METHODS: A total of 86 patients for elective ERCP were randomly ordered to receive TEA (n = 43) at acupoints PC6 and ST36 or Sham-TEA (n = 43) at sham points from 24 hours before ERCP (pre-ERCP) to 24 hours after ERCP (PE24). Scores of gastrointestinal (GI) motility-related symptoms and abdominal pain, gastric slow waves, and autonomic functions were recorded through the spectral analysis of heart rate variability; meanwhile, circulatory levels of inflammation cytokines of tumor necrosis factor-α (TNF-α) and interleukin (IL)-10 and GI hormones of motilin, ghrelin, cholecystokinin (CCK), and vasoactive intestinal peptide (VIP) were assessed by enzyme-linked immunosorbent assay.
RESULTS: 1) TEA, but not Sham-TEA, decreased the post-ERCP GI motility-related symptom score (2.4 ± 2.6 vs 7.9 ± 4.6, p < 0.001) and abdominal pain score (0.5 ± 0.7 vs 4.1 ± 2.7, p < 0.001) at PE24, and decreased the post-ERCP hospital day by 20.0% (p <0.05 vs Sham-TEA); 2) TEA improved the average gastric percentage of normal slow waves and dominant frequency by 34.6% and 33.3% at PE24, respectively (both p < 0.001 vs Sham-TEA); 3) TEA, but not Sham-TEA, reversed the ERCP-induced increase of TNF-α but not IL-10 at PE24, reflected as a significantly lower level of TNF-α in the TEA group than in the Sham-TEA group (1.6 ± 0.5 pg/mL vs 2.1 ± 0.9 pg/mL, p < 0.01); 4) compared with Sham-TEA, TEA increased vagal activity by 37.5% (p < 0.001); and 5) TEA caused a significantly higher plasma level of ghrelin (1.5 ± 0.8 ng/ml vs 1.1 ± 0.7 ng/ml, p < 0.05) but not motilin, VIP, or CCK than did Sham-TEA at PE24.
CONCLUSIONS: TEA at PC6 and ST36 accelerates the post-ERCP recovery, reflected as the improvement in GI motility and amelioration of abdominal pain, and suppression of the inflammatory cytokine TNF-α may mediate through both autonomic and ghrelin-related mechanisms.
方法:共有86例择期ERCP患者被随机命令在ERCP前24小时(ERCP前)至ERCP后24小时(PE24)接受PC6和ST36穴位TEA(n=43)或Sham-TEA(n=43)。胃肠道(GI)运动相关症状和腹痛的分数,胃慢波,通过心率变异性的频谱分析记录自主神经功能;同时,肿瘤坏死因子-α(TNF-α)和白细胞介素(IL)-10的炎症细胞因子和胃动素的GI激素的循环水平,ghrelin,胆囊收缩素(CCK),通过酶联免疫吸附试验评估血管活性肠肽(VIP)。
结果:1)TEA,但不是假茶,PE24时ERCP后胃肠动力相关症状评分(2.4±2.6vs7.9±4.6,p<0.001)和腹痛评分(0.5±0.7vs4.1±2.7,p<0.001),ERCP后住院天数减少20.0%(p<0.05vsSham-TEA);2)TEA在PE24时,正常慢波和主导频率的平均胃百分比分别提高了34.6%和33.3%(ShEA<3)但不是假茶,在PE24处逆转了ERCP诱导的TNF-α而不是IL-10的增加,反映为TEA组的TNF-α水平明显低于Sham-TEA组(1.6±0.5pg/mLvs2.1±0.9pg/mL,p<0.01);4)与假TEA相比,TEA使迷走神经活动增加37.5%(p<0.001);5)TEA引起血浆ghrelin水平显著升高(1.5±0.8ng/mlvs1.1±0.7ng/ml,p<0.05),但不是胃动素,VIP,或CCK比PE24的Sham-TEA。
结论:TEA在PC6和ST36加速ERCP后的恢复,表现为胃肠动力的改善和腹痛的改善,炎性细胞因子TNF-α的抑制可能通过自主神经和生长素释放肽相关机制介导。