基于脑肠轴理论探讨针刺治疗肾阴虚型绝经综合征伴焦虑障碍的临床疗效

Clinical efficacy of acupuncture treatment for menopausal syndrome with deficiency of kidney yin with anxiety disorder based on brain-gut axis theory

关键词:  脑肠轴理论  针刺  绝经综合征伴焦虑障碍  脑肠肽

Key words:  brain gut axis theory  acupuncture  menopausal syndrome with anxiety disorder  cerebrointestinal peptide

摘要:

[目的] 探讨针刺治疗肾阴虚型绝经综合征伴焦虑障碍的疗效，并基于脑肠轴理论分析其作用机制。[方法] 采用随机、对照研究方法，将天津中医药大学第一附属医院于2020年1月至2020年6月收治的60例肾阴虚型绝经综合征伴焦虑障碍患者随机分组。对照组口服莉芙敏治疗，研究组患者在对照组的基础上采用针刺治疗，疗程为8周，比较两组中医证候疗效、潮热评分、焦虑症状、性激素水平及脑肠肽水平。[结果] 治疗后，研究组中医证候疗效的有效率（96.67%）高于对照组（73.33%），差异有统计学意义（P＜0.05）；研究组患者潮热评分、改良女性绝经期自测量表评分及汉密尔顿焦虑量表（HAMA）评分均低于对照组，差异有统计学意义（P＜0.05）；与治疗前比较，两组治疗后血清雌二醇（E2）有升高趋势，血清促卵泡生成素（FSH）、促黄体生成素（LH）有下降趋势，且两组患者FSH、LH、E2水平比较，差异无统计学意义（P＞0.05）；研究组患者血清血管活性肠肽（VIP）、生长抑素（SS）、神经肽Y（NPY）、降钙素基因相关肽（CGRP）及5-羟色胺（5-HT）水平均低于对照组（P＜0.05）。[结论] 在西医常规治疗基础上结合针刺治疗肾阴虚型绝经综合征伴焦虑障碍能够明显缓解患者潮热、绝经及焦虑症状，改善性激素水平，其作用机制可能与针刺调节脑肠肽水平的表达有关。

Abstract:

[Objective] To explore the therapeutic effect of acupuncture on menopausal syndrome of kidney yin deficiency type with anxiety disorder，and to analyze its mechanism of action based on the brain gut axis theory. [Methods] A randomized and controlled study method was used to investigate 60 patients with renal yin deficiency menopause syndrome with anxiety disorder admitted to the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2020 to June 2020. They were randomly divided into control group and research group. The control group was treated with oral rivamine，and the patients in the research group were treated with acupuncture on the basis of the control group for 8 weeks. The efficacy of traditional Chinese medicine（TCM） syndrome， hot flash score，anxiety symptoms，sex hormone levels and brain-intestinal peptide levels were compared between the two groups. [Results] After treatment，the effective rate of TCM syndrome in the research group（96.67%） was higher than that in the control group（73.33%）；the difference was statistically significant（P<0.05）. After treatment，the hot flash score，Kupperman rating scale and HAMA score of the research group were lower than those of the control group，with statistical significance（P<0.05）. There was no significant difference in the levels of serum follicle-stimulating hormone（FSH），luteinizing hormone（LH） and serum estradiol（E2） between the two groups（P>0.05），but compared with before treatment，E2 showed an increasing trend and FSH and LH showed a decreasing trend after treatment. Serum levels of vasoactive intestinal peptide（VIP），somatostatin（SS），neuropeptide Y（NPY），calcitonin gene-related peptide（CGRP） and 5-hydroxytryptamine（5-HT） in research group were significantly lower than those in control group（P<0.05）. [Conclusion] On the basis of conventional Western medicine，the treatment of renal yin deficiency type menopause syndrome with anxiety disorder combined with acupuncture has a good effect，which can significantly relieve the symptoms of hot flashes，menopause and anxiety，improve the level of sex hormones. The mechanism of the acupuncture may be related to the regulation of brain and intestinal peptide level expression.