“脑肠同调”法针刺对缺血性脑卒中患者运动功能及肠道菌群的影响

蒋志明; 刘磊; 张辽; 李丽丽; 丁彬; 胡玲; 吴子建

doi:10.13703/j.0255-2930.20231109-k0009

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“脑肠同调”法针刺对缺血性脑卒中患者运动功能及肠道菌群的影响

针灸与康复 | 更新时间：2024-07-11

- “脑肠同调”法针刺对缺血性脑卒中患者运动功能及肠道菌群的影响
- Effects of "brain-gut coherence" method of acupuncture on motor function and intestinal microflora in the patients with cerebral ischemic stroke
- 中国针灸 2024年44卷第7期页码：740-748
- 作者机构：
  
  1.安徽皖北煤电集团总医院康复医学科，宿州　234000
  2.安徽皖北煤电集团总医院中心实验室，宿州　234000
  3.安徽省中医药科学院针灸经络研究所
  4.安徽中医药大学针灸推拿学院
  5.经脉脏腑相关安徽省重点实验室
- 作者简介：
  
  蒋志明，住院医师。E-mail：jzm629027aa@163.com
- 基金信息：
  
  安徽省自然科学基金项目(2108085MH307)
- DOI：10.13703/j.0255-2930.20231109-k0009
  中图分类号：
- 收稿：2023-11-09，
  
  网络首发：2024-04-26，
  
  纸质出版：2024-07-12
- 稿件说明：
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蒋志明, 刘磊, 张辽, 等. “脑肠同调”法针刺对缺血性脑卒中患者运动功能及肠道菌群的影响[J]. 中国针灸, 2024,44(7):740-748.

JIANG Zhiming, LIU Lei, ZHANG Liao, et al. Effects of "brain-gut coherence" method of acupuncture on motor function and intestinal microflora in the patients with cerebral ischemic stroke[J]. Chinese Acupuncture & Moxibustion, 2024, 44(7): 740-748.
蒋志明, 刘磊, 张辽, 等. “脑肠同调”法针刺对缺血性脑卒中患者运动功能及肠道菌群的影响[J]. 中国针灸, 2024,44(7):740-748. DOI： 10.13703/j.0255-2930.20231109-k0009.

JIANG Zhiming, LIU Lei, ZHANG Liao, et al. Effects of "brain-gut coherence" method of acupuncture on motor function and intestinal microflora in the patients with cerebral ischemic stroke[J]. Chinese Acupuncture & Moxibustion, 2024, 44(7): 740-748. DOI： 10.13703/j.0255-2930.20231109-k0009.

摘要

目的：

观察“脑肠同调”法针刺治疗缺血性脑卒中的临床疗效，探讨其作用机制。

方法：

将82例缺血性脑卒中患者随机分为观察组（41例，脱落3例、中止2例）和对照组（41例，脱落4例、剔除2例）。两组均采用常规基础治疗，观察组予“脑肠同调”法针刺治疗，穴取患侧顶颞前斜线，中脘、关元，双侧天枢、足三里、上巨虚、下巨虚；对照组予常规针刺，穴取百会、印堂，双侧风池、足三里，患侧合谷、肩髃、曲池、外关、伏兔、三阴交、太冲。均每次30 min，每日1次，每周治疗5 d，共治疗4周。比较两组患者治疗前后Fugl-Meyer运动功能评定量表（FMA）、Berg平衡量表（BBS）、改良Barthel指数(MBI）评分及胃肠症状积分；检测两组患者治疗前后中性粒细胞计数（NUE）及血清N末端B型利钠肽原（NT-proBNP）含量；采用16S rRNA基因测序检测两组患者治疗前后肠道菌群组成结构及相对丰度；ELISA法检测两组患者治疗前后血清脂肪酸结合蛋白（iFABP）、D-乳酸（D-LA）、脂多糖（LPS）、脂多糖结合蛋白（LBP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）含量。

结果：

治疗后，两组患者FMA、BBS、MBI评分均较治疗前升高（

0.05），胃肠症状积分较治疗前降低（

0.05）；观察组FMA、BBS、MBI评分高于对照组（

0.05），胃肠症状积分低于对照组（

0.05）。治疗后，两组患者NEU及血清NT-proBNP含量较治疗前降低（

0.05）；观察组血清NT-proBNP含量低于对照组（

0.05）。治疗后，两组患者Chao1指数、Ace指数、Sobs指数、Shannon指数较治疗前升高（

0.05），且观察组高于对照组（

0.05）；两组患者拟杆菌科、肠杆菌科、颤螺菌科、链球菌科、梭菌科相对丰度较治疗前降低（

0.05），且观察组低于对照组（

0.05）。治疗后，两组患者毛螺菌科、瘤胃球菌科、双歧杆菌科、红蝽菌科相对丰度较治疗前升高（

0.05），且观察组高于对照组（

0.05）。治疗后，两组患者血清iFABP、D-LA、LPS、LBP、TNF-α、IL-1β、IL-6含量较治疗前降低（

0.05），且观察组低于对照组（

0.05）。

结论：

“脑肠同调”法针刺可改善缺血性脑卒中患者运动功能、胃肠道功能，可能与调节肠道菌群组成结构，减轻炎性反应，促进肠道屏障修复有关。

Abstract

Objective

To observe the clinical effect of "brain-gut coherence" method of acupuncture on cerebral ischemic stroke (CIS) and explore its action mechanism.

Methods

A total of 82 patients with CIS were randomly divided into an observation group (41 cases

3 cases dropped out

2 cases discontinued) and a control group (41 cases

4 cases dropped out

2 cases excluded). The conventional basic treatment was administered in the two groups. Additionally

in the observation group

"brain-gut coherence" method of acupuncture was delivered. The stimulating points included the parietal and temporal anterior oblique line on the affected side

Zhongwan (CV 12)

Guanyuan (CV 4)

and bilateral Tianshu (ST 25)

Zusanli (ST 36)

Shangjuxu (ST 37) and Xiajuxu (ST 39). In the control group

the routine acupuncture was operated at Baihui (GV 20)

Yintang (GV 24

)

bilateral Fengchi (GB 20) and Zusanli (ST 36)

and Hegu (LI 4)

Jianyu (LI 15)

Quchi (LI 11)

Waiguan (TE 5)

Futu (ST 32)

Sanyinjiao (SP 6) and Taichong (LR 3) on the affected side. Acupuncture stimulation lasted 30 min each time

once daily

and for 5 days a week. The intervention for 4 weeks was required. The scores of Fugl-Meyer assessment scale (FMA)

Berg balance scale (BBS) and the modified Barthel index (MBI)

as well as the score of gastrointestinal symptoms were compared before and after treatment in the two groups. The neutrophil count (NUE) and the content of the serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected before and after treatment in the two groups. Using 16S rRNA gene sequencing

the structure and relative abundance of intestinal microflora was detected before and after treatment; and with the enzyme linked immunosorbent assay (ELISA) adopted

the levels of intestinal fatty acid-binding protein (iFABP)

D-lactate (D-LA)

lipopolysaccharide (LPS)

lipopolysaccharide binding protein (LBP)

tumor necrosis factor-α(TNF-α)

interleukin (IL)-1β and IL-6 in the serum were detected before and after treatment in the two groups.

Results

After t

reatment

the scores of FMA

BBS and MBI were increased (

0.05)

and the scores of gastrointestinal symptoms were decreased (

0.05) compared with those before treatment in the two groups. Compared with the control group

the scores of FMA

BBS and MBI were higher (

0.05) and the score of gastrointestinal symptoms was lower (

0.05) in the observation group after treatment. NEU and the content of serum NT-proBNP were reduced in the two groups (

0.05)

and the content of serum NT-proBNP in the observation group was lower than that of the control group (

0.05) after treatment. Chao1

Ace

Sobs and Shannon indexes were increased after treatment compared with those before treatment in the two groups (

0.05); and these indexes in the observation group were higher when compared with the control group (

0.05). After treatment

the relative abundance of

Bacteroidaceae

Enterobacteriaceae

Oscillospiraceae

Streptococcaceae

and

Sutterellaceae

was reduced in comparison with that before treatment in the two groups (

0.05); and the relative abundance of these microflora was lower in the observation group when compared with the control group (

0.05). After treatment

the relative abundance of

Lachnospiraceae

Ruminococcaceae

Bifidobacteriaceae

and

Coriobacteriaceae

was

increased in comparison with that before treatment in the two groups (

0.05); and the relative abundance of these microflora was elevated in the observation group when compared with the control group (

0.05). After treatment

the levels of iFABP

D-LA

LPS

LBP

TNF-α

IL-1β and IL-6 were reduced when compared with those before treatment in the two groups

(

0.05)

and these levels of the observation group were lower than those of the control group (

0.05).

Conclusion

"Brain-gut coherence" method of acupuncture can improve the motor function and gastrointestinal function of the patients with cerebral ischemic stroke

which may be related to modulating the structure of intestinal microflora

alleviating inflammatory reactions and accelerating the intestinal barrier repair.

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