Objective: To observe the effect of acupuncture-moxibustion on negative emotions and plasma tryptophan (Trip)-kynurenine (Kyn) metabolism in the patients with Crohn's disease (CD) at the mild and moderate active stage.
Methods: A total of 66 CD patients were randomized into an observation group (33 cases, 1 case dropped off) and a control group (33 cases, 2 cases dropped off). In the observation group, acupuncture was applied in combination with moxibustion. In the control group, the sham-acupuncture was used in combination with sham-moxibustion. In both of the observation group and the control group, acupuncture was applied to Zhongwan (CV 12), Shangjuxu (ST 37), Sanyinjiao (SP 6), Gongsun (SP 4), Hegu (LI 4), Quchi (LI 11), Taixi (KI 3) and Taichong (LR 3), and moxibustion was applied to Tianshu (ST 25) and Zusanli (ST 36). The treatment was given once every two days, 3 times a week, totally for 12 weeks. Separately, before and after treatment, the score of the hospital anxiety-depression scale (HADS) and the score of intestinal core symptoms (degree of abdominal pain and frequency of diarrhea) were observed in the patients of the two groups. The concentration of plasma indoleamine 2,3-dioxygenase 1 (IDO1) and the ratios of Kyn/Trp, QuinA/Kyn, KynA/Kyn and KynA/QuinA were compared between the two groups.
Results: Compared with before treatment, the scores of HADS-A and HADS-D in the observation group and the score of HADS-A in the control group were all reduced after treatment (P<0.01, P<0.05). The scores of abdominal pain degree in the two groups and score of diarrhea frequency in the observation group were all reduced after treatment (P<0.001). After treatment, the reducing ranges of the score of HADS-A and the scores of abdominal pain degree and diarrhea frequency in the observation group were all larger than the control group (P<0.01, P<0.05). Compared with before treatment, the plasma IDO1 concentration in the two groups and the ratios of plasma Kyn/Trp and QuinA/Kyn in the observation group were all reduced after treatment (P<0.001, P<0.05, P<0.01), the ratios of plasma KynA/Kyn and KynA/QuinA were increased after treatment in the observation group (P<0.05, P<0.01). After treatment, the changes in IDO1 concentration and the ratios of plasma QuinA/Kyn and KynA/QuinA in the observation were larger than the control group (P≤0.01, P<0.05). In the observation group, the difference in the ratio of plasma KynA/Kyn before and after treatment was negatively related to the improvement value of HADS-D (r =-0.67, P<0.05). After treatment, plasma IDO1 concentration was positively related to HADS-A in the observation group (r =0.65, P<0.05).
Conclusion: Acupuncture and moxibustion relieve the negative emotions of anxiety and depression in CD patients at mild and moderate active stage, which is probably related to the regulation of plasma Trp-Kyn metabolic pathway.
目的：观察针灸对轻、中度活动期克罗恩病（CD）患者负性情绪及血浆色氨酸（Trp）-犬尿氨酸（Kyn）代谢的影响。方法：将66例CD患者随机分为观察组（33例，脱落1例）和对照组（33例，脱落2例）。观察组采用针刺联合艾灸治疗，对照组采用假针刺联合假艾灸治疗，两组针刺选取中脘、上巨虚、三阴交、公孙、合谷、曲池、太溪、太冲穴，艾灸选取天枢、足三里，隔日1次，每周治疗3次，共治疗12周。分别于治疗前后观察两组患者医院焦虑抑郁量表（HADS）评分及肠道核心症状（腹痛程度和腹泻次数）评分，并比较治疗前后血浆吲哚胺2,3-双加氧酶1（IDO1）浓度以及Kyn/Trp、喹啉酸（QuinA）/Kyn、犬尿喹啉酸（KynA）/Kyn和KynA/QuinA的比值。结果：与治疗前比较，治疗后观察组HADS焦虑亚量表（HADS-A）、抑郁亚量表（HADS-D）评分及对照组HADS-A评分均降低（P<0.01，P<0.05），两组腹痛程度评分和观察组腹泻次数评分均降低（P<0.001）；观察组治疗后HADS-A评分、腹痛程度和腹泻次数评分降低幅度大于对照组（P<0.01，P<0.05）。与治疗前比较，治疗后两组血浆IDO1浓度、观察组血浆Kyn/Trp及QuinA/Kyn比值降低（P<0.001，P<0.05，P<0.01），观察组血浆KynA/Kyn、KynA/QuinA比值增加（P<0.05，P<0.01）；观察组治疗后IDO1浓度、QuinA/Kyn及KynA/QuinA比值的变化幅度大于对照组（P≤0.01，P<0.05）。观察组治疗前后血浆KynA/Kyn的差值与HADS-D的改善值呈负相关（r =-0.67，P<0.05），观察组治疗后血浆IDO1浓度与HADS-A呈正相关（r =0.65，P<0.05）。结论：针灸可改善轻、中度活动期CD患者焦虑和抑郁负性情绪，可能与调节血浆Trp-Kyn代谢通路水平有关。.
Keywords: Crohn's disease; acupuncture and moxibustion; negative emotions; randomized controlled trial (RCT); tryptophan.