艾灸与针刺治疗炎症性肠病大鼠内脏痛的镇痛效应研究
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摘要
目的:观察艾灸、针刺(天枢和气海穴)对炎症性肠病大鼠内脏痛的影响,从痛行为、痛情绪及血清P物质含量角度对比观察艾灸与针刺治疗炎症性肠病内脏痛的效应异同。方法:SD(Sprague Dawley)大鼠随机分为正常组、模型组、艾灸组及针刺组,采用三硝基苯磺酸合50%乙醇灌肠的方法制备炎症性肠病内脏痛模型。通过检测大鼠腹壁收缩反射阈值、机械性缩足反射阈值、热缩足潜伏期观察大鼠痛行为变化,应用旷场实验、高架十字迷宫测验观察大鼠痛情绪变化,运用苏木素-伊红染色法观察结肠组织形态学变化,采用酶联免疫吸附测定法检测血清P物质含量。结果:与正常组比较,炎症性肠病模型组大鼠结肠损伤严重,表现为溃疡、炎症反应,经艾灸、针刺治疗后大鼠结肠损伤均有所减轻。与正常组比较,模型组大鼠不同压力刺激下腹壁收缩反射评分显著升高,机械性缩足反射时间、热缩足潜伏期缩短(均P<0.01),呈现内脏高敏和痛阈降低。与模型组比较,艾灸组、针刺组大鼠治疗后不同压力刺激下腹壁收缩反射评分明显降低,机械性缩足反射时间、热缩足潜伏期延长(均P<0.01)。与针刺组比较,艾灸组大鼠治疗后在40、60 mmHg压力刺激下腹壁收缩反射评分降低明显(P<0.01,P<0.05)。与正常组比较,模型组大鼠活动总路程、直立次数、开臂时间及开臂次数均明显减少(均P<0.01),经艾灸、针刺治疗后大鼠活动总路程、直立次数、开放臂时间及次数比例增加(均P<0.01)。与艾灸组比较,针刺组大鼠治疗后直立次数升高明显(P<0.05)。与正常组比较,模型组大鼠血清P物质含量升高,经艾灸、针刺治疗后血清P物质含量降低(均P<0.01)。与针刺组比较,艾灸组大鼠血清P物质含量下降明显(P<0.01)。结论:艾灸、针刺(天枢和气海穴)对炎症性肠病内脏痛大鼠痛行为、痛情绪均有改善作用,均能降低血清P物置的含量;其中艾灸天枢和气海穴的作用优于针刺治疗。
Objective:To observe the influence of moxibustion and acupuncture on Tianshu( ST25),Qihai( CV6) on visceral pain of rats with inflammatory bowel disease and compare the similarities and differences of their effects from the point of pain-related behavior and emotion and content of P substance in serum. Methods: SD rats were randomly divided into four groups as a normal group,a model group,a moxibustion group and an acupuncture group. Rat model with inflammatory bowel disease and represented visceral pain was established by enema with trinitrobenzene sulfonic acid and 50% ethyl alcohol. Abdominal withdrawal reflex( AWR) score,mechanical withdrawal threshold( MWT) and thermal withdrawal latency( TWL) were surveyed to inspect visceral sensitivity and pain related behavior. The Open Field Test and Elevated Plus Maze Test were executed for estimating pain related emotion. Hematoxylin-eosin staining was used to observe changes in colonic histomorphology. Enzyme-linked immunosorbent assay was adopted to detect content of P substance in serum. Results: Compared with normal group,the colonic damage of rats model with inflammatory bowel dis-ease was severe,manifested with ulcers and inflammation and injury of colon was alleviated to some extent after moxibustion and acupuncture treatment. Compared to normal group,AWR scores of rats in model group under different expansion pressure stimulus were significantly increased and their MWT and TWL were shortened( all P < 0. 05),indicating visceral hypersensitivity and low threshold of pain. Compared with model group,AWR scores of rats under different expansion pressure stimulus were reduced in moxibustion group and acupuncture group and their MWT and TWL were also prolonged after treatment( all P < 0. 05). Compared with acupuncture group,AWR scores in moxibustion group were markedly decreased at 40 mmHg and 60 mmHg expansion pressure stimulus( P < 0. 01,P < 0. 05). Compared to normal group,the total distance of horizontal motion,number of vertical movement,number of entry into the open arms and residence time in the open arms were cut down in model group( all P < 0. 01). After moxibustion and acupuncture treatment,the total distance of horizontal motion,number of vertical movement,number of entry into the open arms and residence time in the open arms were also raised( all P < 0. 01). Compared with moxibustion group,the number of vertical movement of rats in acupuncture group was obviously ascended( P < 0. 05). Compared to normal group,the content of P substance of model rats in serum was promoted and it was lessened after moxibustion and acupuncture treatment( all P < 0. 01). Compared with acupuncture group,the content of P substance of rats in moxibustion group in serum was visibly lowered( P <0. 01). Conclusion: Moxibustion and acupuncture [Tianshu( ST25),Qihai( CV6)] both can improve the pain-related behavior and pain related emotion of inflammatory bowel disease-induced visceral pain rats. The effect of moxibustion at Tianshu( ST25) and Qihai( CV6) is superior to that of acupuncture.
Objective:To observe the influence of moxibustion and acupuncture on Tianshu( ST25),Qihai( CV6) on visceral pain of rats with inflammatory bowel disease and compare the similarities and differences of their effects from the point of pain-related behavior and emotion and content of P substance in serum. Methods: SD rats were randomly divided into four groups as a normal group,a model group,a moxibustion group and an acupuncture group. Rat model with inflammatory bowel disease and represented visceral pain was established by enema with trinitrobenzene sulfonic acid and 50% ethyl alcohol. Abdominal withdrawal reflex( AWR) score,mechanical withdrawal threshold( MWT) and thermal withdrawal latency( TWL) were surveyed to inspect visceral sensitivity and pain related behavior. The Open Field Test and Elevated Plus Maze Test were executed for estimating pain related emotion. Hematoxylin-eosin staining was used to observe changes in colonic histomorphology. Enzyme-linked immunosorbent assay was adopted to detect content of P substance in serum. Results: Compared with normal group,the colonic damage of rats model with inflammatory bowel dis-ease was severe,manifested with ulcers and inflammation and injury of colon was alleviated to some extent after moxibustion and acupuncture treatment. Compared to normal group,AWR scores of rats in model group under different expansion pressure stimulus were significantly increased and their MWT and TWL were shortened( all P < 0. 05),indicating visceral hypersensitivity and low threshold of pain. Compared with model group,AWR scores of rats under different expansion pressure stimulus were reduced in moxibustion group and acupuncture group and their MWT and TWL were also prolonged after treatment( all P < 0. 05). Compared with acupuncture group,AWR scores in moxibustion group were markedly decreased at 40 mmHg and 60 mmHg expansion pressure stimulus( P < 0. 01,P < 0. 05). Compared to normal group,the total distance of horizontal motion,number of vertical movement,number of entry into the open arms and residence time in the open arms were cut down in model group( all P < 0. 01). After moxibustion and acupuncture treatment,the total distance of horizontal motion,number of vertical movement,number of entry into the open arms and residence time in the open arms were also raised( all P < 0. 01). Compared with moxibustion group,the number of vertical movement of rats in acupuncture group was obviously ascended( P < 0. 05). Compared to normal group,the content of P substance of model rats in serum was promoted and it was lessened after moxibustion and acupuncture treatment( all P < 0. 01). Compared with acupuncture group,the content of P substance of rats in moxibustion group in serum was visibly lowered( P <0. 01). Conclusion: Moxibustion and acupuncture [Tianshu( ST25),Qihai( CV6)] both can improve the pain-related behavior and pain related emotion of inflammatory bowel disease-induced visceral pain rats. The effect of moxibustion at Tianshu( ST25) and Qihai( CV6) is superior to that of acupuncture.
引文
[1]Molodecky NA,Soon IS,Rabi DM,et al.Increasing incidence and prevalence of the inflammatory bowel diseases with time,based on systematic review[J].Gastroenterology,2012,142:46-54.
[2]Cosnes J,Gower-Rousseau C,Seksik P,et al.Epidemiology and natural history of inflammatory bowel diseases[J].Gastroenterology,2011,140:1785-1794.
[3]Wlodarczyk M,Sobolewska-Wlodarczyk A,Stec-Michalska K,et al.The influence of family pattern abnormalities in the early stages of life on the course of inflammatory bowel diseases[J].Pharmacol Rep,2016,68(4):852-858.
[4]Bernklev T,Jahnsen J,Schulz T,et al.Course of disease,drug treatment and health-related quality of life in patients with inflammatory bowel disease 5 years after initial diagnosis[J].Eur JGastroenterol Hepatol,2005,10:1037-1045.
[5]Zeitz J,Ak M,Müller-Mottet S,et al.Pain in IBD Patients:Very Frequent and Frequently Insufficiently Taken into Account[J].PLo S One,2016,11(6):e0156666.
[6]Casellas F,Lopez-Vivancos J,Casado A,et al.Factors affecting health related quality of life of patients with inflammatory bowel disease[J].Qual Life Res,2002,8:775-781.
[7]Burkhalter H,Stucki-Thür P,David B,et al.Assessment of inflammatory bowel disease patient’s needs and problems from a nursing perspective[J].Digestion,2015,91(2):128-141.
[8]郭保君,陆鹏,张镭潇,等.针灸健脾补肾法治疗溃疡性结肠炎疗效观察[J].四川中医,2016(5):182-185.
[9]包春辉,吴璐一,吴焕淦,等.针灸治疗活动期克罗恩病:随机对照研究[J].中国针灸,2016(7):683-688.
[10]Zhao C,Bao C,Li J,et al.Moxibustion and Acupuncture A-meliorate Crohn’s Disease by Regulating the Balance between Th17 and Treg Cells in the Intestinal Mucosa[J].Evid Based Complement Alternat Med,2015:938054.
[11]Bao CH,Zhao JM,Liu HR,et al.Randomized controlled trial:moxibustion and acupuncture for the treatment of Crohn‘s disease[J].World J Gastroenterol,2014,20(31):11000-11011.
[12]Gerald P.Morris,Paul L.Beck,Margaret S,et al.Hapteninduced model of chronic inflammation and ulceration in the Rat colon[J].Gastroenterology,1989,96:795-803.
[13]Qi Qi Zhou,Donald D,Price DD.Visceral and somatic hypersensitivity in TNBS-induced colitis in rats[J].Dig Dis Sci,2008,53:429-435.
[14]Tarrerias AL,Millecamps M,Alloui A,et al.Short-chain fatty acid enemas fail to decrease colonic hypersensitivity and inflammation in TNBS-induced colonic inflammation in rats[J].Pain,2006,12:91-97.
[15]Chaplan SR,Bach FW,Pogrel JW,et al.Quantitative assessment of tactile allodynia in the rat paw[J].J Neurosci Methods,1994,1:55-63.
[16]Hargreaves K,Dubner R,Brown F,et al.A new and sensitive method for measuring thermal nociception in cutaneous hyperalgesia[J].Pain,1988,1:77-88.
[17]Shin J,Gireesh G,Kim SW,et al.Phospholipase C beta 4 in the medial septum controls cholinergic theta oscilliations and anxiety behaviors[J].J Neurosci,2009,49:15375-15385.
[18]Roy V,Chapillon P,Jeljeli M,et al.Free versus of reed exposure to an elevated plus maze:evidence of new behavioral interpretations during test and retest[J].Psycho Pharmacology,2009,1:131-141.
[19]周云仙.炎症性肠病患者生存质量调查及影响因素分析[J].浙江中医药大学学报,2014,1:97-100.
[20]Morrison G,Van Langenberg DR,Gibson SJ,et al.Chronic pain in inflammatory bowel disease:characteristics and associations of a hospital-based cohor[J]t.Inflamm Bowel Dis,2013,6:1210-1217.
[21]Graff LA,Walker JR,Bernstein CN.Depression and anxiety in inflammatory bowel disease:a review of comorbidity and management[J].Inflamm Bowel Dis,2009,15:1105-1118.
[22]Engstrom I.Mental health and psychological functioning in children and adolescents with inflammatory bowel disease:a comparison with children having other chronic illnesses and with healthy children[J].J Child Psychol Psychiatry,1992,33:563-582.
[23]Fuller-Thomson E,Sulman J.Depression and inflammatory bowel disease:findings from two nationally representative Canadian surveys[J].Inflamm Bowel Dis,2006,12:697-707.
[24]De Schepper HU,De Man JG,Moreels TG,et al.Gastrointestinal sensory and motor disturbances in inflammatory bowel disease-clinical relevance and pathophysiological mechanisms[J].Aliment Pharmacol Ther,2008,27:621-637.
[25]Farrokhyar F,Marshall JK,Easterbrook B,et al.Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease:prevalence and impact on health[J].Inflamm Bowel Dis,2006,12:38-46.
[26]Simrén M,Axelsson J,Gillberg R,et al.Quality of life in inflammatory bowel disease in remission:the impact of IBS-like symptoms and associated psychological factors[J].Am J Gastroenterol,2002,97:389-396.
[27]朱毅,李凝,励建安.中医药在疼痛管理中的应用进展[J].中国康复理论与实践,2013,12:1140-1143.
[28]季庆洁,杨继国.针刺镇痛的研究现状[J].山东中医杂志,2012,10:770-771.
[29]章进,章震.毛莨灸治疗胃脘痛56例[J].中国针灸,2006,10:744.
[30]张必萌,吴焕淦.灸法在软组织疼痛性疾病中的应用进展[J].上海针灸杂志,2005,2:43-46.
[31]Huang Y,Yang YT,Liu XX,et al.Effect of herbal-partitioned moxibustion at Tianshu(ST 25)and Qihai(CV 6)on pain-related behavior and emotion in rats with chronic inflammatory visceral pain[J].J Acupunct Tuina Sci,2015,13:1-8.
[32]Zhou En-hua,Liu Hui-rong,Wu Huan-gan,et al.Herb-partition moxibustion relieves chronic visceral hyperalgesia and 5-HT concentration in colon mucosa of rats[J].Neurological Research,2009,7:734-737.
[33]李晗,赵继梦,郑桂芝,等.针刺和艾灸对躯体疼痛镇痛效果差异的Meta分析[J].世界科学技术-中医药现代化,2016(3):381-388.
[34]石斐.针刺与艾灸三阴交穴对寒湿凝滞型原发性痛经患者即时镇痛效应的比较研究[D].石家庄:河北医科大学,2015.
[35]杨筱秋,邓建敏,曹正和.不同温灸法对阳虚寒凝型膝骨关节炎的镇痛效果比较及其部分机制研究[J].世界中医药,2015(9):1402-1405.
[36]郭保君,陆鹏,张镭潇,冒冬冬,余思奕,申治富,任毅,钟贞,胡卡明,胡幼平.针灸健脾补肾法治疗溃疡性结肠炎疗效观察[J].四川中医,2016(5):182-185.
[37]包春辉,吴璐一,吴焕淦,刘慧荣,赵继梦,曾晓清,马丽黎,李璟,赵琛,王思瑶.针灸治疗活动期克罗恩病:随机对照研究[J].中国针灸,2016(7):683-688.
[38]张赛,贾思涵,郑斌,等.针刺治疗肠易激综合征随机对照研究[J].中国中医基础医学杂志,2016(3):404-406,425.
[39]史灵心,哈丽娟,曹方,等.现代针灸文献治疗腹痛的同功穴规律分析[J].世界中医药,2016(2):198-201.
[2]Cosnes J,Gower-Rousseau C,Seksik P,et al.Epidemiology and natural history of inflammatory bowel diseases[J].Gastroenterology,2011,140:1785-1794.
[3]Wlodarczyk M,Sobolewska-Wlodarczyk A,Stec-Michalska K,et al.The influence of family pattern abnormalities in the early stages of life on the course of inflammatory bowel diseases[J].Pharmacol Rep,2016,68(4):852-858.
[4]Bernklev T,Jahnsen J,Schulz T,et al.Course of disease,drug treatment and health-related quality of life in patients with inflammatory bowel disease 5 years after initial diagnosis[J].Eur JGastroenterol Hepatol,2005,10:1037-1045.
[5]Zeitz J,Ak M,Müller-Mottet S,et al.Pain in IBD Patients:Very Frequent and Frequently Insufficiently Taken into Account[J].PLo S One,2016,11(6):e0156666.
[6]Casellas F,Lopez-Vivancos J,Casado A,et al.Factors affecting health related quality of life of patients with inflammatory bowel disease[J].Qual Life Res,2002,8:775-781.
[7]Burkhalter H,Stucki-Thür P,David B,et al.Assessment of inflammatory bowel disease patient’s needs and problems from a nursing perspective[J].Digestion,2015,91(2):128-141.
[8]郭保君,陆鹏,张镭潇,等.针灸健脾补肾法治疗溃疡性结肠炎疗效观察[J].四川中医,2016(5):182-185.
[9]包春辉,吴璐一,吴焕淦,等.针灸治疗活动期克罗恩病:随机对照研究[J].中国针灸,2016(7):683-688.
[10]Zhao C,Bao C,Li J,et al.Moxibustion and Acupuncture A-meliorate Crohn’s Disease by Regulating the Balance between Th17 and Treg Cells in the Intestinal Mucosa[J].Evid Based Complement Alternat Med,2015:938054.
[11]Bao CH,Zhao JM,Liu HR,et al.Randomized controlled trial:moxibustion and acupuncture for the treatment of Crohn‘s disease[J].World J Gastroenterol,2014,20(31):11000-11011.
[12]Gerald P.Morris,Paul L.Beck,Margaret S,et al.Hapteninduced model of chronic inflammation and ulceration in the Rat colon[J].Gastroenterology,1989,96:795-803.
[13]Qi Qi Zhou,Donald D,Price DD.Visceral and somatic hypersensitivity in TNBS-induced colitis in rats[J].Dig Dis Sci,2008,53:429-435.
[14]Tarrerias AL,Millecamps M,Alloui A,et al.Short-chain fatty acid enemas fail to decrease colonic hypersensitivity and inflammation in TNBS-induced colonic inflammation in rats[J].Pain,2006,12:91-97.
[15]Chaplan SR,Bach FW,Pogrel JW,et al.Quantitative assessment of tactile allodynia in the rat paw[J].J Neurosci Methods,1994,1:55-63.
[16]Hargreaves K,Dubner R,Brown F,et al.A new and sensitive method for measuring thermal nociception in cutaneous hyperalgesia[J].Pain,1988,1:77-88.
[17]Shin J,Gireesh G,Kim SW,et al.Phospholipase C beta 4 in the medial septum controls cholinergic theta oscilliations and anxiety behaviors[J].J Neurosci,2009,49:15375-15385.
[18]Roy V,Chapillon P,Jeljeli M,et al.Free versus of reed exposure to an elevated plus maze:evidence of new behavioral interpretations during test and retest[J].Psycho Pharmacology,2009,1:131-141.
[19]周云仙.炎症性肠病患者生存质量调查及影响因素分析[J].浙江中医药大学学报,2014,1:97-100.
[20]Morrison G,Van Langenberg DR,Gibson SJ,et al.Chronic pain in inflammatory bowel disease:characteristics and associations of a hospital-based cohor[J]t.Inflamm Bowel Dis,2013,6:1210-1217.
[21]Graff LA,Walker JR,Bernstein CN.Depression and anxiety in inflammatory bowel disease:a review of comorbidity and management[J].Inflamm Bowel Dis,2009,15:1105-1118.
[22]Engstrom I.Mental health and psychological functioning in children and adolescents with inflammatory bowel disease:a comparison with children having other chronic illnesses and with healthy children[J].J Child Psychol Psychiatry,1992,33:563-582.
[23]Fuller-Thomson E,Sulman J.Depression and inflammatory bowel disease:findings from two nationally representative Canadian surveys[J].Inflamm Bowel Dis,2006,12:697-707.
[24]De Schepper HU,De Man JG,Moreels TG,et al.Gastrointestinal sensory and motor disturbances in inflammatory bowel disease-clinical relevance and pathophysiological mechanisms[J].Aliment Pharmacol Ther,2008,27:621-637.
[25]Farrokhyar F,Marshall JK,Easterbrook B,et al.Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease:prevalence and impact on health[J].Inflamm Bowel Dis,2006,12:38-46.
[26]Simrén M,Axelsson J,Gillberg R,et al.Quality of life in inflammatory bowel disease in remission:the impact of IBS-like symptoms and associated psychological factors[J].Am J Gastroenterol,2002,97:389-396.
[27]朱毅,李凝,励建安.中医药在疼痛管理中的应用进展[J].中国康复理论与实践,2013,12:1140-1143.
[28]季庆洁,杨继国.针刺镇痛的研究现状[J].山东中医杂志,2012,10:770-771.
[29]章进,章震.毛莨灸治疗胃脘痛56例[J].中国针灸,2006,10:744.
[30]张必萌,吴焕淦.灸法在软组织疼痛性疾病中的应用进展[J].上海针灸杂志,2005,2:43-46.
[31]Huang Y,Yang YT,Liu XX,et al.Effect of herbal-partitioned moxibustion at Tianshu(ST 25)and Qihai(CV 6)on pain-related behavior and emotion in rats with chronic inflammatory visceral pain[J].J Acupunct Tuina Sci,2015,13:1-8.
[32]Zhou En-hua,Liu Hui-rong,Wu Huan-gan,et al.Herb-partition moxibustion relieves chronic visceral hyperalgesia and 5-HT concentration in colon mucosa of rats[J].Neurological Research,2009,7:734-737.
[33]李晗,赵继梦,郑桂芝,等.针刺和艾灸对躯体疼痛镇痛效果差异的Meta分析[J].世界科学技术-中医药现代化,2016(3):381-388.
[34]石斐.针刺与艾灸三阴交穴对寒湿凝滞型原发性痛经患者即时镇痛效应的比较研究[D].石家庄:河北医科大学,2015.
[35]杨筱秋,邓建敏,曹正和.不同温灸法对阳虚寒凝型膝骨关节炎的镇痛效果比较及其部分机制研究[J].世界中医药,2015(9):1402-1405.
[36]郭保君,陆鹏,张镭潇,冒冬冬,余思奕,申治富,任毅,钟贞,胡卡明,胡幼平.针灸健脾补肾法治疗溃疡性结肠炎疗效观察[J].四川中医,2016(5):182-185.
[37]包春辉,吴璐一,吴焕淦,刘慧荣,赵继梦,曾晓清,马丽黎,李璟,赵琛,王思瑶.针灸治疗活动期克罗恩病:随机对照研究[J].中国针灸,2016(7):683-688.
[38]张赛,贾思涵,郑斌,等.针刺治疗肠易激综合征随机对照研究[J].中国中医基础医学杂志,2016(3):404-406,425.
[39]史灵心,哈丽娟,曹方,等.现代针灸文献治疗腹痛的同功穴规律分析[J].世界中医药,2016(2):198-201.