浮针疗法对轻中度腹泻型肠易激综合征患者内脏敏感性、胃肠动力、肠道菌群及肠黏膜屏障功能的影响研究

背景　腹泻型肠易激综合征（IBS-D）是消化系统常见病、多发病之一，但目前单纯应用西药治疗尚不能取得满意疗效，且治疗后易复发。浮针疗法用于治疗IBS-D效果肯定，但其具体作用机制仍不明确。目的　探讨浮针疗法对轻中度IBS-D患者内脏敏感性、胃肠动力、肠道菌群及肠黏膜屏障功能的影响。方法　选取 2019年8月-2020 年3月在华北理工大学附属医院消化科门诊及针灸门诊就诊的轻中度IBS-D患者60例，采用随机数字表法分为对照组和观察组，每组30例。对照组患者在常规干预基础上给予复方谷氨酰胺肠溶胶囊治疗，观察组患者在常规干预基础上采用浮针疗法治疗；两组患者均连续治疗14 d。比较两组患者治疗前后肠易激综合征症状严重程度量表（IBS-SSS）评分、内脏敏感指数（VSI）评分、直肠容量刺激感觉指标、肠道菌群数量、生化指标，记录两组患者治疗期间不良反应/并发症发生情况。结果　对照组中1例患者被剔除，观察组中2例患者脱落，最终对照组、观察组分别纳入29例、28例患者。治疗后两组患者IBS-SSS、VSI评分及血清白介素6、白介素8、干扰素γ、血管活性肠肽、胃动素、D-乳酸、肿瘤坏死因子α（TNF-α）水平均低于治疗前，排便阈值、疼痛阈值、感觉阈值及血清P物质水平均高于治疗前，双歧杆菌、乳杆菌、拟杆菌数量均多于治疗前（P<0.05）；治疗后对照组患者肠杆菌数量少于治疗前（P<0.05）；治疗后观察组患者双歧杆菌数量少于对照组，肠杆菌数量多于对照组，血清干扰素γ水平高于对照组（P<0.05）。两组患者治疗期间均未出现明显不良反应/并发症。结论　浮针疗法可有效减轻轻中度IBS-D患者症状严重程度，降低患者内脏敏感性，提高患者直肠顺应性，有利于纠正患者肠道菌群失调，并可能通过调节炎性因子、胃肠激素及肠黏膜屏障相关因子而促进轻中度IBS-D患者肠黏膜屏障功能的恢复及胃肠激素的分泌，达到增强胃肠道免疫功能和减轻应激反应的目的，且安全性较高。

Effect of Fu's Subcutaneous Needling on Visceral Sensitivity，Gastrointestinal Motility，Intestinal Flora and Intestinal Mucosal Barrier Function in Mild and Moderate Irritable Bowel Syndrome with Diarrhea

Background　Irritable bowel syndrome with diarrhea（IBS-D）is a common and frequently-occurring disease of the digestive system，which shows unsatisfactory response to Western medicine treatment，and is easy to recur.Fu's subcutaneous needling has been proved to be effective in treating IBS-D，but the specific mechanism of action is not clear.Objective　To explore the effect of Fu's subcutaneous needling on visceral sensitivity，gastrointestinal motility，intestinal flora and intestinal mucosal barrier function in mild and moderate IBS-D.Methods　A total of 60 outpatients with mild and moderate IBS-D were selected in Gastroenterology Clinic and Acupuncture and Moxibustion Clinic of North China University of Science and Technology from August 2019 to March 2020 and equally divided into control group and observation group by use of a random number table，receiving a 14-day oral administration of compound glutamin entersoluble capsule with routine care，and Fu's subcutaneous needling with routine care，respectively.Pre- and post-treatment Irritable Bowel Syndrome Severity Scoring System（IBS-SSS） score，visceral sensitivity index（VSI）score，indices related to rectal sensitivity to distension，quantity of intestinal flora and biochemical indicators were compared between the two groups.The incidence of treatment-related adverse reactions/complications was recorded.Results　We finally enrolled 29 controls（other one was excluded）and 28 cases（other two were lost to follow up）.After treatment，both groups showed significantly decreased IBS-SSS score，VSI score，serum levels of IL-6，IL-8，IFN-γ，vasoactive intestinal peptide，motilin，D-lactic acid and TNF-α，obviously higher defecation threshold，pain threshold，sensory threshold and serum substance P level，as well as notably increased quantities of bifidobacteria，lactobacilli and bacteroides（P<0.05）.The post-treatment quantity of enteric bacilli in control group was significantly less than that before treatment（P<0.05）.The observation group had significantly less quantity of bifidobacteria，significantly increased quantity of enteric bacilli and obviously higher serum IFN-γ level than the control group after treatment（P<0.05）.No one in the two groups occurred any obvious treatment-related adverse reactions/complications during treatment.Conclusion　In patients with mild and moderate IBS-D，Fu's subcutaneous needling could effectively reduce the severity of symptoms and visceral sensitivity，improve the rectal compliance and enteric dysbacteriosis.Moreover，it may promote the recovery of intestinal mucosal barrier function and secretion of gastrointestinal hormones，and then enhance the immune function of gastrointestinal tract and reduce the stress reaction of gastrointestinal tract possibly by adjusting inflammatory cytokines，gastrointestinal hormones and factors related to intestinal mucosal barrier，with relatively high safety.