Ningbo Pace Translational Medical Research Center, Beilun.
Department of Gastroenterology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi.
J Clin Gastroenterol. 2020 Jul;54(6):536-544. doi: 10.1097/MCG.0000000000001184.
Combined transcutaneous neuromodulation (TN) at acupoint ST36 (Zusanli) and TN at the posterior tibial nerve (PTN) has been reported effective in treating functional constipation. This study was designed to compare the effectiveness of TN between these 2 points.
Eighteen functional constipation patients (M/F: 9/9) were recruited to participate in a cross-over study with a 2-week TN at ST36 and a 2-week TN at PTN. A bowel movement diary, and the questionnaires of Patient Assessment of Constipation Symptom (PAC-SYM) and Constipation Quality of Life (PAC-QoL) were completed; anorectal manometry and spectral analysis of heart rate variability for assessing the autonomic function were performed.
(1) Both TN at ST36 and TN at PTN improved constipation-related symptoms (PAC-SYM scores on pre-TN vs. post-TN: 1.4±0.1 vs. 0.6±0.1 for ST36, 1.4±0.1 vs. 0.9±0.1 for PTN, both P≤0.001). (2) TN at ST36, but not TN at PTN, increased the number of weekly spontaneous bowel movements (0.9±0.2 pre-TN vs. 3.5±0.7 post-TN, P<0.001) and decreased the total PAC-QoL score. TN at ST36 was more potent than TN at PTN in improving the PAC-SYM score (decrement 0.8±0.1 vs. 0.5±0.1, P<0.05). (3) TN at ST36 rather than TN at PTN resulted in a reduction in sensation thresholds, including rectal distention for urge (134.1±14.3 mL pre-TN vs. 85.6±6.5 mL post-TN, P<0.01) and maximum tolerance (P<0.05). (4) Both TN at ST36 and TN at PTN significantly increased vagal activity and decreased sympathetic activity (P<0.05).
TN at ST36 is more potent than TN at PTN in treating constipation and improving constipation-related symptoms and rectal sensation.
经皮神经电刺激穴位 ST36（足三里）联合胫后神经电刺激已被报道对功能性便秘有效。本研究旨在比较这两种刺激方法的疗效。
18 名功能性便秘患者（男女比 9:9）参与了一项交叉研究，分别接受 ST36 经皮神经电刺激（TN）和胫后神经 TN 治疗各 2 周。记录排便日记，并完成便秘患者症状评估量表（PAC-SYM）和便秘生活质量量表（PAC-QoL）问卷；进行肛肠测压和心率变异性的频谱分析以评估自主神经功能。
（1）ST36 和胫后神经 TN 均改善便秘相关症状（治疗前 PAC-SYM 评分 1.4±0.1 比治疗后 0.6±0.1，P≤0.001）。（2）ST36-TN 而非胫后神经 TN 增加每周自发性排便次数（治疗前 0.9±0.2 比治疗后 3.5±0.7，P<0.001）和降低总 PAC-QoL 评分。ST36-TN 比胫后神经 TN 更能改善 PAC-SYM 评分（降低 0.8±0.1 比 0.5±0.1，P<0.05）。（3）与胫后神经 TN 相比，ST36-TN 降低了感觉阈值，包括直肠扩张欲便感（治疗前 134.1±14.3mL 比治疗后 85.6±6.5mL，P<0.01）和最大耐受量（P<0.05）。（4）ST36-TN 和胫后神经 TN 均显著增加迷走神经活性，降低交感神经活性（P<0.05）。
与胫后神经 TN 相比，ST36-TN 治疗便秘的疗效更显著，能更有效地改善便秘相关症状和直肠感觉。
