Objective: To observe the clinical efficacy of shuanggu yitong acupuncture therapy (the therapy for both replenishment and unblocking) combined with domperidone on diabetic gastroparesis (DGP) of liver stagnation and spleen deficiency pattern and explore its effect mechanism.
Methods: DGP patients differentiated as liver stagnation and spleen deficiency pattern were divided into a control group (n=42) and an observation group (n=42) according to the random number table. The patients in the control group took domperidone tablets orally, 10 mg each time, 3 times a day for 28 days. In the observation group, on the base of the treatment as the control group, shuanggu yitong acupuncture therapy was applied to Baihui (GV20), Shenting (GV24), Zhongwan (CV12), bilateral Zusanli (ST36), Hegu (LI4)and Taichong (LR3), stimulated for 30 min in each treatment. Acupuncture was given once daily, 3 times a weeks for 28 days consecutively. Fasting blood glucose (FBG), 2-hour postprandial blood glucose (2 h PBG) and glycosylated hemoglobin (HbA1c) were detected before and after treatment in the patients of two groups separately. The score of symptom severity index of gastroparesis (GCSI), traditional Chinese medicine (TCM) syndrome score and gastric emptying rate were assessed in the patients of two groups. Using ELISA, radioimmunoassay and colorimentry methods, the contents of motilin in plasma, gastrin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β) and interferon-gamma (INF-γ) in serum, as well as the activity of superoxide dismutase (SOD), reactive oxygen species (ROS) and malondialdehyde (MDA) in the serum were determined in the two groups. The clinical curative effect was evaluated.
Results: After treatment, the levels of FBG, 2 h PBG and HbA1c, the scores of GCSI and TCM syndrome, the contents of motilin in plasma, gastrin, TNF-α and MDA, as well as the activity of ROS in serum were all reduced when compared with those before treatment in each group (P<0.05, P<0.01), while gastric emptying rate and SOD activity in the serum were higher than those before treatment (P<0.05, P<0.01). After treatment, the serological content of INF-γ was lower than that before treatment in the control group (P<0.05), and the contents of IL-6 and IL-1β were reduced than those before treatment in the observation group (P<0.05). Compared with the control group, the levels of FBG, 2 h PBG and HbA1c, the scores of GCSI and TCM symptoms, the contents of motilin in plasma, gastrin, TNF-α, MDA, IL-6 and IL-1β, and the activity of ROS in serum in the observation group were all lower significantly (P<0.05, P<0.01), while the SOD activity and gastric emptying rate in the observation group were higher than those in the control group (P<0.05, P<0.01). The total effective rate was 90.5% (38/42) in the observation group, better than the control group (73.8%, 31/42, P<0.05).
Conclusion: Shuanggu yitong acupuncture therapy combined with domperidone remarkably relieves the clinical symptoms and improves the gastric emptying rate, effectively reduces motilin and gastrin and regulates oxidative stress and inflammatory responses in the patients with DGP of liver stagnation and spleen deficiency.
目的：观察双固一通针刺联合多潘立酮治疗肝郁脾虚型糖尿病胃轻瘫(DGP)的临床疗效并探讨其作用机制。方法：采用随机数字表法将肝郁脾虚型DGP患者随机分为对照组和观察组，每组42例。对照组予以多潘立酮片口服治疗，10 mg/次，3次/d，治疗28 d。观察组在对照组基础上予以双固一通针刺治疗，取百会、神庭、中脘及双侧足三里、合谷、太冲，刺激30 min，每日1次，每周治疗3次，治疗28 d。检测两组患者治疗前后空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)；评估两组患者治疗前后胃轻瘫症状严重指数量表(GCSI)评分、中医证候评分；钡餐造影检测两组患者治疗前后胃排空率；ELISA法、放射免疫法、比色法检测两组患者治疗前后血浆胃动素及血清胃泌素、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-1β和干扰素-γ(INF-γ)含量和血清超氧化物歧化酶(SOD)、活性氧(ROS)活性及丙二醛(MDA)含量；评定两组患者临床疗效。结果：治疗后，两组患者FBG、2 h PBG、HbA1c、GCSI评分、中医证候评分及血浆胃动素、血清胃泌素含量和血清ROS活性及TNF-α、MDA含量均低于本组治疗前(P<0.05，P<0.01)，胃排空率和血清SOD活性高于本组治疗前(P<0.05，P<0.01)；对照组血清INF-γ含量低于本组治疗前(P<0.05)，观察组IL-6、IL-1β含量低于本组治疗前(P<0.05)。治疗后，观察组FBG、2 h PBG、HbA1c、GCSI评分、中医证候评分及血浆胃动素、血清胃泌素含量和血清ROS活性及MDA、TNF-α、IL-6、IL-1β含量均显著低于对照组(P<0.05，P<0.01)，胃排空率、血清SOD活性高于对照组(P<0.05，P<0.01)。观察组总有效率为90.5%(38/42)高于对照组的73.8%(31/42，P<0.05)。结论：双固一通针刺联合多潘立酮治疗肝郁脾虚型DGP可以明显改善患者临床症状、提高胃排空率，同时能有效降低胃动素、胃泌素水平，调节氧化应激和炎性反应水平。.
Keywords: Diabetic gastroparesis; Domperidone; Inflammatiory responses; Liver stagnation and spleen deficiency; Oxidative stress; Shuanggu yitong acupuncture.