Objective: To compare the effects of electroacupuncture(EA) and mild-warm moxibustion(Mox) therapies for constipation-predominant irritable bowel syndrome(C-IBS) patients. Methods: Sixty C-IBS patients were assigned to 2 groups by simple randomized method, i.e. EA group(30 cases) and Mox group(30 cases). Both EA and Mox treatments were performed on bilateral Tianshu(ST 25) and Shangjuxu(ST 37) for 30 min each time, 6 times per week, for 4 consecutive weeks. The gastrointestinal symptoms and psychological symptoms of the two groups were scored before and after treatment. The effects on the corresponding functional brain areas, namely the anterior cingulate cortex(ACC), insular cortex(IC) and prefrontal cortex(PFC) were observed by functional magnetic resonance imaging(f MRI) before and after treatment. Results: Compared with the Mox group, greater improvements in abdominal distension, defecation frequency, difficulty in defecation and stool features were observed in the EA group(all P<0.01), both Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale scores were significantly decreased in the EA group(all P<0.01). Finally, decreased activated voxel values were observed in the ACC, right IC and PFC brain regions of EA group with 150 m L colorectal distension stimulation(P<0.05 or P<0.01). Conclusions: Both EA and Mox could significantly improve some of the most intrusive symptoms of C-IBS patients, and EA was more effective than Mox. The therapeutic effect of these two therapies might through modulating of the brain-gut axis function.
目的:观察并比较不同参数电针和不同温度艾灸对内脏高敏感模型大鼠穴区肥大细胞(mast cells,MC)活化的影响。方法:将50只内脏高敏感模型大鼠随机分组后分别给予1m A、3 m A电针和43℃、4℃艾灸刺激天枢穴,并与模型组和正常大鼠进行对照,采用甲苯胺蓝染色法观察各组大鼠天枢穴区肥大细胞M C数量、脱颗粒数、脱颗粒率情况,同时采用腹部撤回反射(abdominalwithdrawl reflex,AWR)评分评价各组大鼠的内脏高敏感反应。结果:与正常组和模型组比较,艾灸43℃组、艾灸4℃组、电针1m A组及电针3m A组大鼠穴区组织M C个数有显著性增加(P<0.05,P<0.01,P<0.01,P<0.01),大鼠穴区组织M C脱颗粒数和脱颗粒率均有显著性增加(P<0.01,P<0.01,P<0.05,P<0.01)。与模型组相比,在20 mm Hg、40 mm Hg、0 mm Hg、80 mm Hg结直肠扩张(colorectal distension,CRD)刺激下,艾灸43℃组、艾灸4℃组、电针1m A组和电针3m A组的A WR评分均显著降低(20 mm Hg刺激下电针1 m A和电针3m A组,P<0.05,其余均P<0.01);艾灸4℃组、艾灸43℃组大鼠在C RD刺激强度为20 mm Hg、40 mm Hg、0 mm Hg、80 mm Hg时与正常组的A WR评分均无统计学差异(均P>0.05);电针1m A组在0 mm Hg和80 mm Hg时AWR评分均显著高于正常组(均P<0.01);电针3m A组在0 mm Hg时AWR评分亦显著高于正常组(P<0.01),在20 mm Hg和80 mm Hg时亦高于正常组(均P<0.05);在40 mm Hg和80 mm Hg时,电针1m A组AWR评分高于艾灸4℃组(均P<0.05);电针3m A组在40 mm Hg时AWR评分高于艾灸4℃组(P<0.05)。结论:不同参数电针和不同温度艾灸刺激对内脏高敏感模型大鼠穴区肥大细胞活化的影响以及改善其内脏高敏感反应存在差异,其中以4℃的艾灸效应最显著。
Objective:To compare the effects of electroacupuncture(EA) and moxibustion therapies on patients with diarrhea-predominant irritable bowel syndrome(D-IBS).Methods:A total of 60 D-IBS patients were randomly allocated to the EA group(30 cases) and moxibustion group(30 cases).Before and after treatment,the gastrointestinal symptoms and psychological symptoms were scored by Visual Analogue Scale,Bristol Stool Form Scale,Hamilton Anxiety Rating Scale(HAMA),and Hamilton Depression Rating Scale(HAMD);the expressions of 5-hydroxytryptamine(5-HT),5-HT_3 receptor(5-HT3R),and 5-HT_4 receptor(5-HT4R) in the sigmoid mucosal tissue were measured by immunohistochemical staining.Additionally,the effects on the functional brain areas of the anterior cinguiate cortex(ACC),insular cortex(IC) and prefrontal cortex(PFC)were observed by functional magnetic resonance imaging.Results:Compared with before treatment,both EA and moxibustion groups reported significant improvements in abdominal pain and abdominal bloating after treatment(P<0.01 or P<0.05).The moxibustion group reported greater improvements in defecation emergency,defecation frequency,and stool feature than the EA group(P<0.01).Both HAMA and HAMD scores were significantly decreased in the moxibustion group than in the EA group(P<0.01).Both groups demonstrated significantly reduced expressions of 5-HT,5-HT3 R and 5-HT4 R in the colonic mucosa after treatment(P<0.01),with a greater reduction of 5-HT in the moxibustion group(P<0.05).Finally,decreased activated voxel values were observed in the left IC,right IC and PFC brain regions of patients in the moxibustion group under stimulation with 150 mL colorectal distension after treatment(P<0.05 or P<0.01),while in the EA group only PFC area demonstrated a reduction(P<0.05).Conclusion:Moxibustion can significantly improve the symptoms of D-IBS,suggesting that moxibustion may be a more effective therapy than EA for D-IBS patients.
