上巨虚”治疗CD的机制可能是通过调控肠道菌群紊乱状态,减轻肠道炎症损伤,从而维持肠道免疫稳态。

关于足三里、上巨虚、下巨虚的下合顺序与主治特异性思考

足三里、上巨虚和下巨虚均归属于下合穴,自上而下依次分布于足阳明胃经下肢循行线上,按其在下合穴对应的脏腑来看,自上而下的分布顺序为胃、大肠、小肠。这与现代医学胃、小肠、大肠的消化道生理功能顺序存在明显差异,但却符合三者在解剖位置中由上而下的排列顺序。为了进一步证实足三里、上巨虚和下巨虚的穴位主治特异性与解剖位置有紧密的联系,查阅大量古今文献发现,这3个下合穴的功能主治分别与胃、大肠、小肠确实存在明显相关性,进而提示足三里、上巨虚和下巨虚排列顺序与所通之腑的解剖位置的排列顺序相关,而这一研究的发现,可有助于探讨解剖定位在认识穴位主治特异性过程中的重要作用。

电针对大鼠失神经支配骨骼肌萎缩及IGF-1/PI3K/AKT表达的影响

目的:观察电针对失神经支配骨骼肌萎缩及IGF-1/PI3K/AKT信号通路表达的影响,探讨电针对失神经肌肉萎缩的可能作用机制。方法:36只雄性SD大鼠随机分为对照组、模型组和电针组。模型组和电针组大鼠切断左后肢坐骨神经制备失神经肌萎缩模型。电针组予电针治疗,穴取"足三里"和"上巨虚",疏密波,2 Hz/33 Hz,1.5～2 mA,每次30 min,每日1次,每5次间隔2 d,共20次。对照组与模型组每日同样鼠笼固定,但不电针。疗程结束后观察各组坐骨神经功能指数,称量腓肠肌肌湿重,HE染色测量患/健侧肌纤维横截面积比和肌细胞直径比,TUNEL和免疫荧光双染色的方法评价肌细胞凋亡和增殖分化情况。荧光定量PCR法检测胰岛素样生长因子-1(insulin-like growth factor-1,Igf-1)和蛋白激酶B(protein kinase B,PKB,又被称作Akt)的mRNA表达,免疫蛋白印迹法检测局部肌肉Akt总蛋白及其磷酸化形式p-AKT(Ser473)和p-AKT(Thr308)的表达量。结果:与对照组相比,模型组大鼠的坐骨神经功能指数,患侧/健侧腓肠肌湿重比、肌纤维横截面积比和肌细胞直径比均明显下降,肌细胞凋亡指数明显升高(均P<0.01);与模型组相比,电针组上述指标均得到改善(均P<0.05),与肌卫星细胞增殖分化相关的PAX3和PAX7表达明显增高(均P<0.01),p-AKT(Ser473)蛋白水平增加(P<0.05)。结论:电针可改善失神经肌肉的萎缩情况,减少肌细胞凋亡,促进肌卫星细胞增殖分化,其作用机制可能与提高p-AKT(Ser473)水平、激活AKT信号通路有关。