摘要
目的:基于肠道菌群研究水沟穴对持续植物状态(PVS)患者营养状态影响的临床疗效,从机制层面初步阐述针刺水沟穴是否可通过调节肠道菌群及代谢产物从而调整PVS患者营养状况的关系及其之间的相关关系,为PVS患者的营养支持方案寻找新的理论和实践依据。方法:选取在本院接受治疗的PVS患者76例,随机数字分组方法将入选患者分为试验组(n=38)和对照组(n=38)。两组均接受常规治疗及康复治疗,在此基础上试验组给予针刺水沟穴联合肠内营养混悬液(TPF)治疗,对照组给予同样成分TPF治疗。在治疗前后收集所有受试者粪便样本,进行菌种鉴定和生物信息学分析受试者肠道菌群群落结构变化;对所有受试者粪便样本进行代谢产物检测,分析短链脂肪酸(SCFAs)(乙酸、丙酸、丁酸和戊酸)的含量。于治疗前后检测所有受试者血清白蛋白、前白蛋白及血红蛋白水平。于治疗前后及随访的第30天、90天对所有受试者行营养风险筛查表(NRS2002)评定。结果:治疗后试验组和对照组Chao指数、Ace指数、Shannon指数与本组治疗前比较均显著增高(P<0.05),Simpson指数显著降低(P<0.05)。治疗后试验组乙酸、丁酸、戊酸含量与治疗前比较均显著增高(P<0.05),丙酸含量显著降低(P<0.05)。治疗后两组上述血清营养指标与本组治疗前比较均显著增高(P<0.05),且试验组显著高于对照组(P<0.05)。结论:针刺水沟穴联合肠内营养治疗PVS患者临床疗效较好,能够调节肠道菌群结构及其代谢产物,显著改善患者营养状况。其机制可能为针刺水沟穴疗法可兴奋脑神经元、改善脑血流,从而开窍醒脑,联合肠内营养治疗可能通过调节肠道菌群结构、影响短链脂肪酸(SCFAs)水平,进而通过“微生物-肠-脑”轴改善PVS患者营养状况。
Objective:To explore the clinical effect of needling Shuigou acpoint(DU26)on nutritional status of the patients with persistent vegetate state(PVS)based on intestinal flora,to preliminarily expound whether needling DU26 can adjust nutritional state of PVS patients by regulating intestinal flora and metabolites and the correlation between them,thus to find a new theoretical and practical basis for nutritional supportive scheme applied to PVS patients.Methods:A total of 76 patients with PVS were randomly divided into the study group(n=38)and the control group(n=38).Both groups received routine treatment and rehabilitation therapy;on this basis,the study group was also treated with needling DU26 combined with enteral nutrition suspension(TPF),whereas the control group was only treated with TPF.The fecal samples were collected before and after the treatment for bacteria identification and bioinformatics analysis of intestinal flora structure.The metabolites of fecal samples were detected to analyze the contents of short-chain fatty acids(SCFAs),including acetic acid,propionic acid,butyric acid and pentanoic acid.The serum levels of albumin,prealbumin and hemoglobin were detected before and after the treatment.All patients were assessed by nutrition risk screening table(NRS 2002)before and after the treatment,as well as on 30th and 90th day of the follow-up.Results:Chao index,Ace index and Shannon index were all significantly increased(P<0.05),and Simpson index was significantly decreased after the treatment compared to those before the treatment in the two groups(P<0.05);of which the improvements in the study group were more significant(P<0.05).The contents of acetic acid,butyric acid and pentic acid were significantly higher(P<0.05),and the content of propionic acid was significantly lower after the treatment than those before the treatment in the study group(P<0.05).After the treatment,the serum nutritional indicators were significantly increased compared to those before the treatment in the two groups(P<0.05),and the increases were more significant in the study group(P<0.05).Conclusion:Needling DU26 combined with TPF is effective in the treatment of PVS.It can regulate the intestinal flora structure and its metabolites,as well as improve the nutritional status of the patients.The mechanism may be related to exciting neurons and improving cerebral blood flow through needling DU26;when combined with TPF,it can adjust the intestinal flora structure to affect the levels of SCFAs,and then improve the nutritional status in the patients with PVS through the‘microbe-intestine-brain’axis.
作者
刘烜玮
赵娜娜
肖鹏
陈嘉敏
文琼
王玉龙
LIU Xuanwei;ZHAO Nana;XIAO Peng;CHEN Jiamin;WEN Qiong;WANG Yulong(Nan'ao People's Hospital of Shenzhen Dapeng New Area, Shenzhen 518121, China;Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518000, China;Health Science Center, Shenzhen University, Shenzhen 518035, China)
出处
《针灸临床杂志》
2021年第11期26-31,共6页
Journal of Clinical Acupuncture and Moxibustion
基金
深圳市大鹏新区科技创新和产业发展专项资金,编号:YL202001-17。
关键词
肠道菌群
针刺
水沟穴
持续植物状态
营养状态
Intestinal flora
Acupuncture
DU26
Persistent vegetative state
Nutritional status
作者简介
刘烜玮(1981-),男,主治医师,2020级针灸推拿学专业博士研究生,研究方向:针灸对植物人促醒相关研究;通讯作者:王玉龙(1964-),男,主任医师,研究方向:老年病康复。
