【作者】 吴晓亮；

【导师】 孙建华；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2011， 硕士

【摘要】 研究目的：通过分析针刺对肠易激综合征的临床疗效及其脑-肠交互作用模型CGRP、HT、NPY的干预效果,探索针刺治疗肠易激综合征的机制。研究方法：采用单盲随机对照研究,将117例IBS患者随机分为两组,治疗组56例,予针刺治疗,对照组61例,予药物治疗,比较两组治疗前后症状积分和腹痛或不适程度视觉评分(VAS),评价临床疗效；将实验大鼠分为模型组、治疗组和对照组,通过慢急性联合应激建立和再评价脑-肠交互作用IBS动物模型,待建模成功后,部分模型大鼠作为治疗组,接受电针治疗14天后,与常规喂养的模型组和对照组比较一般行为学指标,并检测三组大鼠下丘脑、脊髓腰膨大和远端结肠中CGRP、HT、NPY的含量,评估针刺的影响作用。研究结果：①两组基线比较具有可比性,治疗结束后,治疗组症状评分低于对照组(p<0.05),两组随访评分较治疗结束时均有不同程度的升高(P<0.05),但治疗组仍低于对照组；针刺治疗组总有效率为90.0%,优于药物对照组84.0%(p<0.01),两组临床痊愈率均偏低。②复制并评价慢急性联合应激大鼠模型,证实该模型兼具肠道动力异常、内脏高敏感和心理行为的改变,其结肠未见明显的组织病理学异常发生,提示建模成功。③经连续2周电针干预后,治疗组1小时排便颗粒数、糖水摄取量和CRD阈值明显不同于模型组(P<0.01),接近对照组(P>0.05)；模型组结肠、下丘脑和脊髓标本的5-HT、CGRP和NPY的含量均有异常改变(P<0.05),而治疗组含量均接近对照组(P>0.05)。结论：①针刺治疗IBS,临床起效较快,并随疗程越长,临床症状的改善效果越明显,能够明显减轻患者的腹痛或不适症状,治疗结束1月后,患者病情均有不同程度的复发,但其长期疗效仍明显优于药物治疗。②电针治疗能够调节脑-肠交互作用肠易激综合征模型大鼠的肠动力异常、心理行为异常和内脏高敏感等引起的症状,脑-肠轴5-HT、CGRP和NPY的含量异常与IBS症状密切相关,而针刺治疗能够调节模型大鼠5-HT、CGRP和NPY异常表达,使之恢复正常状态,达到治疗IBS的目的。更多还原

【Abstract】 Purpose:Through clinical observation and animal research, to explore the effect of interference and the regulation mechanism of acupuncture on irritable bowel syndrome and the CGRP,5HT, NPY of the brain-gut interaction model.Methods:It’s a single-blind randomized controlled clinical trial, and 117 patients with IBS were randomly divided into two groups. Treatment group with 56 patients were accepted with acupuncture, and the control group with 61 patients was treated with Pinaverium Bromide Tablets and Fiberform for symptomatic treatment. Symptom scores and VAS scores of abdominal pain or discomfort before and after treatment were compared to evaluate its clinical effect; this research is to build and re-evaluate the brain-gut interaction model of IBS with the slow acute joint stress,16 of the successful models were randomly selected as the treatment group with EA therapy. After the treatment, the role of acupuncture was assessed with its general behavior and the detection of levels of CGRP,5HT, NPY in the hypothalamus, spinal cord (L4-L6) and distal colon among three groups.Results:①Symptom scores were compared, the treatment group score have been lower than the control group (p<0.05) since the first week.1 month after the treatment, both groups score increased than the score after treatment(P<0.05); the total effective rate of treatment group was 90.0%, better than the drug control group 84.0%(p<0.01), both clinical cure rates are low.②After the modeling and evaluation, the result have confirmed that the model established with abnormal intestinal motility, visceral hypersensitivity and psychological behavior change, and there is no obvious intestinal histopathological abnormalities occur, which suggest modeling success.③After the treatment with EA for 2 weeks, stool particles for 1 hour, syrup intake and CRD threshold of treatment group were significantly different from the model group (P<0.01), similar number of the control group (P>0.05); the levels of 5-HT, CGRP and NPY in the colon, hypothalamic and spinal cord specimens of model group were abnormal (P<0.05), while the levels of the treatment group were similar to the control group (P> 0.05).Conclusion:①The acupunctrue therapy for IBS produce faster effect and have more obvious effects with the longer course of treatment, can significantly reduce abdominal pain or discomfort. After the treatment, patients often have got the IBS symptoms again, but acupuncture still have better long-term effect than drug treatment.②Electroacupuncture can regulate the symptoms caused by intestinal motility disorders, psychological and behavioral abnormalities and visceral hypersensitivity on the brain-gut interaction rat model of irritable bowel syndrome.The 5-HT, CGRP and NPY of the brain-gut axis were closely related with the IBS symptoms, while acupuncture can regulate the abnormal expression of 5-HT. CGRP and NPY, so as to restore the balance and to get good effect on IBS.更多还原