Objective: To compare the curative effect on diarrhea-predominant irritable bowel syndrome (IBS-D) between acupuncture for regulating shen and strengthening spleen and pinaverium bromide, and explore the relevant mechanism of curative effect of acupuncture in view of polymorphism of 5-hydroxytryptamine transporter gene-linked polymorphic region (5-HTTLPR).
Methods: A total of 231 patients with IBS-D were randomized into an acupuncture group (154 cases) and a western medication group (77 cases) at the ratio of 2 to 1. In the acupuncture group, acupuncture was applied to acupoint regimen for regulating shen and strengthening spleen, i.e. Baihui (GV 20), Yintang (GV 29), Tianshu (ST 25), Shangjuxu (ST 37) and Zusanli (ST 36), etc. The treatment was given once every 2 days, 3 times a week. In the western medication group, pinaverium bromide was prescribed for oral administration, 50 mg each time, 3 times daily. The duration of treatment was 6 weeks in each group. Separately, before treatment, after treatment and in 3-month follow-up, the IBS symptom severity scale (IBS-SSS) and IBS quality of life scale (IBS-QOL) scores were adopted in assessment. After treatment, the curative effect and safety were compared between the two groups. Before treatment, 5-HTTLPR genotypes were determined in the patients.
Results: After treatment and in follow-up, the total scores of IBS-SSS in the patients of the two groups were all reduced as compared with those before treatment (P<0.01) and the scores in the acupuncture group were lower than those in the western medication group (P<0.01). After treatment and in follow-up, the total scores of IBS-QOL in the two groups were all increased as compared with those before treatment (P<0.01) and the score in the acupuncture group was higher than the western medication group in follow-up (P<0.01). The total effective rate was 79.2% (122/154) in the acupuncture group, higher than 58.4% (45/77) in the western medication group (P<0.01). There was no severe adverse reaction found in the two groups. The difference in the total score of IBS-SSS before and after treatment in the patients with LS and SS genotypes was greater than that in the patients with LL in the acupuncture group (P<0.01). The difference in the total score of ISB-SSS before and after treatment in the patients with SS genotype was greater than that in the patients with LL in the western medication group (P<0.01). The difference in the total score of IBS-SSS before and after treatment in the patients with LS and SS genotypes in the acupuncture group was greater than that in the patients with the same genotypes in the western medication group (P<0.01).
Conclusion: Acupuncture for regulating shen and strengthening spleen achieves the more curative effect on IBS-D as compared with pinaverium bromide. The acupuncture regimen effectively relieves the clinical symptoms and improves the quality of life in patients as well as presents a satisfactory long-term effect and safety. The clinical curative effect of acupuncture is correlated with 5-HTTLPR polymorphism, in which, the curative effect of acupuncture may be more effective in the patients with LS and SS genotypes.
目的：比较“调神健脾”针刺与匹维溴铵片治疗腹泻型肠易激综合征（IBS-D）的疗效，从5-羟色胺转运体基因多态性区（5-HTTLPR）基因多态性角度探讨针刺疗效的相关机制。方法：将231例IBS-D患者按照2∶1的比例随机分为针刺组（154例）和西药组（77例）。针刺组予“调神健脾”组方针刺，穴取百会、印堂、天枢、上巨虚、足三里等，隔日1次，每周3次；西药组口服匹维溴铵片，每次50 mg，每日3次，均治疗6周。分别于治疗前、治疗后及3个月随访期评价两组IBS症状严重程度量表（IBS-SSS）与IBS生活质量量表（IBS-QOL）总分，于治疗后比较两组疗效及安全性；在治疗前测定患者5-HTTLPR基因型。结果：治疗后及随访时，两组患者IBS-SSS总分均较治疗前降低（P<0.01），且针刺组低于西药组（P<0.01）；治疗后及随访时，两组患者IBS-QOL总分均较治疗前升高（P<0.01），且针刺组随访时高于西药组（P<0.01）。针刺组总有效率为79.2%（122/154），高于西药组的58.4%（45/77，P<0.01），两组均未出现严重不良反应。针刺组LS及SS基因型患者IBS-SSS总分治疗前后差值均大于LL基因型（P<0.01）；西药组SS基因型患者IBS-SSS总分治疗前后差值大于LL基因型（P<0.01）；针刺组LS及SS基因型患者IBS-SSS总分治疗前后差值均大于西药组同基因型（P<0.01）。结论：“调神健脾”针刺治疗腹泻型肠易激综合征的疗效优于匹维溴铵片，可有效缓解患者临床症状，改善患者生活质量，具有较好的疗效及安全性；针刺临床疗效与5-HTTLPR基因多态性具有相关性，LS、SS基因型患者针刺治疗的疗效可能更优。.
Keywords: 5-HT transporter gene-linked polymorphic region (5-HTTLPR); acupuncture; diarrhea-predominant irritable bowel syndrome (IBS-D); gene polymorphism; randomized controlled trial (RCT).