针刺双向调节效应——“调神健脾”法针刺治疗肠易激综合征多中心随机对照试验亚组分析  

Bidirectional regulation of acupuncture: a subgroup analysis of multicenter randomized controlled trial of acupuncture with Tiaoshen Jianpi for irritable bowel syndrome

作　　者：郭静 孙建华 陈璐 耿昊 杨国辉[2] 沈蓉蓉[3] 丁敏 陆瑾[5] 刘炼[6] 方向东[7] 裴丽霞 GUO Jing;SUN Jian-hua;CHEN Lu;GENG Hao;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;Shuyang Hospital of TCM;Nantong Hospital of TCM;Wuxi Hospital of TCM;Nanjing Hospital of Chinese Medicine;Jiangbin Hospital of Zhenjiang City;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 [3]南通市中医院 [4]无锡市中医医院 [5]南京市中医院 [6]镇江市江滨医院 [7]昆山市中医院

出　　处：《中国针灸》2021年第8期845-850,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:基于"调神健脾"法针刺治疗肠易激综合征(IBS)多中心随机对照试验进行亚组分析,探讨针刺的双向调节作用。方法:共有519例患者纳入分析,其中便秘型IBS(IBS-C)患者137例(针刺组92例,聚乙二醇组45例),腹泻型IBS(IBS-D)患者382例(针刺组252例,匹维溴铵组130例)。针刺组穴取百会、印堂、天枢、上巨虚、足三里、三阴交、太冲,隔日1次,每周3次;聚乙二醇组口服聚乙二醇4000散;匹维溴铵组口服匹维溴铵片,均治疗6周。分别于基线期、治疗期(治疗2、4、6周)及随访12周评定各组患者IBS症状严重程度评分(IBS-SSS);并于基线期、治疗6周及随访12周评定各组患者IBS生活质量量表(IBS-QOL)评分。结果:两组IBS-C患者治疗2、4、6周及随访12周IBS-SSS总积分均较基线期降低(P<0.01);IBS-C针刺组随访12周IBS-SSS总积分低于聚乙二醇组(P<0.05)。两组IBS-D患者治疗2、4、6周及随访12周IBS-SSS总积分均较基线期降低(P<0.01);IBS-D针刺组治疗2、4、6周及随访12周IBS-SSS总积分均低于匹维溴铵组(P<0.05)。两组IBS-C患者治疗6周及随访12周IBS-QOL总分均较基线期升高(P<0.01)。两组IBS-D患者治疗6周及随访12周IBS-QOL总分均较基线期升高(P<0.01);IBS-D针刺组随访12周IBS-QOL总分高于匹维溴铵组(P<0.05)。结论:"调神健脾"法针刺可改善IBS-C和IBS-D患者的临床症状,提高患者生活质量;可治疗同一疾病(肠易激综合征)的不同功能状态(便秘、腹泻),体现了针刺的双向调节效应。Objective To explore the bidirectional regulation of acupuncture based on a subgroup analysis of multicenter randomized controlled trial of acupuncture with Tiaoshen Jianpi for irritable bowel syndrome(IBS). Methods A total of 519 patients were included in the analysis, including 137 patients with constipation type irritable bowel syndrome(IBS-C)(92 cases in the acupuncture group and 45 cases in the polyethylene glycol [PEG] group), and 382 patients with diarrhea type irritable bowel syndrome(IBS-D)(252 cases in the acupuncture group and 130 cases in the pinaverium group). The patients in the acupuncture group were given acupuncture at Baihui(GV 20), Yintang(GV 29), Tianshu(ST 25), Shangjuxu(ST 37), Zusanli(ST 36), Sanyinjiao(SP 6) and Taichong(LR 3) once every other day, 3 times a week. The patients in the PEG group received polyethylene glycol 4000 powder orally, and the pinaverium group received pinaverium bromide tablets orally. All were treated for 6 weeks. The IBS symptom severity score(IBS-SSS) was assessed at baseline, treatment period(2, 4, 6 weeks of treatment) and 12 weeks of follow-up, and the IBS quality of life(IBS-QOL) score was evaluated at the baseline period, 6 weeks of treatment and 12 weeks of follow-up. Results The total IBS-SSS scores of the two groups of IBS-C patients at 2, 4, 6 weeks of treatment and follow-up of 12 weeks were lower than those in the baseline period(P<0.01). The total IBS-SSS score in the IBS-C acupuncture group was lower than that in the PEG group at 12 weeks of follow-up(P<0.05). The total IBS-SSS scores of the two groups of IBS-D patients at 2, 4, 6 weeks of treatment and 12 weeks of follow-up were lower than those in the baseline period(P<0.01). The total IBS-SSS scores in the IBS-D acupuncture group were lower than those in the pinaverium group at 2, 4, 6 weeks of treatment and 12 weeks of follow-up(P<0.05). The total IBS-QOL scores at 6 weeks of treatment and 12 weeks of follow-up were higher than those in the baseline period in both groups of patients with IBS-C(P<

关 键 词：肠易激综合征 针刺 调神健脾 双向调节效应 多中心随机对照试验 亚组分析 

分 类 号：R246.1[医药卫生—针灸推拿学]