基于尺肤理论的针药联合模式对腹泻型肠易激综合征患者内脏敏感度改善效果及病情严重程度与肿瘤坏死因子α、神经肽Y、血管紧张素Ⅱ的相关性研究  

Combination of Acupuncture and drugs on visceral sensation in patients with diarrhea-predominant irritable bowel syndrome and its influences on tumor necrosis factor-α,neuropeptide Y,angiotensinⅡ:Based on ulnar skin theory

作　　者：张晓敬[1] 高社光[1] 王维[1] 孙胜振[1] 张吉敏 ZHANG Xiaojing;GAO Sheguang;WANG Wei;SUN Shengzhen;ZHANG Jimin(Department of Nephrology and Endocrinology,Handan Hospital of Traditional Chinese Medicine,Handan,Hebei 056000)

机构地区：[1]河北省邯郸市中医院肾病内分泌科,河北邯郸056000

出　　处：《河北中医》2023年第5期742-746,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：河北省中医药管理局科研计划项目(编号:2019378)。

摘　　要：目的观察基于尺肤理论的针药联合治疗对腹泻型肠易激综合征(IBS-D)患者内脏敏感度改善效果及病情严重程度与肿瘤坏死因子α(TNF-α)、神经肽Y(NPY)、血管紧张素Ⅱ(AT-Ⅱ)的相关性。方法将127例IBS-D患者按照随机数字表法分为西药组(n=39)、中药组(n=43)及针药联合组(n=45),西药组采用匹维溴铵片口服治疗,中药组采用痛泄逍遥方治疗,针药联合组在中药组治疗基础上联合尺肤针刺疗法,3组均治疗4周。比较3组治疗前后IBS病情严重程度量表(IBS-SSS)评分、内脏敏感指数(VSI)评分;观察3组治疗前后直肠容量刺激感觉指标(排便阈值、疼痛阈值、感觉阈值及最大耐受阈值)水平;对比3组治疗前后血清TNF-α、NPY、AT-Ⅱ水平;Pearman相关系数分析IBS-SSS与血清TNF-α、NPY、AT-Ⅱ水平相关性。结果3组治疗后IBS-SSS、VSI评分均较本组治疗前降低(P<0.05),且针药联合组治疗后均低于西药组、中药组(P<0.05),中药组治疗后均低于西药组(P<0.05)。3组治疗后排便、疼痛、感觉、最大耐受阈值均较本组治疗前升高(P<0.05),且针药联合组治疗后均高于西药组、中药组(P<0.05),中药组治疗后均高于西药组(P<0.05)。3组治疗后TNF-α、AT-Ⅱ水平均较本组治疗前降低(P<0.05),NPY水平均升高(P<0.05),且治疗后针药联合组各项改善均优于西药组、中药组(P<0.05),中药组治疗后各项改善均优于西药组(P<0.05)。Pearson相关系数分析显示IBS-SSS评分与TNF-α、AT-Ⅱ呈正相关(P<0.05),与NPY呈负相关(P<0.05)。结论基于尺肤理论的针药联合治疗对提高IBS-D患者临床疗效、降低内脏敏感度等具有积极影响,亦可改善患者机体血清TNF-α、NPY、AT-Ⅱ水平,且本研究进一步证实IBS-D患者病情严重程度与血清TNF-α、NPY、AT-Ⅱ水平密切相关,为后续临床监测患者病情发展情况、制定针对性地有效诊疗方案提供参考。Objective To observe the combination of acupuncture and drugs based on ulnar skin theory on visceral sensation in patients with diarrhea-predominant irritable bowel syndrome(IBS-D)and its influences on tumor necrosis factor-α(TNF-α),neuropeptide Y(NPY),angiotensinⅡ(AT-Ⅱ).Methods Totally 127 IBS-D patients were randomly assigned to receive oral pinaverium bromide tablets(the Western medicine[WM]group,n=39)or Tongxie Xiaoyao Formula(the traditional Chinese medicine[TCM]group,n=43)or ulnar skin acupuncture+Tongxie Xiaoyao Formula(the combined group,n=45).A 4-week treatment was performed to compare IBS Severity Scoring System(IBS-SSS),Visceral sensitivity index(VSI),sensory indexes of rectal volume stimulation(threshold of defecation,pain,feeling,maximal tolerance),TNF-α,NPY,AT-Ⅱ.The correlation between IBS and serum levels of TNF-α,NPY,AT-Ⅱwas analyzed using Pearman correlation coefficient.Results After treatment,IBS-SSS and VSI in groups were decreased(P<0.05),the combined group was lower than those in the TCM group,and the TCM group were lower than the WM group(all P<0.05).The threshold of defecation,pain,feeling,maximal tolerance in groups were increased(P<0.05),the combined group was higher than the TCM group,and the TCM group were higher than the WM group(all P<0.05).Decreased TNF-αand AT-Ⅱand increased NPY were detected in the three groups after treatment(all P<0.05),improvement of which in the combined group were better than the TCM group(P<0.05),and the TCM group was better than the WM group(P<0.05).Pearson correlation coefficient showed that IBS-SSS was positively correlated with TNF-αand AT-Ⅱ,and negatively correlated with NPY(P<0.05).Conclusion For IBS-D patients,ulnar skin acupuncture combined drugs can effectively improve clinical efficacy,reduce visceral sensitivity,improve the levels of TNF-α,NPY and AT-Ⅱ,which is worthy of clinical application.However,the correlation degree of each index in this study needs to be further confirmed,aiming to provide reference for subsequent clinic

关 键 词：肠易激综合征 腹泻 针刺疗法 中药疗法 

分 类 号：R574[医药卫生—消化系统] R245.31[医药卫生—内科学]