"升清降浊"法电针调节肠道菌群改善糖尿病胃肠功能障碍的临床疗效观察OA北大核心CSTPCDMEDLINE
Clinical efficacy observation of electroacupuncture based on the"ascending lucidity and descending turbidity"theory:a study of gut microbiota in patients with diabetic gastrointestinal dysfunction
目的:探索"升清降浊"法电针对糖尿病胃肠功能障碍患者的疗效及对肠道菌群的调节作用.方法:将48例糖尿病胃肠功能障碍患者通过简单随机法随机分为"升清降浊"法电针组(24例,脱落3例)和对照组(24例,无脱落),电针组取中脘、天枢、中府,双侧章门、太白、太渊、足三里、上巨虚电针治疗(15 Hz/100 Hz),对照组采用非经非穴浅刺法,接电针仪但不通电,两组均30 min/次,1次/d,治疗5 d休息2 d,连续治疗2周.于治疗前后和治疗结束4周后采用胃肠道症状评分量表(GSRS)和胃轻瘫基本症状指数(GCSI)评价患者的消化道症状变化情况,在治疗期间每日监测空腹血糖,治疗开始前和结束时收集粪便样本送检16S rDNA测序分析肠道菌群组成变化.结果:与同时间点对照组比较,治疗后和随访时电针组患者的GSRS和GCSI评分显著下降(P<0.001);与同组治疗前比较,治疗后和随访时电针组GSRS和GCSI评分显著下降(P<0.001).16S rDNA测序提示治疗后在门水平电针组患者肠道变形菌门相对丰度相对高于对照组(FDR<0.05);在属水平,两组共计 18个肠道差异菌群,与对照组比较,电针组患者肠道假单胞菌属、碱性杆菌属相对丰度显著降低(FDR<0.05),其余16个差异菌属相对丰度显著升高(FDR<0.05).与治疗前比较,治疗后电针组欧陆森氏菌属显著上调(FDR<0.05),而假单胞菌属显著下调(FDR<0.05).结论:"升清降浊"法电针能改善糖尿病患者的胃肠功能障碍,缓解患者的消化道症状并调节肠道菌群分布,一定程度上增加益生菌丰度,降低致病菌丰度.
Objective To explore the efficacy of electroacupuncture(EA)based on the"ascending lucidity and descending turbidity"theory in patients with diabetic gastrointestinal dysfunction and its regulatory effect on gut microbiota.Methods A total of 48 patients with diabetic gastrointestinal dysfunction were randomly divided into the EA group(24 cases,3 cases dropped-off)and the control group(24 cases,no dropped off).Both groups received blood glucose control and basic symptomatic treatment.EA(15 Hz/100 Hz)was applied to Zhongwan(CV12),Tianshu(ST25),Zhongfu(LU1),bilateral Zhangmen(LR13),bilateral Taibai(SP3),bilateral Taiyuan(LU9),bilateral Zusanli(ST36),and bilateral Shangjuxu(ST37)in the EA group.Sham EA was applied to corresponding non-acupoints without electric stimulation in the control group.Both groups received treatment for 30 min per time,once daily,for a total of 5 treatments followed by a 2-day break,over a consecutive period of 2 weeks.Symptoms were evaluated by gastrointestinal symptom rating scale(GSRS)and gastroparesis cardinal symptom index(GCSI)before and after treatment,and 4 weeks after treatment.During the treatment period,fasting blood glucose levels were monitored daily.Stool samples were collected before and after treatment for 16S rDNA sequencing analysis to examine changes in gut microbiota.Results Compared with the control group,GSRS and GCSI scores in the EA group were significantly decreased(P<0.001)after treatment and at follow-up at the same time point,and compared with those before treatment,GSRS and GCSI scores in the EA group were significantly decreased after treatment and at follow-up(P<0.001).After treatment,the 16S rDNA sequencing showed that at the phylum level,the ratio of Proteobacteria in the EA group was higher than that in the control group(FDR<0.05).At the genus level,a total of 18 different gut microbiota were identified between the two groups.Compared to the control group,patients in the EA group showed a significant decrease in the abundance of Pseudomonas and Alkalibacter(FDR<0.05),while the abundance of the remaining 16 gut microbiota was significantly increased(FDR<0.05).Compared to the baseline,the EA group showed a significant up-regulation of Olsenella(FDR<0.05)and a significant down-regulation of Pseudomonas(FDR<0.05)after treatment.Conclusion EA based on the"ascending lucidity and descending turbidity"theory can effectively improve the symptoms of patients with diabetic gastrointestinal dysfunction.EA can also affect the distribution of gut microbiota by up-regulating the levels of certain beneficial bacteria and suppressing pathogenic bacteria.
林文佳;郑爽;杨晓晴;卢立宏;刘文文;陈楚云
广州医科大学附属中医医院针灸科,广州 510130
糖尿病胃肠功能障碍电针肠道菌群临床疗效
Diabetic gastrointestinal dysfunctionElectroacupunctureGut microbiotaClinical efficacy
《针刺研究》 2024 (010)
1084-1091 / 8
广东省中医药局科研项目(No.20211296);广州市卫生健康科技项目(No.20212A011003);广州市科技计划项目基础研究计划(No.202102080214)
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