Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China.
Brain Res. 2022 Sep 1;1790:147956. doi: 10.1016/j.brainres.2022.147956. Epub 2022 Jun 1.
Evidence suggests that the pathogenesis of Parkinson's disease (PD) is initiated in the gut rather than in the brain. Thus, targeting the gut in early stages may have the potential to halt disease progression and alleviate symptoms. Various acupuncture techniques have been used to treat patients with PD and have shown promising results. However, previous acupuncture techniques focused on the brain and motor symptoms. We aimed to determine if targeting PD patients' gut-brain axis through electroacupuncture could be an effective, safe, and low-cost therapeutic option for management of non-motor and motor symptoms.
Thirty patients with mild to moderate PD were randomised into an intervention (n = 15) and a control group (n = 15). The intervention group received electroacupuncture twice a week for 30 min based on conventional drug treatment for 8 weeks. Conventional drug treatment was continued in the control group. The primary outcomes were changes in the score of clinical scales including the Non-motor Symptom Rating Scale (NMSS), PD Sleep Scale (PDSS), Bristol Stool Function Scale (BSFS), and Patient Associated Constipation and Quality of Life Scale (PAC-QOL). The secondary outcomes were the Unified PD Rating Scale (UPDRS) and Modified Hoehn-Yahr Staging Scale scores. Stool samples from the intervention group were collected before and after the procedure and were sent for gene sequencing. Adverse effects and personal impressions of the patients were noted during the course of the trial.
An 8-week course of scalp-abdominal electroacupuncture treatment was effective in improving the NMSS, PDSS, and UPDRS scores in patients with PD. Further, there was statistical significance in the two subdomains of NMSS, namely sleep/fatigue and miscellaneous, further implying the efficacy of acupuncture on sleep disturbance. However, although the current acupuncture treatment was gut targeted, it had no effect on BSFS or PAC-QOL. Apart from improved UPDRS motor scores and activities of daily living scores, acupuncture had no significant impact on scores of mentation, behaviour, mood, and therapy complications. Acupuncture did not alter the Hoehn and Yahr stage. Significant alterations in gut bacterial composition were detected in nine taxa at the genus level. The relative abundances of the genera Bacteroides and Parasutterella were significantly increased after the intervention, whereas the abundances of the genera Dialister, Hungatella, Barnesiella, Megasphaera, Allisonella, Intestinimon, and Moryella were significantly lower.
An 8-week scalp-abdominal electroacupuncture treatment may be a complementary and alternative vehicle for PD patients. We detected nine taxa at the genus level which were significantly altered after treatment, emphasising the role of the gut-brain axis in the process.
有证据表明，帕金森病（PD）的发病机制始于肠道而非大脑。因此，在早期阶段针对肠道进行治疗可能具有阻止疾病进展和缓解症状的潜力。各种针灸技术已被用于治疗 PD 患者，并显示出有希望的结果。然而，以前的针灸技术主要针对大脑和运动症状。我们旨在确定通过电针对 PD 患者的肠-脑轴进行靶向治疗是否是一种有效、安全且低成本的治疗选择，可用于管理非运动和运动症状。
将 30 名轻度至中度 PD 患者随机分为干预组（n=15）和对照组（n=15）。干预组在常规药物治疗的基础上每周接受两次电针治疗，每次 30 分钟，共 8 周。对照组继续接受常规药物治疗。主要结局是临床量表评分的变化，包括非运动症状评分量表（NMSS）、帕金森睡眠量表（PDSS）、布里斯托尔粪便功能量表（BSFS）和患者相关便秘和生活质量量表（PAC-QOL）。次要结局是统一帕金森病评定量表（UPDRS）和改良 Hoehn-Yahr 分期量表评分。干预组的粪便样本在治疗前后采集，并进行基因测序。在试验过程中记录了不良反应和患者的个人印象。
为期 8 周的头皮-腹部电针治疗可有效改善 PD 患者的 NMSS、PDSS 和 UPDRS 评分。此外，NMSS 的两个亚域，即睡眠/疲劳和杂项，有统计学意义，进一步表明针灸对睡眠障碍的疗效。然而，尽管目前的针灸治疗是针对肠道的，但它对 BSFS 或 PAC-QOL 没有影响。除了改善 UPDRS 运动评分和日常生活活动评分外，针灸对思维、行为、情绪和治疗并发症的评分没有显著影响。针灸没有改变 Hoehn 和 Yahr 分期。在属水平上检测到 9 个分类群的肠道细菌组成发生了显著变化。干预后，拟杆菌属和 Parasutterella 属的相对丰度显著增加，而 Dialister、Hungatella、Barnesiella、Megasphaera、Allisonella、Intestinimon 和 Moryella 属的丰度显著降低。
为期 8 周的头皮-腹部电针治疗可能是 PD 患者的一种补充和替代治疗方法。我们在治疗后检测到 9 个属水平的分类群发生了显著变化，强调了肠-脑轴在这一过程中的作用。
