“调神健脾”针刺治疗腹泻型肠易激综合征的疗效与5-HTTLPR基因多态性的相关性  

Correlation between curative effect and 5-HTTLPR polymorphism in treatment of diarrhea-predominant irritable bowel syndrome with acupuncture for regulating shen and strengthening spleen

作　　者：郭静 孙建华 陈璐 耿昊 吴晓亮 宋亚芳 杨国辉[2] 沈蓉蓉[3] 丁敏[4] 陆瑾[5] 刘炼[6] 方向东[7] 裴丽霞 GUO Jing;SUN Jian-hua;CHEN Lu;GENG Hao;WU Xiao-liang;SONG Ya-fang;YANG Guo-hui;SHEN Rong-rong;DING Min;LU Jin;LIU Lian;FANG Xiang-dong;PEI Li-xia(Department of Acupuncture-Moxibustion and Rehabilitation,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu Province,China;Department of Acupuncture-Moxibustion,Shuyang Hospital of TCM;Department of Acupuncture-Moxibustion,Nantong Hospital of TCM;Department of Acupuncture-Moxibustion,Wuxi Hospital of TCM;Department of Acupuncture-Moxibustion,Nanjing Hospital of Chinese Medicine;Department of Acupuncture-Moxibustion,Affiliated Hospital of Jiangsu University;Department of Acupuncture-Moxibustion,Kunshan Hospital of TCM)

机构地区：[1]南京中医药大学附属医院针灸康复科,江苏南京210029 [2]沭阳县中医院针灸科 [3]南通市中医院针灸科 [4]无锡市中医医院针灸科 [5]南京市中医院针灸科 [6]江苏大学附属医院针灸科 [7]昆山市中医医院针灸科

出　　处：《中国针灸》2021年第4期365-370,共6页Chinese Acupuncture & Moxibustion

基　　金：江苏省中医消化病临床医学中心项目:BL2014100-4;江苏省中医药管理局领军人才项目:SLJ0206;江苏省中医院高峰人才项目:y2018rc05;国家中医药管理局“中医药循证能力建设项目”:2019XZZX-ZJ008。

摘　　要：目的:比较"调神健脾"针刺与匹维溴铵片治疗腹泻型肠易激综合征(IBS-D)的疗效,从5-羟色胺转运体基因多态性区(5-HTTLPR)基因多态性角度探讨针刺疗效的相关机制。方法:将231例IBS-D患者按照2∶1的比例随机分为针刺组(154例)和西药组(77例)。针刺组予"调神健脾"组方针刺,穴取百会、印堂、天枢、上巨虚、足三里等,隔日1次,每周3次;西药组口服匹维溴铵片,每次50 mg,每日3次,均治疗6周。分别于治疗前、治疗后及3个月随访期评价两组IBS症状严重程度量表(IBS-SSS)与IBS生活质量量表(IBS-QOL)总分,于治疗后比较两组疗效及安全性;在治疗前测定患者5-HTTLPR基因型。结果:治疗后及随访时,两组患者IBS-SSS总分均较治疗前降低(P<0.01),且针刺组低于西药组(P<0.01);治疗后及随访时,两组患者IBS-QOL总分均较治疗前升高(P<0.01),且针刺组随访时高于西药组(P<0.01)。针刺组总有效率为79.2%(122/154),高于西药组的58.4%(45/77,P<0.01),两组均未出现严重不良反应。针刺组LS及SS基因型患者IBS-SSS总分治疗前后差值均大于LL基因型(P<0.01);西药组SS基因型患者IBS-SSS总分治疗前后差值大于LL基因型(P<0.01);针刺组LS及SS基因型患者IBS-SSS总分治疗前后差值均大于西药组同基因型(P<0.01)。结论:"调神健脾"针刺治疗腹泻型肠易激综合征的疗效优于匹维溴铵片,可有效缓解患者临床症状,改善患者生活质量,具有较好的疗效及安全性;针刺临床疗效与5-HTTLPR基因多态性具有相关性,LS、SS基因型患者针刺治疗的疗效可能更优。Objective To compare the curative effect on diarrhea-predominant irritable bowel syndrome(IBS-D)between acupuncture for regulating shen and strengthening spleen and pinaverium bromide,and explore the relevant mechanism of curative effect of acupuncture in view of polymorphism of 5-hydroxytryptamine transporter gene-linked polymorphic region(5-HTTLPR).Methods A total of 231 patients with IBS-D were randomized into an acupuncture group(154 cases)and a western medication group(77 cases)at the ratio of 2 to 1.In the acupuncture group,acupuncture was applied to acupoint regimen for regulating shen and strengthening spleen,i.e.Baihui(GV 20),Yintang(GV 29),Tianshu(ST 25),Shangjuxu(ST 37)and Zusanli(ST 36),etc.The treatment was given once every 2 days,3 times a week.In the western medication group,pinaverium bromide was prescribed for oral administration,50 mg each time,3 times daily.The duration of treatment was 6 weeks in each group.Separately,before treatment,after treatment and in 3-month follow-up,the IBS symptom severity scale(IBS-SSS)and IBS quality of life scale(IBS-QOL)scores were adopted in assessment.After treatment,the curative effect and safety were compared between the two groups.Before treatment,5-HTTLPR genotypes were determined in the patients.Results After treatment and in follow-up,the total scores of IBS-SSS in the patients of the two groups were all reduced as compared with those before treatment(P<0.01)and the scores in the acupuncture group were lower than those in the western medication group(P<0.01).After treatment and in follow-up,the total scores of IBS-QOL in the two groups were all increased as compared with those before treatment(P<0.01)and the score in the acupuncture group was higher than the western medication group in follow-up(P<0.01).The total effective rate was 79.2%(122/154)in the acupuncture group,higher than 58.4%(45/77)in the western medication group(P<0.01).There was no severe adverse reaction found in the two groups.The difference in the total score of IBS-SSS before and after t

关 键 词：腹泻型肠易激综合征 针刺 5-羟色胺转运体基因多态性区 基因多态性 随机对照试验 

分 类 号：R246.1[医药卫生—针灸推拿学]