耳甲电针治疗功能性消化不良的临床效果

目的:观察耳甲电针治疗功能性消化不良的疗效。方法:选取2018年6月至2019年5月北京同仁医院收治的功能性消化不良患者90例作为研究对象,按照随机数字表法分为对照组和观察组,每组45例,对照组采用对照刺激,观察组采用耳甲电针刺激,所有患者治疗前后均使用功能性消化不良主要症状评分表、功能性消化不良生命质量量表(FDDQL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)评估患者症状的严重程度,并参照功能性消化不良中医诊疗专家共识意见和功能性消化不良中西医结合诊疗共识意见的疗效评估方法,对比分析观察组与对照组治疗功能性消化不良的疗效。结果:观察组和对照组治疗前主要症状评分表、功能性消化不良生命质量量表(FDDQL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)差异无统计学意义(P>0.05),治疗后观察组症状及量表评分与对照组差异有统计学意义(P<0.05)。观察组治疗有效率82.22%,对照组治疗有效率57.78%,差异有统计学意义(P<0.05)。结论:耳甲电针对于功能性消化不良的各项症状具有较好的疗效。     

经皮耳迷走神经刺激干预功能性消化不良模型大鼠的效应及机制研究

ObjectiveTo explore the effect and its possible mechanism of the intervention of transcutaneous auricular vagus nerve stimulation (taVNS) for the functional dyspepsia (FD) model rats.MethodsOf the 25 male SD rats, 6 rats were set as blank group, the other 19 rats were established to be the functional dyspepsia (FD) model by iodoacetamide intragastric administration, and 18 FD models were successfully established. The 18 model rats were randomly divided into a model group, a sham-taVNS group, and taVNS group, with 6 rats in each group. There was no intervention applied to the rats in the blank and model groups. Whereas, the rats in sham-taVNS group received stimulation to the rim of auricular concha of both sides, and those in taVNS group received stimulation to the cavity of auricular concha of both sides, for 30 min each time, once a day, 7 days in succession. After the intervention, the gastric sensitivity of the rats in each group under different pressure conditions in the stomach, the expressions of serum brain-gut peptide motilin (MTL), cholecystokinin (CCK), glucagon-likepeptide1 (GLP-1), and inflammatory factors IL-4, IL-10, and IL-1β were detected.Results(1) Gastric sensitivity: compared with the blank group, the gastric sensitivity of the model group was higher (P <0.05). Compared with the model group, the gastric sensitivity of the taVNS group was lower (P < 0.05). Compared with the sham-taVNS group, the gastric sensitivity of the taVNS group was lower (P <0.05).(2) Expression of brain-gut peptide: compared with the blank group, MTL was lower, CCK and GLP-1 were higher in the model group (all P <0.05). Compared with the model group, MTL was higher, CCK and GLP-1 were lower in the taVNS group (all P <0.05). Compared with the sham-taVNS group, CCK and GLP-1 were lower in the taVNS group (both P<0.05). (3)Expression of inflammatory factors: compared with the blank group, IL-4 and IL-10 were lower and IL-1β was higher in the model group (all P <0.05). Compared with the model group, IL-10 was higher and IL-1β was lower in the sham-taVNS group (all P <0.05), while IL-4 and IL-10 were higher and IL-1β was lower in the taVNS group (all P <0.05). Compared with the sham-taVNS group, IL-4 and IL-10 were higher and IL-1β was lower in the taVNS group (all P <0.05).ConclusionTaVNS can reduce the gastric sensitivity of FD model rats by peripheral anti-inflammatory action and regulating the abnormal secretion of brain-gut peptide.     

温肾健脾调枢方对脾肾阳虚型腹泻型肠易激综合征大鼠GFAP、BDNF表达的影响

目的 观察温肾健脾调枢方对脾肾阳虚型腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,IBS-D)大鼠胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)表达的影响,从实验角度探讨该方对IBS-D的疗效及作用机制.方法 72只Wistar大鼠随机分为6组:正常组(NG)、模型组(MG)、中药高中低剂量组(WHG、WMG、WLG)和匹维溴铵对照组(CG),每组12只.除NG外,其余各组均采用避水应激+番泻叶灌胃法建立脾肾阳虚型IBS-D大鼠模型.造模结束后,中药治疗组分别予温肾健脾调枢方高、中、低剂量灌胃,CG予匹维溴铵灌胃,MG、NG予等体积生理盐水灌胃,疗程10d.观察各组大鼠排便粒数、内脏敏感性和组织病理学,免疫组化检测结肠组织中GFAP、BDNF表达.结果 治疗结束,WHG、CG和WMG排便粒数显著少于MG (P ＜0.01),且WHG少于CG (P ＜0.05);60、80 mmHg时各组大鼠腹壁撤退反射(AWR)评分表现出差异,各治疗组AWR评分低于MG (P ＜0.05),且WHG低于CG(P＜0.05);组织病理学观察MG和WLG黏膜可见轻度水肿;各治疗组大鼠结肠组织GFAP表达均低于MG (P ＜0.05),且WMG低于CG(P＜0.05);WHG、WMG和CG结肠组织BDNF表达低于MG (P ＜0.05),且WHG低于CG (P＜0.05).结论 温肾健脾调枢方能够减少IBS-D大鼠排便粒数、降低内脏敏感性,其治疗机理可能是通过影响结肠组织中GFAP、BDNF的表达,进而起到调节内脏敏感性的作用.     

经皮耳穴迷走神经刺激治疗功能性消化不良的机制研究

目的:观察经皮耳穴迷走神经刺激(taVNS)对功能性消化不良(FD)模型大鼠胃敏感性及胃动力的影响，探讨其作用机制。方法:选用5日龄SD大鼠，以灌服碘乙酰胺法复制FD模型。大鼠随机分为空白组、模型组、taVNS组、膈下迷走神经刺激组、膈下迷走神经假刺激组。taVNS组大鼠予以taVNS,膈下迷走神经刺激组通过植入的电极给予膈下迷走神经刺激，膈下迷走神经假刺激组仅植入电极而不予刺激，模型组不予刺激。以上干预均为30 min/次，1次/d,连续干预14 d。分别于干预前后检测各组大鼠颈斜方肌肌电(EMG)变化率，于干预后测定胃排空率，ELISA法检测十二指肠组织乙酰胆碱(ACh)、烟碱型乙酰胆碱N型受体α7亚单位(α7nAChR)、白细胞介素(IL)-6、IL-1β及肿瘤坏死因子-α(TNF-α)的含量，Western blot法测定十二指肠组织中核因子-κB(NF-κB)p65的表达。结果:与空白组比较，模型组大鼠在40、60、80 mm Hg压力时颈斜方肌EMG变化率、十二脂肠组织NF-κB p65表达及IL-6、IL-1β、TNF-α含量均升高(P<0.05,P<0.01...     

胃不和则卧不安——魏玮教授从脾胃论治失眠的学术思想

＂卧不安＂现代医学多理解为失眠,中医将失眠命名＂不寐＂、＂不得卧＂＂目不瞑＂。古代医家通过长期临床实践发现不寐和胃家不和症状常常兼夹出现,因此提出＂胃不和则卧不安＂的重要理论,认为脾胃疾病患者不寐是多种原因导致胃气失于和降,浊气上泛,扰乱心神而卧不安,即“胃不和则卧不安”。     

经皮耳穴迷走神经刺激对功能性消化不良大鼠的肠道连接蛋白的作用

Objective:Transcutaneous auricular vagus nerve stimulation(taVNS) can relieve the symptoms of functional dyspepsia(FD) and improve the quality of life of patients,however,the mechanism underlying this effect remains unclear.Therefore,this study aimed to investigate the effects of taVNS on the expression of intestinal mucosal ligandins.Methods:This study was conducted on 24 specific Spathogen-free Sprague-Dawley rats(12 males and12 females).The rat model of FD was established by tail-clip stimulation.After FD was established successfully,all rats were randomized to either the normal group(n=6),model group(n=6),taVNS group(n=6),or sham-taVNS group(n=6).After two weeks of the respective intervention,the score of their general conditions,3 h food intake,gastric emptying rate,and the histology of gastric antrum tissues were observed to evaluate modeling success,and then the effect of taVNS was evaluated.Western blotting was used to assess the expression of the tight junction ligandins-ZO-1 and occludin-and the adhesion ligandin-β-catenin-in the duodenum.The effect of taVNs on the expression of intestinal mucosal barrier ligandins-ZO-1,occludin,and β-catenin-in FD rats was preliminarily investigated.Results:When the model-induced period was finished,the manifestations of FD in the model group rats were mental exhaustion,reduced activities,decreased score of the general conditions,and decreased3 h food intake,compared to the normal group rats.In addition,minimal eosinophil infiltration,without any mucosal erosion or ulcer,was observed in the gastric antrum mucosa.At the end of the study,the mental state of the FD rats improved,and their activities and gastric emptying rate increased in the taVNS group rats.Compared to the normal rats,the duodenal mucosa had less expression of the tight junction ligandins ZO-1 and occludin,but β-catenin expression remained unchangedin the model rats.The expression of the tight junction ligandins ZO-1 and occludin were increased in the duodenal mucosa of model rats after the taVNS intervention.Conclusion:TaVNS can improve the gastric motility and mental state of rats with FD.It may play a therapeutic role by improving the expression of the tight junction ligandin ZO-1 and occludin in the duodenal mucosa,while also repairing the duodenal mucosal barrier.     

胃康宁治疗功能性消化不良寒热错杂证患者的心理疗效观察

正功能性消化不良(functional dyspepsia,FD)是一组以持续性或反复性发作上腹部疼痛、食后饱胀、腹部胀气、嗳气、早饱、厌食、恶心等上腹部不适为主要症状的临床症候群,属功能性胃肠病范畴~([1])。付朝伟等~([2])研究发现FD患者合并焦虑或(和)抑郁症状的患者为23.6%,在具有焦虑或(和)抑郁症状的FD患者中,焦虑障碍或(和)抑郁的患病率为68.7%。在临床中既能帮