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目的探讨不同经脉及不同神经节段支配的穴位对同一疾病不同症状的疗效差异及相关机制。方法新生Wistar大鼠随机分为空白组、模型组、足三里组和合谷组,每组10~12只。除空白组外,均采用母子分离加醋酸灌肠结合结直肠扩张(CRD)联合制备肠易激综合征(IBS)模型。造模成功者,2月龄时,足三里组、合谷组给予相应穴位电针刺激,20 min/次,隔日1次,共5次。观察各组大鼠电针前后的粪便性状,采用Bristol分型标准评分;腹部回撤反射(AWR)评价内脏痛觉敏感性;免疫组化法检测结肠辣椒素受体(TRPV1)、5-HT2AR的阳性表达。结果与空白组比较,针刺前,模型组、足三里组及合谷组大鼠的Bristol评分均显著升高(P<0.01);针刺后,模型组(P<0.01)、合谷组(P<0.05)大鼠的评分升高;模型组、足三里组腹抬压力阈值明显降低(P<0.01),收缩波明显增加(P<0.01),结肠TRPV1阳性表达均升高(P<0.01),合谷组结肠TRPV1表达增高(P<0.05)。模型组、合谷组结肠5-HT2AR阳性表达升高(P<0.01)。与模型组比较,足三里组及合谷组,针刺后Bristol大便评分降低(P<0.01);腹抬压力阈值升高(P<0.01)、收缩波个数减少(P<0.01);结肠TRPV1、5-HT2AR阳性表达均显著性降低(P<0.01)。与足三里组相比,合谷组针后Bristol评分升高(P<0.05),结肠TRPV1表达下降(P<0.01),5-HT2AR表达升高(P<0.01)。结论电针足三里穴和合谷穴均能降低IBS大鼠肠道痛敏感性,改善胃肠动力障碍。两穴比较,合谷穴对IBS内脏痛的治疗效应略优于足三里穴,而足三里穴对胃肠运动的调节效应更具优势。说明不同经脉、不同神经节段支配的穴位可以治疗同一病症,但存在效应差异,证实了经穴效应特异性存在且具有相对性。
Objective To investigate the difference of curative effect between different meridians and different nerve branches on different symptoms of the same disease and related mechanisms. Methods Newborn Wistar rats were randomly divided into blank group, model group, Zusanli group and Hegu group, with 10-12 rats in each group. In addition to the blank group, the model of irritable bowel syndrome (IBS) was established by combining mother and child with acetic acid enema and colorectal distension (CRD). At 2 months of age, Zusanli and Hegu groups were given electroacupuncture at the corresponding acupoints for 20 min every other day for 5 times. The stool characteristics before and after electroacupuncture were observed in each group. The Bristol score was used to evaluate the stool sensitivity. The visceral hyperalgesia was evaluated by abdomen retraction reflex (AWR). The expressions of colon capsaicin receptor (TRPV1), 5-HT2AR Positive expression. Results Compared with blank group, Bristol scores of model group, Zusanli group and Hegu group were significantly increased before acupuncture (P <0.01). After acupuncture, model group (P <0.01), Hegu group (P <0.01). The levels of TRPV1 in colon and Zusanli groups were significantly decreased (P <0.01), the contraction wave was significantly increased (P <0.01) , And the expression of TRPV1 in Hegu group increased (P <0.05). The positive expression of 5-HT2AR in model group and Hegu group was increased (P <0.01). Compared with the model group, the Bristol stool score was decreased (P <0.01), the threshold of abdominal pressure increased (P <0.01) and the number of contraction wave decreased (P <0.01) in the Zusanli and Hegu groups. The colon TRPV1 , 5-HT2AR positive expression was significantly decreased (P <0.01). Compared with the Zusanli group, the Bristol score of the Hegu group was significantly higher than that of the Zusanli group (P <0.05). The expression of TRPV1 in the colon was decreased (P <0.01) and the expression of 5-HT2AR was increased (P <0.01). Conclusion Electroacupuncture at Zusanli and Hoku can reduce intestinal pain sensitivity and improve gastrointestinal dysmotility in IBS rats. Compared with the two points, Hegu acupoints had a slightly better therapeutic effect on visceral pain in IBS than Zusanli acupoint. The regulation effect of Zusanli on gastrointestinal motility was more superior. It shows that different meridians, different nerve segments dominate the acupuncture points can treat the same disease, but there are differences in the effect, confirming the acupoints specificity exists and has relativity.