结直肠癌根治术后温针灸干预对患者免疫功能和肠道菌群的影响  

Effect of warm-needle moxibustion intervention on immune function and intestinal flora in patients after colorectal cancer radical operation

作　　者：孙晖 张波[1] 钱海华 陈志成[1] SUN Hui;ZHANG Bo;QIAN Hai-hua;CHEN Zhi-cheng(Anorectum Department of Zhongda Hospital Affiliated to Southeast University,Nanjing 210000,China;Anorectum Department of The Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210000)

机构地区：[1]东南大学附属中大医院肛肠科,南京210000 [2]南京中医药大学附属医院肛肠科,南京210000

出　　处：《针刺研究》2021年第7期592-597,共6页Acupuncture Research

基　　金：国家科技支撑计划(No.2015BAI04B00);江苏中医药管理局面上项目(No.YB2017099)。

摘　　要：目的:观察温针灸对结直肠癌术后患者T细胞亚群、血清炎性因子水平及肠道微生态平衡的影响,从免疫功能及肠道菌群的调节角度探讨其作用机制。方法:将84例择期行结直肠癌根治术的患者随机分为对照组和针灸组,各42例。对照组给予术后抗感染、补液等常规治疗,针灸组在常规治疗的基础上选取双侧足三里、三阴交、阴陵泉、上巨虚、照海平补平泻,于针柄套置燃烧的艾条,留针45 min,于术后第1天开始,1次/d,持续15 d。检测两组患者外周血中T细胞亚群(CD3~+、CD4~+、CD8~+)及血清肿瘤坏死因子(TNF)-α、白细胞介素6(IL-6)、C反应蛋白(CRP)等炎性因子水平;检测粪便中双歧杆菌、乳杆菌、大肠杆菌、肠球菌水平;观察两组患者术后不良反应的发生情况。结果:与治疗前比较,治疗后针灸组CD3~+、CD4~+T细胞及CD4~+/CD8~+水平及双歧杆菌、乳杆菌水平均升高(P<0.05),CD8~+T细胞、TNF-α、IL-6、CRP水平及大肠杆菌、肠球菌水平降低(P<0.05);对照组TNF-α、IL-6、CRP水平降低(P<0.05)。与对照组比较,治疗后针灸组CD3~+、CD4~+T细胞及CD4~+/CD8~+水平及双歧杆菌、乳杆菌水平均升高(P<0.05),CD8~+T细胞、TNF-α、IL-6、CRP水平及大肠杆菌、肠球菌水平降低(P<0.05)。针灸组患者白细胞下降、恶心呕吐、外周静脉炎、冷刺激敏感等不良反应的发生率均低于对照组(P<0.05)。结论:对结直肠癌根治术后患者实施温针灸治疗,可显著提升患者免疫功能,降低炎性因子水平,调节肠道有益菌群数量,同时还可降低术后不良反应发生率。Objective To explore the effect of warm-needle moxibustion(WNM)on the levels of T cell subgroups and serum inflammatory factors,intestinal microecological balance and postoperative adverse reactions in patients with colorectal cancer.Methods Eighty-four patients who underwent elective radical resection of colorectal cancer were randomly and equally divided into control(medication)group(23 men and 19 women)and WNM group(24 men and 18 women).Patients of the control group received conventional medication treatment(such as postoperative anti-infection and fluid supplementation),and those of the WNM group received conventional medication plus WNM stimulation(the acupuncture needle handle warmed by ignited moxa stick)of bilateral Zusanli(ST36),Sanyinjiao(SP6),Yinlingquan(SP9),Shangjuxu(ST37),and Zhaohai(KI6).The acupuncture needles were retained for 45 minutes every time,starting on the first day after surgery,once a day for 15 days.The number of T cell subsets(CD3+,CD4+,CD8+)positive cells was counted under fluorescence microscope,and the contents of serum tumor necrosis factorα(TNF-α)and interleukin-6(IL-6)were detected by using ELISA,and the level of C-reactive protein(CRP)was detected by using immunoturbidimetry.The levels(logarithm of colony-forming units per gram of wet fecal weight)of Bifidobacterium,Lactobacillus,Escherichia coli and Enterococcus were determined.The adverse reactions(leukocyte decline,nausea and vomiting,peripheral phlebitis,cold stimulation sensitivity)were recorded after surgery.Results Before treatment,there were no significant differences between the two groups in the number of T cell subgroups,TNF-αand IL-6 contents,and intestinal flora numbers(P>0.05).After the treatment,self-comparison showed that the numbers of CD3+and CD4+positive cells,the ratio of CD4+/CD8+and the intestinal Bifidobacterium and Lactobacillus levels in the WNM group were significantly increased(P<0.05),whereas the number of CD8+positive cells,intestinal Escherichia coli and Enterococcus levels in the WNM group,and

关 键 词：温针灸 结直肠癌术后 免疫功能 肠道菌群 炎性因子 

分 类 号：R246.5[医药卫生—针灸推拿学]