Effect of fire needle combined with Guishao Lizhong Decoction on intestinal microecology and brain-intestine interaction in patients with chronic functional constipation of Qi deficiency and Yang failure type
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摘要: 目的 观察火针与中药(归芍理中汤)单独及配合治疗对气虚阳衰型慢性功能性便秘患者的疗效。方法 将105例确诊为慢性功能性便秘(气虚阳衰型)的病例随机分为中药组、火针组、联合治疗组，每组各35例，中药组口服归芍理中汤治疗，火针组给予火针疗法，联合治疗组在口服归芍理中汤的同时配合火针治疗，3组疗程均为1个月。治疗结束后评价患者临床疗效，将3组治疗前后中医主证评分、Wexner便秘评分、便秘患者生活质量评分(PAC-QOL)进行比较，取患者粪便、血液样本，测定粪便乳杆菌、双歧杆菌、酵母菌、肠杆菌数量及脑肠肽(5-HT、SP、VIP)水平。结果 3组患者治疗前各指标差异无统计学意义(P>0.05)；疗程结束后，联合治疗组临床疗效优于中药组、火针组(P < 0.05)；与中药组、火针组比较，联合治疗组中医主证积分、Wexner便秘评分、PAC-QOL评分明显下降(P < 0.05)，粪便中乳杆菌、双歧杆菌数量显著增多，酵母菌、肠杆菌数量显著减少(P < 0.05)，血清VIP水平较中药组、火针组明显降低，5-HT、SP水平明显提升(P < 0.05)。结论 针对气虚阳衰型慢性功能性便秘患者，应用火针和归芍理中汤治疗均有确切效果，两者联用具有协同效果，有助于维持患者肠道菌群稳态，纠正脑肠肽的异常表达，促进脑-肠互动平衡，疗效优于单独应用。Abstract: Objective To observe the curative effect of fire needles and Traditional Chinese Medicine (Guishao Lizhong Decoction) alone and in combination on chronic functional constipation with deficiency of Qi and Yang.Methods One hundred and five cases of chronic functional constipation (deficiency of Qi and Yang) were randomly divided into the Chinese medicine group, fire needle group, and combined treatment group, with 35 cases each. The Chinese medicine group was treated with Guishao Lizhong Decoction orally, the fire needle group was treated with fire needle therapy, and the combined treatment group was treated with fire needle at the same time as Guishao Lizhong Decoction orally. The course of treatment of the three groups was one month. After treatment, evaluate the clinical efficacy of the patients. Compare the main syndrome score of traditional Chinese medicine, the Wexner constipation score, and the PAC-QOL quality of life score of the three groups before and after treatment. Take the stool and blood samples of the patients to measure the number of lactobacillus faecalis, bifidobacterium, saccharomyces cerevisiae, and enterobacter, and the level of serum brain-gut peptide(5-HT, SP, VIP).Results Before treatment, there was no significant difference among the three groups (P>0.05). After the course of treatment, the clinical efficacy of the combined treatment group was better than that of the traditional Chinese medicine group and the fire needle group(P>0.05). Compared with the Traditional Chinese Medicine group and the fire needle group, the main syndrome score, Wexner and PAC-QOL scores of the combined treatment group decreased significantly(P>0.05). The number of lactobacillus and bifidobacterium in feces increased significantly, and the number of yeast and enterobacillus decreased significantly(P>0.05). The serum VIP level was significantly lower than that of the Traditional Chinese Medicine group and the fire needle group, the plasma 5-HT and SP levels were significantly higher(P>0.05).Conclusion For patients with chronic functional constipation due to a deficiency of Qi and Yang, the application of a fire needle and Guishao Lizhong decoction has a definite effect. The combination of the two has a synergistic effect, which is helpful to maintain the stable intestinal flora of the patients, correcting the abnormal expression of brain-gut peptide, and promoting the brain-gut interaction balance. The effect is better than that of a single application.
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表 1 3组患者治疗后临床疗效比较
例(%) 组别 痊愈 显效 有效 无效 总有效 中药组(n=35) 4(11.4) 6(17.1) 14(40.0) 11(31.4) 24(68.6) 火针组(n=35) 5(14.3) 5(14.3) 18(51.4) 7(20.0) 28(80.0)1) 联合治疗组(n=35) 7(20.0) 6(17.1) 20(57.1) 2(5.7) 33(94.3)1)2) 与中药组比较，1)P < 0.05；与火针组比较，2)P < 0.05。 
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表 2 3组患者中医主证评分比较
分，X±S 组别 治疗前 治疗后 中药组(n=35) 15.75±2.13 6.96±1.091) 火针组(n=35) 15.69±1.72 5.13±0.871)2) 联合治疗组(n=35) 15.79±1.68 3.36±0.651)2)3) 与治疗前比较，1)P < 0.05；与治疗后中药组比较，2)P < 0.05，与治疗后火针组比较，3)P < 0.05。
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表 3 3组患者WCGS评分比较
分，X±S 组别 治疗前 治疗后 中药组(n=35) 20.24±4.03 13.58±2.751) 火针组(n=35) 21.31±4.12 11.93±3.071)2) 联合治疗组(n=35) 20.20±3.82 8.14±2.651)2)3) 与治疗前比较，1)P < 0.05；与治疗后中药组比较，2)P < 0.05，与治疗后火针组比较，3)P < 0.05。
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表 4 3组患者PAC-QOL评分比较
分，X±S 组别 时间 躯体不适 心理社会不适 担心和焦虑 满意度 中药组(n=35) 治疗前 11.85±1.50 19.37±3.38 27.75±4.62 15.04±3.12 治疗后 8.73±1.341) 15.42±3.211) 23.85±3.431) 11.71±2.241) 火针组(n=35) 治疗前 11.97±2.60 18.64±2.49 28.69±3.80 14.82±2.85 治疗后 6.58±1.421)2) 12.30±2.271)2) 20.06±3.621)2) 9.36±1.701)2) 联合治疗组(n=35) 治疗前 10.82±2.57 19.86±4.01 28.81±4.51 14.57±2.59 治疗后 4.31±0.841)2)3) 10.42±2.311)2)3) 15.49±3.451)2)3) 6.59±1.121)2)3) 与治疗前比较，1)P < 0.05；与治疗后中药组比较，2)P < 0.05；与治疗后火针组比较，3)P < 0.05。
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表 5 3组患者肠道菌群水平比较
log10CFU/g，X±S 组别 时间 乳杆菌 双歧杆菌 酵母菌 肠杆菌 中药组(n=35) 治疗前 5.01±0.90 6.68±0.97 7.61±1.48 10.19±2.10 治疗后 6.41±1.181) 8.21±2.101) 6.68±1.061) 8.52±1.551) 火针组(n=35) 治疗前 5.12±1.04 6.57±1.05 7.55±1.76 10.56±1.50 治疗后 7.28±1.231)2) 9.55±1.671)2) 5.01±0.821)2) 7.03±0.891)2) 联合治疗组(n=35) 治疗前 5.24±1.41 6.47±1.04 7.47±1.04 9.87±1.22 治疗后 8.76±1.051)2)3) 10.96±1.521)2)3) 3.50±0.751)2)3) 6.15±1.681)2)3) 与治疗前比较，1)P < 0.05；与治疗后中药组比较，2)P < 0.05；与治疗后火针组比较，3)P < 0.05。
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表 6 3组患者血清脑肠肽水平比较
X±S 组别 时间 5-HT/(pg/mL) SP/(pg/mL) VIP/(ng/mL) 中药组(n=35) 治疗前 83.67±6.49 18.35±4.23 27.54±3.04 治疗后 94.75±5.821) 35.48±6.301)2) 20.31±2.431) 火针组(n=35) 治疗前 80.61±7.56 19.32±5.17 26.68±2.25 治疗后 109.78±9.641)2) 41.63±5.221)2) 16.25±2.371)2) 联合治疗组(n=35) 治疗前 84.31±7.33 18.38±4.15 26.47±3.45 治疗后 128.94±12.091)2)3) 57.84±6.241)2)3) 11.50±2.851)2)3) 与治疗前比较，1)P < 0.05；与治疗后中药组比较，2)P < 0.05；与治疗后火针组比较，3)P < 0.05。
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