艾灸治疗溃疡性结肠炎临床疗效及对维生素D受体的影响  

Clinical efficacy of moxibustion for ulcerative colitis and its influence on vitamin D receptor

作　　者：林晓映 王文佳 祁琴 李琪 吴梦蝶 吴焕淦 刘雅楠 黄艳 朱毅 郑寒丹 吴璐一 IM Hyoyoung;WANG Wenjia;QI Qin;LI Qi;WU Mengdie;WU Huangan;LIU Yanan;HUANG Yan;ZHU Yi;ZHENG Handan;WU Luyi(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200437,China;Shanghai Research Institute of Acupuncture and Meridian,Shanghai,200030,China;Shanghai University of Traditional Chinese Medicine,Shanghai,201203,China)

机构地区：[1]Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200437,China [2]Shanghai Research Institute of Acupuncture and Meridian,Shanghai,200030,China [3]Shanghai University of Traditional Chinese Medicine,Shanghai,201203,China

出　　处：《Journal of Acupuncture and Tuina Science》2023年第1期40-50,共11页针灸推拿医学（英文版）

基　　金：国家自然科学基金项目,No.81973955,No.82174501,No.81973953;上海市卫生健康委员会科研项目,No.20194Y0005;上海市科学技术委员会青年科技英才扬帆计划项目,No.20YF1445200;上海市教委预算内科研项目,No.2021LK094.

摘　　要：目的观察隔药饼灸治疗溃疡性结肠炎(UC)的临床疗效,并从维生素D受体(VDR)信号通路角度阐释其效应机制。方法将63例UC患者随机分为观察组30例(采用隔药饼灸治疗)和对照组33例(采用假隔药饼灸治疗)。两组均取气海和双侧天枢、上巨虚治疗,每周3次,共治疗12周。比较两组的总有效率、患者腹胀和腹痛视觉模拟量表(VAS)和医院焦虑抑郁量表(HADS)评分;酶联免疫吸附测定法检测血清C反应蛋白(CRP)、25羟维生素D[25(OH)D]、白细胞介素-12(IL-12)/白细胞介素-23(IL-23)p40的浓度;免疫组化法检测结肠VDR和再生基因蛋白IV(Reg IV)蛋白的表达;实时荧光定量聚合酶链反应检测结肠黏膜VDR、细胞色素P450家族成员27B1(CYP27B1)和Reg IV mRNA的表达。结果治疗后,观察组总有效率为86.7%,明显高于对照组的51.5%(P<0.05)。治疗后,观察组腹痛和腹胀VAS评分降低(P<0.01),HADS的抑郁亚量表(HADS-D)和焦虑亚量表(HADS-A)评分均降低(P<0.05),对照组仅腹痛VAS评分明显降低(P<0.05);观察组评分改善情况均优于对照组(P<0.05)。治疗后,两组患者血清CRP浓度、观察组血清IL-12/IL-23 p40浓度均降低(P<0.05),观察组的浓度均低于对照组(P<0.05);两组患者结肠VDR蛋白和mRNA的表达明显升高(P<0.01),而Reg IV蛋白和mRNA以及CYP27B1 mRNA的表达均明显降低(P<0.05或P<0.01),观察组较对照组改善更为显著(P<0.05或P<0.01)。结论隔药饼灸能有效缓解UC患者腹痛、腹泻症状,改善抑郁、焦虑情绪,并能调节VDR信号通路相关蛋白的表达。其作用机制可能是通过减少促炎细胞因子IL-12/IL-23 p40的释放来抑制肠道炎症。Objective To observe the clinical efficacy of herbal cake-partitioned moxibustion for ulcerative colitis(UC)and elucidate its mechanism by targeting the vitamin D receptor(VDR)signaling pathway.Methods A total of 63 patients with UC were randomly divided into an observation group(30 cases,treated with herbal cake-partitioned moxibustion)and a control group(33 cases,treated with sham herbal cake-partitioned moxibustion).Moxibustion treatment was performed at Qihai(CV6)and bilateral Tianshu(ST25)and Shangjuxu(ST37),3 times per week for 12 weeks.The total effective rate,visual analog scale(VAS)score for abdominal bloating and pain,and hospital anxiety and depression scale(HADS)score were compared between the two groups.Enzyme-linked immunosorbent assay was used to detect the concentrations of serum C-reactive protein(CRP),25-hydroxyvitamin D[25(OH)D],and interleukin-12(IL-12)/interleukin-23(IL-23)p40.Immunohistochemistry was used to observe the expression levels of VDR and regenerating gene IV(Reg IV)proteins in colonic mucosa.The expression levels of VDR,cytochrome p45027B1(CYP27B1),and Reg IV mRNAs were detected by real-time fluorescence quantitive polymerase chain reaction.Results After treatment,the total effective rate in the observation group was 86.7%,which was significantly higher than 51.5%in the control group(P<0.05).After treatment,the VAS scores for abdominal bloating and pain in the observation group were significantly decreased(P<0.01),as well as the HADS-depression subscale(HADS-D)and HADS-anxiety subscale(HADS)scores(P<0.05),while only the VAS score for abdominal pain in the control group was reduced(P<0.05),and the improvements of the scores in the observation group were more significant than those in the control group(P<0.05).After treatment,the serum CRP concentrations in both groups and the IL-12/IL-23 p40 concentration in the observation group were significantly decreased(P<0.05),and the concentrations in the observation group were lower than those in the control group(P<0.05).The expression lev

关 键 词：灸法 药饼灸疗法 结肠炎 溃疡性 黏膜 维生素D受体 临床试验 

分 类 号：R245.8[医药卫生—针灸推拿学]