经皮穴位电刺激改善功能性消化不良患者症状和胃容受性的相关机制  

Mechanism of transcutaneous electrical acupoint stimulation in improving the symptoms and gastric accommodation in patients with functional dyspepsia

作　　者：陈小丽[1] 陈新 杜丽君[1] 陈彬睿 黄智慧[1] 戴宁[1] 吴加国[1] Chen Xiaoli;Chen Xin;Du Lijun;Chen Binrui;Huang Zhihui;Dai Ning;Wu Jiaguo(Department of Gastroenterology,Sir Run Run Shaw Hospital,Medical School Zhejiang University,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院消化内科,杭州310016

出　　处：《中华消化杂志》2021年第1期16-22,共7页Chinese Journal of Digestion

基　　金：浙江省自然科学基金(LQ19H030013);浙江省医药卫生科技项目(2020RC068,2019KY419)。

摘　　要：目的探索经皮穴位电刺激(TEAS)治疗功能性消化不良(FD)中餐后不适综合征(PDS)的疗效和机制。方法采用双盲、随机、对照研究,前瞻性选择于浙江大学医学院附属邵逸夫医院就诊、满足罗马Ⅳ诊断标准中的18~70岁的PDS患者40例,患者知情同意后随机分入TEAS组和模拟TEAS组,分别接受经皮电针刺激足三里、内关穴和其相对应的模拟穴位治疗4周,比较2组患者治疗前后症状、胃容受性[初始饱腹量(ISV)、最大耐受量(MTV)]、固体胃半排空时间(T_(1/2))和心率变异(高频段、低频段、低频段与高频段的比值)。采用PCR检测PDS患者和24名健康志愿者的十二指肠黏膜炎性因子表达,并比较TEAS组患者治疗前后炎性因子变化。统计学方法采用独立样本t检验、Mann-Whitney U检验、卡方检验。结果共26例PDS患者纳入研究,TEAS组和模拟TEAS组各13例,2组患者性别构成、年龄,以及治疗前健康调查量表36(SF-36)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、消化不良症状严重程度指数(DSSI)评分、ISV、MTV、T_(1/2)和心率变异参数(高频段、低频段、低频段与高频段的比值)差异均无统计学意义(P均>0.05)。治疗后TEAS组患者DSSI评分低于模拟TEAS组[(13.5±5.3)分比(19.9±9.3)分],ISV、MTV均高于模拟TEAS组[(180.0±44.6)mL比(121.9±61.0)mL,(480.4±200.7)mL比(338.5±108.8)mL],差异均有统计学意义(t=2.18、2.77、2.24,P均<0.05)。治疗后TEAS组患者的T_(1/2)与模拟TEAS组比较差异无统计学意义(P>0.05)。TEAS组患者治疗前后的T_(1/2)比较差异无统计学意义(P>0.05)。治疗后TEAS组的高频段较治疗前增加(5.3±1.2比4.0±0.9),低频段与高频段比值降低(1.0±0.2比1.3±0.2),差异均有统计学意义(t=-3.31、3.73,P均<0.01)。PDS患者十二指肠球部和降部黏膜组织中IL-6的mRNA表达水平均高于健康志愿者[0.68(0.11,6.74)比0.03(0.02,0.25)、6.46(1.35,12.62)比0.86(0.32,2.90)],差异均有�Objective To investigate the therapeutic efficacy and mechanisms of transcutaneous electrical acupoint stimulation(TEAS)in the treatment of postprandial distress syndrome(PDS)in functional dyspepsia(FD).Methods A double-blinded,randomized,controlled study was conducted.At Sir Run Run Shaw Hospital,Medical School Zhejiang University 40 patients aged 18-70 years old who met the RomeⅣdiagnostic criteria of PDS were prospectively enrolled.After informed consent,the patients were randomly assigned to TEAS group or sham-TEAS group.The patients in the TEAS group received transcutaneous electrical acupoint stimulation at acupoints Zusanli and Neiguan,and those in the sham-TEAS group underwent stimulation at other mimic acupoints for four weeks.The symptoms,gastric accommodation(initial satiety volume(ISV)and maximum tolerable volume(MTV),time of half gastric emptying of solid food(T_(1/2))and heart rate variability(high frequency,low frequency and ratio of low frequency to high frequency)were compared between the two groups before and after treatment.The expression levels of inflammatory cytokines in duodenal mucosa were also evaluated by polymerase chain reaction in PDS patients and 24 healthy volunteers.Independent sample t test,Mann-Whitney U test and chi square test were used for statistical analysis.Results A total of 26 PDS patients were enrolled in the study,13 cases each in the TEAS group and sham-TEAS group.Between the patients of the two groups,there were no statistically significant differences in gender,age,or score of 36-item short form health survey(SF-36),score of self-rating anxiety scale(SAS),score of self-rating depression scale(SDS),score of dyspeptic symptom severity index(DSSI),ISV,MTV,T_(1/2) or heart rate variability indexes(high frequency,low frequency and ratio of low frequency to high frequency)before treatment(all P>0.05).After treatment,the DSSI score of TEAS group was lower than that of sham-TEAS group(13.5±5.3 vs.19.9±9.3),the values of ISV and MTV were both higher than those of sham-TEA

关 键 词：功能性消化不良 经皮穴位电刺激 胃容受性 胃排空 迷走神经 

分 类 号：R57[医药卫生—消化系统]