Liu Jie, Chen Hulin, Wu Dewei, Wei Ruiling, Lv Chaolan, Dong Juan, Wu Dandan, Yu Yue
Department of Gastroenterology, Affiliated Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, China.
Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China.
Evid Based Complement Alternat Med. 2020 Sep 14;2020:8798974. doi: 10.1155/2020/8798974. eCollection 2020.
Stimulant laxatives are still considered the most common treatment for functional outlet obstruction constipation (FOOC). However, the effectiveness of laxatives is unsatisfactory, and the long-term use of laxatives may cause certain adverse events. With this in mind, it is, however, paramount that novel complementary treatment(s) and/or other forms of alternative medicine are adequately investigated.
The study aims to explore the effects and potential mechanism(s) of transcutaneous electrical acustimulation (TEA) combined with adaptive biofeedback training (ABT) on FOOC.
A total of forty-five patients with FOOC were recruited and were randomly assigned to receive either Macrogol 4000 Powder (MAC, 10 g bid) (group A, = 15) only, ABT + MAC + Sham-TEA (group B, = 15), or TEA + ABT + MAC (group C, = 15) in a six-week study. Individual patients' constipation-symptoms (PAC-SYM) and constipation-quality of life (PAC-QOL) were both assessed and scored. Serum acetylcholine (Ach) and nitric oxide (NO) were measured from drawn blood samples while individual patients' heart rate variability (HRV) was calculated at baseline and after each corresponding therapy. Anorectal manometry and balloon expulsion test were both performed before and after treatment.
Firstly, participants in group C had significantly lower scores of PAC-SYM, PAC-QOL, and a decreased anal defecating pressure (ADP) as compared to participants in group B (all < 0.050). These results, however, suggest the TEAs effect. Secondly, the low-frequency band (LF)/(LF + HF) ratio in groups B and C were decreased as compared to group A (=0.037, =0.010, respectively) regarding HRV. On the other hand, the high-frequency band (HF)/(LF + HF) ratio in groups B and C showed an opposite outcome. Finally, the serum Ach in groups B and C was significantly higher as compared to group A (=0.023, =0.012, respectively). Of significant importance, the serum NO in groups B and C were notably low as compared to group A (=0.001, < 0.001, respectively).
TEA, combined with ABT, effectively improves constipation symptoms as well as QOL in FOOC patients. It is, however, achieved by decreasing ADP, which mechanisms are mediated via the autonomic and enteric mechanisms.
刺激性泻药仍被认为是功能性出口梗阻性便秘（FOOC）最常用的治疗方法。然而，泻药的疗效并不理想，长期使用泻药可能会导致某些不良事件。有鉴于此，对新型补充治疗和/或其他形式的替代医学进行充分研究至关重要。
本研究旨在探讨经皮电声刺激（TEA）联合适应性生物反馈训练（ABT）对FOOC的影响及其潜在机制。
共招募了45例FOOC患者，并将他们随机分为三组，在为期六周的研究中，分别接受聚乙二醇4000散（MAC，每日两次，每次10克）（A组，n = 15）、ABT + MAC + 假TEA（B组，n = 15）或TEA + ABT + MAC（C组，n = 15）治疗。评估并记录每位患者的便秘症状（PAC-SYM）和便秘生活质量（PAC-QOL）。采集血样测定血清乙酰胆碱（Ach）和一氧化氮（NO）水平，并在基线及每次相应治疗后计算每位患者的心率变异性（HRV）。治疗前后均进行肛门直肠测压和气囊排出试验。
首先，与B组患者相比，C组患者的PAC-SYM、PAC-QOL评分显著降低，肛门排便压力（ADP）下降（均P < 0.050）。这些结果提示了TEA的作用。其次，就HRV而言，B组和C组的低频带（LF）/（LF + HF）比值低于A组（分别为P = 0.037，P = 0.010）。另一方面，B组和C组的高频带（HF）/（LF + HF）比值则呈现相反的结果。最后，B组和C组的血清Ach水平显著高于A组（分别为P = 0.023，P = 0.012）。重要的是，B组和C组的血清NO水平显著低于A组（分别为P = 0.001，P < 0.001）。
TEA联合ABT可有效改善FOOC患者的便秘症状及生活质量。这是通过降低ADP实现的，其机制是通过自主神经和肠道机制介导的。
