针刺治疗结直肠癌术后胃肠动力障碍的miR-222相关机制研究

发布时间：2018-11-09 20:37

【摘要】：目的本研究采用靳三针疗法中的“足三针”穴组治疗结直肠癌术后出现的胃肠动力障碍,结合对病人病变组织miR-222含量的对比,尝试探索针刺足三针对恢复胃肠活动的相关机制。临床研究采用一般对症治疗与针刺治疗进行对照,目的在于证明针刺治疗比单纯一般对症治疗有优越性。同时,通过比较病变组织miR-222的含量,推导针刺起效的机制与microRNAs的关系。临床研究严格按照随机对照原则进行,可为研究针刺治疗结直肠癌术后胃肠动力障碍的相关机制提供有力的循证医学支持。方法选取符合纳入标准的结直肠癌术后患者32例,根据排除标准排除6例,然后按照随机数表法随机分为治疗组与空白对照组。对照组在术后单纯给予一般对症治疗；治疗组则在此基础上,于术后患者清醒且下肢感觉恢复后即开始加用针刺治疗,选穴以足三针为主(足三里、三阴交、太冲),最长针刺5天。治疗过程中两组分别剔除1例,故最后24例进入评估(每组12例)。观察术后第一次排气、排便及拔除胃管的时间；术后腹痛、腹胀情况；在对照组留取8例癌组织和治疗组留取4例癌组织进行miR-222相对表达量检测。结果1.术后第一次肛门排气比较：对照组与治疗组的差异具有显著性(p0.01),治疗组的首次排气时间更短；2.术后第一次肛门排便比较：对照组与治疗组的差异具有显著性(p0.01),治疗组的首次排便时间更短；首次排便情况(是否成形),治疗组与治疗组的差异无显著性(p0.05)；3.拔除胃管时间比较：对照组与治疗组的差异具有显著性(p0.01),治疗组的拔除胃管时间更短；4.腹痛评级比较：治疗组的前后评分差值与对照组相比有显著差异(p0.01),提示治疗组在腹痛改善方面疗效更佳；5.腹胀评级比较：治疗组的前后评分差值与对照组相比有显著差异(p0.01),提示治疗组在腹胀改善方面疗效更佳；6.组织miR-222的相对表达量比较：对照组与治疗组的癌组织miR-222含量无明显差异(p0.05)；癌旁组织与癌组织的miR-222含量有明显差异(p0.05),癌组织中的含量更多；7.疗效评级比较：对照组与治疗组的差异具有显著性(p0.01),治疗组的疗效更佳；8.miR-222与疗效评级的关系分析：虽然有趋势显示miR-222含量越低,针刺疗效及自然预后越好,但统计未有意义,可能与所收集的标本量较少有关。结论1.在一般支持治疗的基础上,针刺足三针能缩短结直肠癌术后患者的首次排气、排便及拔除胃管的时间,并有较好的缓解腹痛、腹胀症状的效果；2.miR-222在结直肠癌病人的病理组织中普遍存在,且其含量较正常组织更多；3.miR-222的高表达可能影响结直肠癌术后胃肠动力恢复和针刺疗效,尚需加大样本量进行研究。
[Abstract]:Objective to study the effect of Jin's three-needle therapy on gastrointestinal motility in patients with colorectal cancer after operation, and to compare the content of miR-222 in pathological tissues of patients with colorectal cancer. This paper attempts to explore the mechanism of acupuncture for the recovery of gastrointestinal activity. The aim of clinical study is to prove that acupuncture therapy is superior to simple general symptomatic therapy. At the same time, by comparing the content of miR-222 in diseased tissues, the relationship between the mechanism of acupuncture and microRNAs was deduced. The clinical study is carried out strictly according to the principle of random control, which can provide evidence-based medical support for the study of the mechanism of gastrointestinal motility disorder after colorectal cancer treatment by acupuncture. Methods 32 patients with colorectal cancer were selected and 6 patients were excluded according to the exclusion criteria. Then they were randomly divided into treatment group and blank control group according to the method of random number table. The control group was treated with general symptomatic therapy only after operation. On this basis, the patients in the treatment group began to be treated with acupuncture after the patients were awake and the lower limb sensation recovered. The main acupuncture points were three acupuncture points (Zusanli, Sanyinjiao, Taochong), and the longest acupuncture was 5 days (Zusanli, Sanyinjiao, Taicong). In the course of treatment, 1 case was excluded in the two groups, so 24 cases were evaluated (12 cases in each group). The time of first exsufflation, defecation and extubation of stomach tube, abdominal pain and distension after operation were observed. The relative expression of miR-222 was detected in 8 cancer tissues in the control group and 4 cancer tissues in the treatment group. Result 1. Comparison of the first anal exhaust after operation: the difference between the control group and the treatment group was significant (p0.01), the first exhaust time of the treatment group was shorter; 2. Comparison of the first anal defecation after operation: the difference between the control group and the treatment group was significant (p0.01), the first defecation time of the treatment group was shorter than that of the control group. There was no significant difference between the treatment group and the treatment group (p0.05). Comparison of the time of extubation: the difference between the control group and the treatment group was significant (p0.01), the time of removing gastric tube was shorter in the treatment group; 4. Comparison of abdominal pain rating: the difference between the treatment group and the control group was significant (p0.01), suggesting that the treatment group is better in improving abdominal pain; 5. Abdominal distension rating comparison: the difference between the treatment group and the control group was significant (p0.01), suggesting that the treatment group in abdominal distension improvement effect is better; 6. Comparison of the relative expression of miR-222: there was no significant difference in miR-222 content between the control group and the treatment group (p0.05), but there was a significant difference in the miR-222 content between the adjacent tissues and the cancerous tissue (p0.05), and the content of miR-222 in the cancer tissue was more than that in the control group (p0.05). 7. Comparison of curative effect rating: the difference between the control group and the treatment group was significant (p0.01), and the curative effect of the treatment group was better than that of the control group. Analysis of the relationship between 8.miR-222 and efficacy rating: although there is a tendency to show that the lower the miR-222 content, the better the acupuncture effect and the natural prognosis, but the statistical significance is not significant, which may be related to the small amount of samples collected. Conclusion 1. On the basis of general supportive treatment, acupuncture of foot three needles can shorten the time of first exhaust, defecation and extubation of patients with colorectal cancer after operation, and has a better effect of relieving abdominal pain and abdominal distension. 2.miR-222 is prevalent in the pathological tissues of colorectal cancer patients, and its content is more than that in normal tissues. The high expression of 3.miR-222 may affect the recovery of gastrointestinal motility and the effect of acupuncture after colorectal cancer.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.5

【相似文献】