基于肠道菌群针灸干预卒中后便秘的临床研究  

Clinical Study on Acupuncture Treatment for Post-Stroke Constipation Based on Intestinal Flora

作　　者：孙一鸣 张杰 刘佳琳[3,4] 王涛 郭颢龙[3,4] 田光 李桂平[3,4] SUN Yiming;ZHANG Jie;LIU Jialin;WANG Tao;GUO Haolong;TIAN Guang;LI Guiping(Chengdu Eighth People s Hospital,Chengdu 610017,China;Geriatric Hospital of Chengdu Medical College,Chengdu 610017,China;National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300380,China;The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300380,China)

机构地区：[1]成都市第八人民医院,四川成都610017 [2]成都医学院附属老年医院,四川成都610017 [3]国家中医针灸临床医学研究中心,天津300380 [4]天津中医药大学第一附属医院,天津300380

出　　处：《针灸临床杂志》2024年第11期17-24,共8页Journal of Clinical Acupuncture and Moxibustion

基　　金：国家中医药管理局国家中医临床研究基地项目,编号:JDZX2012143;天津市高校中青年骨干创新人才项目,编号:TL19010231。

摘　　要：目的:在研究针刺与艾灸治疗卒中后便秘临床疗效的基础上,探索针刺与艾灸治疗后患者肠道菌群结构变化。方法:观察80名卒中后便秘患者针灸治疗前后便秘患者生活质量量表、便秘症状量表、自然排便性状、自然排便频率、排便耗时和肠鸣音次数等临床指标;采用16S rDNA扩增子测序,检测卒中后便秘患者针灸治疗前后粪便样本,分析针灸对卒中后便秘患者肠道菌群结构的影响。结果:艾灸组患者治疗后肠杆菌、肠球菌和变形菌门相对丰度均较治疗前降低,针刺组患者治疗后肠杆菌、肠球菌和变形菌无显著改变;针刺组与治疗组患者梭菌相对丰度均较治疗前降低,趋近于卒中后无便秘患者组;两组治疗后乳杆菌丰度均提高,艾灸组乳酸杆菌丰度显著高于针刺组,但仍低于卒中后无便秘患者乳酸杆菌丰度;艾灸组治疗后双歧杆菌、乳酸杆菌和总产SCFAs菌相对丰度升高优于针刺组,其中乳酸杆菌、总产SCFAs菌差异具有统计学意义。结论:针刺、艾灸均能够改善卒中后便秘患者临床症状,在改善患者粪便性状及增强肠道蠕动方面,艾灸优于针刺疗法;针刺和艾灸均能调节卒中后便秘患者肠道菌群结构,其中针刺可降低产甲烷菌丰度;艾灸在增加卒中后便秘患者产SCFAs菌、双歧杆菌和乳酸杆菌,减少肠杆菌、肠球菌和梭菌丰度方面作用更加明显。Objective:To explore the changes in gut microbiota structure in patients based on the clinical efficacy of acupuncture and moxibustion treatment for post-stroke constipation.Methods:80 patients with post-stroke constipation were observed before and after acupuncture and moxibustion treatment.Clinical indicators included the Constipation-Related Quality of Life Scale,Constipation Symptom Scale,natural defecation shape,natural defecation frequency,defecation time,and bowel sound frequency.Additionally,16S rDNA amplicon sequencing was used to analyze fecal samples from these patients before and after acupuncture and moxibustion treatment to evaluate the effect on gut microbiota structure in patients with post-stroke constipation.Results:In the moxibustion group,the relative abundances of Enterobacter,Enterococcus and Proteobacteria were all reduced after the treatment compared to those before the treatment.In the acupuncture group,there were no significant changes in Enterobacter,Enterococcus and Proteobacteria after the treatment.The relative abundance of Clostridium in both the acupuncture and moxibustion groups decreased after the treatment,approaching the levels found in the post-stroke patients without constipation.Both groups showed an increase in Lactobacillus abundance after the treatment,with the moxibustion group exhibiting a significantly higher Lactobacillus abundance than the acupuncture group,though still lower than in the post-stroke patients without constipation.Additionally,the moxibustion group showed a greater increase in the relative abundances of Bifidobacterium,Lactobacillus and total SCFAs-producing bacteria compared to the acupuncture group,with statistically significant differences in Lactobacillus and total SCFAs-producing bacteria.Conclusion:Both acupuncture and moxibustion can improve clinical symptoms in patients with post-stroke constipation.In terms of improving stool shape and enhancing intestinal peristalsis,moxibustion is superior to acupuncture.Both acupuncture and moxibustion can

关 键 词：卒中 便秘 针刺 艾灸 肠道菌群 

分 类 号：R246.6[医药卫生—针灸推拿学]