Objective: To compare the clinical therapeutic effect on diarrhea-predominant irritable bowel syndrome (IBS-D) of spleen deficiency and damp excess among fire needling therapy with filiform needle combined with acupoint application therapy, simple acupoint application therapy and pinaverium bromide tablets, and explore the mechanism on the improvements in IBS-D.
Methods: A total of 150 patients with IBS-D of spleen deficiency and damp excess were randomized into a combined treatment group (50 cases, 14 cases dropped off), an acupoint application group (50 cases, 16 cases dropped off ) and a western medication group (50 cases, 13 cases dropped off ). In the western medication group, pinaverium bromide tablets were prescribed for oral administration, 50 mg per time, three times a day. In the acupoint application group, the herbal plaster of shenling baizhu powder mixed with fresh ginger juice was placed on Shenque (CV 8), once every two days. In the combined treatment group, on the base of the treatment as the acupoint application group, the fire needling therapy with filiform needle was exerted at Tianshu (ST 25), Shangjuxu (ST 37), Yinlingquan (SP 9) and Dachangshu (BL 25), once every two days. The duration of treatment in each group was 4 weeks. Separately, before treatment and after 7 and 28 days of treatment, the score of clinical symptoms and the score of quality of life scale for IBS (IBS-QOL) were observed in each group. Before treatment and after 28 days of treatment, the levels of , and T lymphocytes, and the ratio of / in peripheral blood of patients were detected successively; as well as the expressions of 5-HT3R mRNA and 5-HT4R mRNA in colon mucosal tissues in each group separately.
Results: Except the score for abdominal pain in the acupoint application group and the scores for abdominal pain and abdominal distention in the western medication group after 7 days of treatment, the scores for abdominal pain, abdominal distention, defecation frequency, stool form and incomplete bowel movement after 7 and 28 days of treatment were all reduced as compared with those before treatment in each group separately (P<0.05). After 7 days of treatment, the scores for abdominal distention, defecation frequency and stool form in the combined treatment group were all lower than those in the western medication group (P<0.05). After 28 days of treatment, the score of each clinical symptom in the combined treatment group was lower than either of the rest two groups respectively (P<0.05); and the scores for abdominal pain, abdominal distention and incomplete bowel movement in the acupoint application group were lower than those in the western medication group separately (P<0.05). After 7 and 28 days of treatment, the score of each item in IBS-QOL was increased as compared with that before treatment in each group (P<0.05). After 7 days of treatment, except the scores for heterosexual relationship and human relations, scores of the other items, other scores of IBS-QOL in the combined treatment group were higher than those in the western medication group separately (P<0.05); while the scores of anxiety and behavior disorder in the acupoint application group were higher than those in the western medication group (P<0.05). After 28 days of treatment, the each score of IBS-QOL in the combined treatment group was higher than the other two groups respectively (P<0.05), while the scores of anxiety, behavior disorder, dietary control, social reaction and human relations in the acupoint application group were all higher than the western medication group (P<0.05). After treatment, the levels of and T lymphocytes and the ratio of /in peripheral blood, as well as the expressions of 5-HT4R mRNA in colon tissue were all increased in each group (P<0.05), but the levels of T lymphocyte and 5-HT3R mRNA expressions in colon tissue were reduced in each group (P<0.05). After treatment, regarding the levels of and T lymphocytes and the ratio of /in peripheral blood, as well as the expressions of 5-HT4R mRNA in colon tissue, the values in the combined treatment group were all higher than either of the rest two groups respectively (P<0.05), while the values in the acupoint application group were higher than the western medication group (P<0.05). Concerning to the level of T lymphocytes and 5-HT3R mRNA expression, the values in the combined treatment group were lower than the rest two groups respectively (P<0.05), and the values in the acupoint application group were lower than the western medication group (P<0.05).
Conclusion: The combined treatment with the fire needling therapy with filiform needle and the acupoint application therapy effectively relieves the clinical symptoms, improves the quality of life and strengthens the immunity in the patients with IBS-D. The therapeutic effect of this combined regimen is better than either simple acupoint application therapy or the oral medication of pinaverium bromide. The mechanism may be related to the regulation of the levels of T lymphocyte subsets and the modulation of the expressions of 5-HT3R and 5-HT4R mRNA in colon tissue.
目的：比较毫火针联合穴位贴敷、单纯穴位贴敷与匹维溴铵片治疗脾虚湿盛证腹泻型肠易激综合征（IBS-D）的临床疗效，探讨其改善IBS-D的机制。方法：将150例脾虚湿盛证IBS-D患者随机分为联合组（50例，脱落14例）、贴敷组（50例，脱落16例）、西药组（50例，脱落13例）。西药组口服匹维溴铵片，每次50 mg，每日3次；贴敷组于神阙穴贴敷生姜汁调制的参苓白术散，隔日1次；联合组在穴位贴敷基础上，于天枢、上巨虚、阴陵泉、大肠俞穴行毫火针，隔日1次，各组均治疗4周。于治疗前与治疗7、28 d后，观察各组临床症状评分和IBS生活质量量表（IBS-QOL）评分；于治疗前及治疗28 d后，检测各组外周血、、 T淋巴细胞及/比值，以及各组结肠黏膜组织5-羟色胺受体3（5-HT3R）和5-羟色胺受体4（5-HT4R ）mRNA表达。结果：除治疗7 d后贴敷组腹痛评分与西药组腹痛、腹胀评分外，各组治疗7、28 d后腹痛、腹胀、大便次数、大便性状和排便不尽感评分均较治疗前降低（P<0.05）；治疗7 d后，联合组腹胀、大便次数和大便性状评分低于西药组（P<0.05）；治疗28 d后，联合组临床症状各项评分均低于其余两组（P<0.05），贴敷组腹痛、腹胀和排便不尽感评分低于西药组（P<0.05）。治疗7、28 d后，各组IBS-QOL各项评分均较治疗前升高(P<0.05)；治疗7 d后，联合组除异性关系、人际关系外，其余各项IBS-QOL评分均高于西药组(P<0.05)，贴敷组焦虑不安、行为障碍评分高于西药组(P<0.05)；治疗28 d后，联合组IBS-QOL各项评分均高于其余两组(P<0.05)，贴敷组焦虑不安、行为障碍、饮食限制、社会反应和人际关系评分均高于西药组(P<0.05)。治疗后，各组外周血、 T淋巴细胞，/比值与结肠组织中5-HT4R mRNA表达均升高（P<0.05）， T淋巴细胞与结肠组织中5-HT3R mRNA表达均降低（P<0.05）；治疗后，外周血、 T淋巴细胞，/比值与结肠组织中5-HT4R mRNA表达，联合组均高于其余两组（P<0.05），贴敷组高于西药组（P<0.05）；在 T淋巴细胞与5-HT3R mRNA表达方面，联合组低于其余两组（P<0.05），贴敷组低于西药组（P<0.05）。结论：毫火针联合穴位贴敷能够有效改善脾虚湿盛证IBS-D患者的临床症状、生活质量，并可提高患者免疫力，疗效优于单纯穴位贴敷与匹维溴铵片治疗，其机制可能与调节T淋巴细胞亚群、调控结肠组织中5-HT3R和5-HT4R mRNA表达水平有关。.
Keywords: acupoint application; diarrhea-predominant irritable bowel syndrome, spleen deficiency and damp excess; fire needling therapy with filiform needle; randomized controlled trial (RCT).