基于“心胃相关”理论针刺治疗胃食管反流病的临床疗效及对血清胃肠激素的影响  

Clinical effect of acupuncture for gastroesophageal reflux disease based on the"heart-stomach connection"theory and its effects on serum gastrointestinal hormones

作　　者：何婧 李璟[2] 胡智海 王毅 马桂芝 吴焕淦[2,3] 张静静 董烨卿 HE Jing;LI Jing;HU Zhihai;WANG YI;MA Guizhi;WU Huangan;ZHANG Jingjing;DONG Yeqing(Department of Acupuncture and Moxibustion,Shanghai University of TCM,Shanghai TCM-Integrated Hospital,Shanghai 200082,China;Department of Acupuncture and Moxibustion,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of TCM,Shanghai 200437;Immunology Laboratory,Shanghai Research Institute of Acupuncture and Meridian;Department of TCM,Shanghai Jiangwan Hospital)

机构地区：[1]上海中医药大学附属上海市中西医结合医院针灸科,上海200082 [2]上海中医药大学附属岳阳中西医结合医院针灸科,上海200437 [3]上海市针灸经络研究所免疫研究室 [4]上海市江湾医院中医科

出　　处：《中国针灸》2024年第6期625-630,共6页Chinese Acupuncture & Moxibustion

基　　金：上海市卫生和计划生育委员会科研课题青年项目:20184Y0355;上海市“科技创新行动计划”医学创新研究专项项目面上项目:21Y11923500;上海市名老中医学术经验研究工作室建设项目:SHGZS-202212。

摘　　要：目的:观察基于“心胃相关”理论针刺对胃食管反流病的影响,探讨其可能作用机制。方法:将70例胃食管反流病患者随机分为针刺组(35例,脱落2例)和西药组(35例,脱落1例)。针刺组予针刺治疗,穴取双侧神门、内关、不容、天枢、足三里、公孙及中脘,留针30 min,隔日1次,每周3次;西药组予口服奥美拉唑胶囊,每日1次,每次20 mg。两组均治疗8周。观察两组患者治疗前后胃食管反流病问卷(GERDQ)、胃食管反流病生存质量量表(GERD-QOL)、汉密尔顿抑郁量表(HAMD-24)、Zung抑郁自评量表(SDS)、Zung焦虑自评量表(SAS)评分,检测治疗前后血清胃肠激素[胃泌素(GAS)、胃动素(MTL)、血管活性肠肽(VIP)]含量,并评定两组临床疗效。对治疗前GERDQ评分与GERD-QOL、HAMD-24、SDS、SAS评分进行相关性分析。结果:治疗后,两组GERDQ、HAMD-24、SDS、SAS评分均较治疗前降低(P<0.001),GERD-QOL评分均较治疗前升高(P<0.001),血清GAS、MTL含量均较治疗前升高(P<0.001),针刺组血清VIP含量较治疗前降低(P<0.001);针刺组GERD-QOL评分高于西药组(P<0.05),SAS评分低于西药组(P<0.05),血清VIP含量低于西药组(P<0.05)。针刺组总有效率为75.8%(25/33),西药组总有效率为76.5%(26/34),组间比较差异无统计学意义(P>0.05)。治疗前,GERDQ评分与GERD-QOL评分存在负相关关系(r=-0.762,P<0.01),与HAMD-24、SDS、SAS评分存在正相关关系(r=0.709、0.649、0.689,P<0.01)。结论:基于“心胃相关”理论针刺能有效改善胃食管反流病患者的临床症状、生活质量、不良情绪,其机制可能与调节胃肠激素水平,进而促进食管下括约肌收缩有关。Objective To observe the effect of acupuncture on gastroesophageal reflux disease(GERD)based on the"heart-stomach connection"theory,and to explore its possible mechanisms.Methods Seventy patients with GERD were randomly divided into an acupuncture group(35 cases,2 cases dropped out)and a medication group(35 cases,1 case dropped out).The patients in the acupuncture group received acupuncture at bilateral Shenmen(HT 7),Neiguan(PC 6),Burong(ST 19),Tianshu(ST 25),Zusanli(ST 36),Gongsun(SP 4),and Zhongwan(CV 12),with needles retained for 30 min,every other day,three times a week.The patients in the medication group were treated with oral omeprazole capsules,once daily,20 mg each time.Both groups were treated for 8 weeks.Before and after treatment,the GERD questionnaire(GERDQ),GERD-quality of life scale(GERD-QOL),Hamilton depression scale-24(HAMD-24),Zung self-rating depression scale(SDS),and Zung self-rating anxiety scale(SAS)scores were observed.Serum levels of gastrointestinal hormones(gastrin[GAS],motilin[MTL],and vasoactive intestinal peptide[VIP])were measured,and the clinical efficacy of both groups was evaluated.Correlation between pre-treatment GERDQ score and GERD-QOL score,HAMD-24 score,SDS score,and SAS score was analyzed.Results After treatment,the scores of GERDQ,HAMD-24,SDS,and SAS were decreased(P<0.001)and the scores of GERD-QOL were increased(P<0.001),serum levels of GAS and MTL were increased(P<0.001)in both groups,while the serum level of VIP in the acupuncture group was decreased(P<0.001)compared with those before treatment.The acupuncture group had higher GERD-QOL score and lower SAS score than the medication group(P<0.05),with lower serum VIP level(P<0.05).The total effective rate was 75.8%(25/33)in the acupuncture group,and 76.5%(26/34)in the medication group,with no significant difference between the two groups(P>0.05).GERDQ score was negatively correlated with GERD-QOL scores(r=-0.762,P<0.01)and positively correlated with HAMD-24 score,SDS score,and SAS score(r=0.709,0.649,0.689,P<0.01)before

关 键 词：胃食管反流病 针刺 心胃相关 胃肠激素 随机对照试验 

分 类 号：R246[医药卫生—针灸推拿学]