针刺治疗腹泻型肠易激综合征及其对脑-肠肽水平变化的影响  

Clinical response and changes on the level of brain-gut peptide in patients with diarrhea-predominant irritable bowel syndrome with acupuncture

作　　者：占道伟[1] 孙建华[2] 钱立锋[1] ZHAN Daowei;SUN Jianhua;QIAN Lifeng(Department of Rehabilitation Medicine,Jiaxing Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine,Jiaxing 314001,Zhejiang,China;Department of Acupuncture and Moxibustion,Jiangsu Province Hospital of Chinese Medicine(Affiliated Hospital of Nanjing University of Chinese Medicine),Nanjing 210029,Jiangsu,China)

机构地区：[1]浙江中医药大学附属嘉兴市中医医院康复科,浙江嘉兴314001 [2]江苏省中医院(南京中医药大学附属医院)针灸科,江苏南京210029

出　　处：《中国现代医生》2023年第5期15-19,共5页China Modern Doctor

基　　金：浙江省中医药科技计划基金项目(2021ZB289)。

摘　　要：目的观察“调神健脾”配穴针刺治疗腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,IBS-D)的临床疗效及其对脑-肠肽水平变化的影响。方法选取2020年9月至2022年12月嘉兴市中医医院就诊的66例IBS-D患者,采用随机数字表法分为针刺组(n=33)与药物组(n=33)。药物组接受常规药物治疗,针刺组选取百会、印堂及太冲等穴位针刺治疗,疗程均为4周。测定两组患者治疗前后血清脑-肠肽水平变化,比较两组患者在治疗前、治疗后及随访时IBS-D临床症状积分与肠易激综合征生活质量量表(irritable bowel syndrome quality of life,IBS-QOL)评分,评估两组疗效。结果治疗前两组患者脑-肠肽水平比较,差异无统计学意义(P>0.05),治疗后两组均有所下降,差异无统计学意义(P>0.05)。针刺组在临床症状与IBS-QOL部分维度改善程度方面优于药物组,差异有统计学意义(P<0.05);针刺组临床疗效优于对照组,差异有统计学意义(P<0.05)。结论“调神健脾”配穴针刺治疗IBS-D疗效显著,可明显缓解腹痛,提高生活质量,调适负面情绪和焦虑等情绪障碍,可能与针刺通过降低脑-肠肽水平、调节体内脑-肠互动紊乱失衡状态、下调内脏高敏感性有关。Objective To observe the clinical efficacy on patients with diarrhea-predominant irritable bowel syndrome(IBS-D)with acupuncture for regulating shen and strengthening spleen and its influence on the level of brain-intestinal peptide.Methods A total of 66 patients with IBS-D admitted to Jiaxing Hospital of Traditional Chinese Medicine from September 2020 to December 2022 were selected and divided into the acupuncture group(n=33)and the drug group(n=33)according to the random number table method.The drug group received conventional drug treatment and the acupuncture group selected acupuncture points of Baihui,Yin Tang and Tai Chong for 4 weeks.Serum brain-gut peptide levels were measured before and after treatment,and the clinical symptom scores of IBS-D and the irritable bowel syndrome quality of life(IBS-QOL)scores were compared between the two groups before and after treatment,and at follow-up to assess the efficacy of the two groups.Results Compared with the level of brain-gut peptide in the two groups before treatment,the difference was not statistically significant(P>0.05)and decreased in both groups after treatment,the difference was not statistically significant(P>0.05).The acupuncture group outperformed the drug group in terms of improvement in clinical symptoms and some dimensions of IBS-QOL,with a statistically significant difference(P<0.05);the clinical efficacy of the acupuncture group was better than that of the control group,with a statistically significant difference(P<0.05).Conclusion The treatment of acupuncture for regulating shen and strengthening spleen has a significant effect on IBS-D,which can significantly relieve abdominal pain,improve quality of life,adjust negative emotions,anxiety and other emotional disorders,this may be related to the fact that acupuncture regulates the imbalance of brain-gut interaction and down-regulates visceral hypersensitivity by lowering brain-gut peptide levels.

关 键 词：腹泻型肠易激综合征 针刺 调神健脾 5-羟色胺 神经肽Y 降钙素基因相关肽 脑-肠互动 

分 类 号：R245.1[医药卫生—针灸推拿学]