针刺配合隔盐灸治疗脾虚型腹泻型肠易激综合征疗效观察

目的观察针刺配合隔盐灸治疗脾虚型腹泻型肠易激综合征(IBS-D)的临床疗效及其对患者症状、睡眠及内脏高敏性神经肽的影响。方法将61例脾虚型IBS-D患者随机分为治疗组31例和对照组30例。治疗组采用针刺配合隔盐灸治疗,对照组采用口服马来酸曲美布汀片治疗。观察两组治疗前后症状评分、IBS病情严重程度量表(IBS-SSS)评分、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、匹兹堡睡眠质量指数(PSQI)评分及血清5-羟色胺(5-HT)、降钙素基因相关肽(CGRP)、促肾上腺皮质激素释放因子(CRF)水平的变化情况,并比较两组临床疗效及复发率。结果两组治疗后症状评分、IBS-SSS评分、HAMA评分、HAMD评分及PSQI评分与同组治疗前比较差异均具有统计学意义(P<0.05)。治疗组治疗后症状评分及IBS-SSS评分、HAMA评分、HAMD评分及PSQI评分与对照组比较差异均具有统计学意义(P<0.05)。治疗组治疗后5-HT、CGRP及CRF水平均显著减低,对照组治疗后5-HT及CRF水平也显著降低,与同组治疗前比较差异均具有统计学意义(P<0.05)。治疗组治疗后CGRP及CRF水平与对照组比较差异均具有统计学意义(P<0.05)。治疗组总有效率及治疗后4周随访时复发率分别为87.1%和7.4%,对照组分别为63.3%和36.8%,两组比较差异均具有统计学意义(P<0.05)。结论针刺配合隔盐灸是一种治疗脾虚型IBS-D的有效方法,其机制可能与调节血清5-HT、CGRP、CRF水平有关。

Efficacy Observation of Acupuncture Combined with Salt-partitioned Moxibustion for IBS-D of Spleen Deficiency Pattern

Objective To observe the clinical efficacy of acupuncture plus salt-partitioned moxibustion in treating diarrhea-predominant irritable bowel syndrome(IBS-D)of spleen deficiency pattern and the effects on the symptoms,sleep and neuropeptides related to visceral hypersensitivity in the patients.Method Sixty-one patients with IBS-D of spleen deficiency pattern were randomized into a treatment group of 31 cases and a control group of 30 cases.The treatment group was intervened by acupuncture plus salt-partitioned moxibustion,while the control group was treated with oral Trimebutine maleate tablets.The scores of symptoms,irritable bowel syndrome symptom severity scale(IBS-SSS),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD)and Pittsburgh sleep quality index(PSQI),and the levels of serum 5-hydroxy tryptamine(5-HT),calcitonin gene-related peptide(CGRP)and corticotropin releasing factor(CRF)were observed before and after treatment in the two groups.The clinical efficacy and relapse rate were also compared between the two groups.Result The scores of symptoms,IBS-SSS,HAMA,HAMD and PSQI changed significantly after treatment in both groups(P<0.05).After intervention,the scores of symptoms,HAMA,HAMD and PSQI in the treatment group were significantly different from those in the control group(P<0.05).The levels of 5-HT,CGRP and CRF decreased markedly after intervention in the treatment group,and the levels of 5-HT and CRF declined markedly in the control group after treatment,all presenting statistical significance(P<0.05).After treatment,the levels of CGRP and CRF in the treatment group were significantly different from those in the control group(P<0.05).The total effective rate was 87.1%and the relapse rate at four-week follow-up was 7.4%in the treatment group,versus 63.3%and 36.8%in the control group,and the between-group differences were statistically significant(P<0.05).Conclusion Acupuncture plus salt-partitioned moxibustion is an effective approach for IBS-D of spleen deficiency pattern,and the mechanism may be associated with the regulation of serum 5-HT,CGRP and CRF levels.