电针足三里穴促胃动力机制研究

目的 探讨电针足三里穴促胃动力作用机制.方法 采用电生理学方法同步观察电针不同穴位后胃电的变化;采用免疫组化荧光双重标记胃电起搏区Cajal间质细胞(interstitial cells of cajal, ICCs)与缝隙连接蛋白43(CX43)、ICCs 与ERK的方法,观察针刺足三里穴引起胃电起搏区ICCs的变化、与ICCs信息传递相关的CX43的变化、丝裂原活化蛋白激酶(MAPK)家族中的ERK的变化情况.结果 电针足三里穴对胃电有明显影响.电针足三里穴可使胃电频率及波幅增高;电针足三里穴可显著激活胃ICCs表达及与ICCs信息传递密切相关的CX43的表达;电针足三里穴能促进胃ICCs调节胃运动的细胞信号转导的MAPK途径中ERK的表达.结论 电针足三里穴对大鼠胃电具有明显的促进作用;电针足三里穴促进胃运动的机制可能通过激活ICCs而产生显著电生理活动,通过ICCs及SMC之间的缝隙连接蛋白传递达到平滑肌进而调节胃运动.这一作用的完成,可能是通过ICCs信号转导MAPK途径中ERK通路实现的.     

针刺胃经穴对M受体阻断大鼠胃电及脑肠肽的影响

目的 :探讨针刺足阳明经对胃电活动影响的外周通路及物质基础。方法 :将 33只大鼠分为 4组 ,对照组、足三里组、阿托品组、足三里加阿托品组。以胃电慢波振幅变化率、高活动相时程比、快波峰簇数及胃动素(MTL)、胃泌素 (GAS)、P物质 (SP)等脑肠肽为指标 ,观察 M受体阻断后针刺足三里对胃电及脑肠肽的影响。结果 :针刺足三里使大鼠胃电慢波振幅变化率、高活动相时程比及快波峰簇数增高 ,血浆及胃窦组织内 MTL、SP升高。M受体被阻断后 ,胃电活动及脑肠肽呈下降趋势。若再施加针刺可部分取消 M受体阻断对胃电的抑制效应 ,同时 MTL、SP释放增加。结论 :迷走胆碱能神经 M受体被阻断后 ,针刺足三里信号可能通过外周 SP等肽能神经调整胃功能活动。     

胆道良性疾病致胆汁反流对胃运动的影响及机制探讨

目的观察良性胆道疾病致胆汁反流对胃运动的影响，并同步观察某些相关胃肠激素水平的变化，初步探讨其可能的机制。方法采用B超确立试验组患者为胆道良性疾病，同时设立健康对照组。采用B超、胃电测定的方法，测定各组胃运动功能；采用胃镜检查并抽取胃液，测定胆汁酸浓度确定胆汁反流；同步抽取患者和健康人空腹静脉血，测定血浆胃动素（motilin，MTL）、胆囊收缩素（cholecystokinin，CCK）水平，并检测胃窦部黏膜中一氧化氮（NO）水平。结果良性胆道疾病患者胆汁反流发生率显著升高，与对照组比较差异有统计学意义（P〈0．05）；胆汁反流患者较无反流者胃肌电正常慢波百分比、主频及振幅显著降低（P〈0．05）；胃排空时间、胃窦收缩频率及胃排空速率存在显著差异（P〈0．05）；胆汁反流患者胃窦黏膜组织NO较无反流者显著增高（P〈0．05），而胆汁反流患者空腹血浆中MTL水平显著降低（P〈0．05）；良性胆道疾病患者空腹血浆CCK与正常组比较无明显差异（P〉0．05）。结论良性胆道疾病致胆汁反流患者存在胃肌电紊乱及胃排空延缓，其原因可能与胆道疾病所致某些胃肠道激素水平变化存在密切关系。     

四种胃肠激素在糖尿病胃动力障碍中的作用

目的通过对糖尿病大鼠模型离体胃窦平滑肌自发性收缩运动的研究,探讨血浆和胃窦组织中生长抑素(SS),血管活性肠肽(VIP),胃动素(MTL),P物质(SP)等在糖尿病胃动力障碍中的作用。方法建立糖尿病大鼠模型,制备实验组和对照组大鼠离体胃窦环行肌及纵行肌肌条,应用张力换能器测定其静息张力、平均振幅、收缩频率等运动指标;用放免法同批测定两组大鼠血浆和胃窦组织中SS,VIP,MTL和SP含量。结果①糖尿病组胃窦肌条自发收缩运动的多项指标均较对照组明显降低(P<0.01);②糖尿病组血浆中SS、VIP、MTL增加,SP降低;胃窦组织中SS增加,MTL和SP降低,VIP无变化;③血浆和胃组织SS与胃运动指标呈负相关;血浆VIP与MTL与胃运动指标呈负相关;血浆和胃组织SP和胃运动指标无明显相关性。结论①糖尿病多伴有胃运动功能障碍;②血浆和胃组织中胃肠激素含量变化在糖尿病胃动力障碍的发病中有一定作用。     

针刺足阳明经穴对大鼠胃运动及脑肠肽的影响

目的：探讨针刺足阳明经穴对胃运动的调整作用与脑肠肽的关系。方法：以乙醇灌胃造成大鼠胃粘膜损伤模型,气囊法测量胃运动频率和波幅的变化率,采用放免分析法（RIA）检测大鼠胃窦及延髓内P物质（SP）、胃动素（MTL）及胃泌素（GAS）含量。结果：模型组胃运动频率和波幅呈抑制状态,针刺四白、天枢、足三里穴可促进胃运动恢复,与此同时胃窦、延髓内SP、MTL、GAS含量出现相应变化。三穴比较：四白主要影响胃窦MTL含量,天枢主要影响胃窦SP及延髓GAS含量,足三里穴对SP、MTL及GAS均有影响。结论：推测针刺足阳明经对胃运动的调整作用有脑肠肽参与,但上述三穴对胃运动的影响所涉及的脑肠肽不完全一致。     

电针抗应激性胃溃疡大鼠脑组织和胃粘膜中一氧化氮合酶的变化

观察应激性胃溃疡大鼠脑组织和胃粘膜中一氧化氮合酶（NOS）活性的变化．并对电外足三里穴和阳陵泉穴NOS的变化及与胃粘膜损伤的关系作了比较。结果发现,应激性胃溃疡大鼠脑组织和胃粘膜NOS均增高，尤其是胃粘膜NOS增高非常显著（P＜0.01）；电针足三里使脑和胃NOS回降，应激前先电针更为明显，使胃溃疡损伤指数显著下降（P＜0.01）；而电针阳陵泉．与应激组相比虽也下降，但无统计学意义。提示NOS参与了电针对应激所致胃粘膜损伤的保护．这种保护作用可能与中枢和肠神经系统对胃功能的双重调节有关，同时NOS的变化与电针胃经足三里穴位特异性有一定的联系。     

电针足阳明经穴对胃粘膜损伤大鼠胃粘膜血流量及生长抑素的影响

目的 :观察电针足阳明经“四白”、“天枢”、“足三里”穴对胃粘膜损伤大鼠胃窦和延髓内生长抑素(SS)含量的影响及与胃粘膜损伤、胃粘膜血流量的关系 ,以探讨经脉 -脏腑相关的物质基础。方法 :健康 SD大鼠 6 0只 ,随机分为正常对照组 (对照组 ) ,模型组 ,针刺四白组、天枢组及非穴点组共 6组 ,以乙醇灌胃造成胃粘膜损伤大鼠模型 ,观察电针大鼠足三里、天枢、四白穴对胃粘膜血流量 (氢气清除法 )的影响 ,用放免分析法检测大鼠胃窦及延髓 SS含量。结果 :胃粘膜血流量在胃粘膜损伤后明显降低 ,针刺四白、天枢、足三里及非穴点后 ,均有不同程度升高 ,尤以足三里和四白组升高明显 (P<0 .0 1) ;胃窦及延髓 SS模型组较对照组升高 (P<0 .0 5 ,<0 .0 1) ,而针刺四白、足三里组升高不明显 (P>0 .0 5 )。结论 :胃窦、延髓 SS含量变化与胃粘膜血流量的改变有一定关系 ,电针足阳明经四白、足三里穴可能通过对胃窦及延髓 SS含量的改变来影响胃粘膜血流量 ,促进胃粘膜损伤的修复。     

电针对糖尿病胃轻瘫大鼠胃电活动与延髓神经元和星状胶质细胞可塑性的影响

[目的]观察电针对糖尿病胃轻瘫（DGP）大鼠胃电活动与延髓迷走孤束复合体（VSC）内神经元和星状胶质细胞可塑性变化的影响。[方法]实验大鼠分为空白对照（空白）组、DGP模型（模型）组、模型加电针足三里穴（足三里）组和模型加电针三阴交穴（三阴交）组。模型制备采用腹腔注射5％四氧嘧啶和熟地灌胃诱导的方法。实验3周后记录大鼠的胃电活动,取延髓进行抗Fos蛋白和抗胶质原纤维酸性蛋白（GFAP）的免疫组化染色。[结果]与空白组比较,模型组的胃电平均频率和振幅明显降低。而足三里组和三阴交组的平均频率和振幅较模型组明显升高（P〈O．01,〈0．05）;以足三里组升高更明显,与三阴交组比较差异有统计学意义（P〈0．05）。除空白组外,Fos阳性神经元、GFAP阳性星状胶质细胞集中表达于VSC。以模型组的Fos和GFAP表达最高,而足三里组与三阴交组的表达较模型组明显减少,且它们之间差异有统计学意义（P〈0．01）。[结论]针刺可改善糖尿病胃运动功能障碍,延髓VSC内免疫阳性神经元和胶质细胞可能参与了此调节作用。     

胃经穴位电针调节胃运动的神经作用机制

目的胃经穴位电针对胃运动具有良好的调节作用，但其作用机制目前还不是很清楚。以往人们推测胃经穴位电针调节胃运动可能是通过对中枢某些核团的激活作用实现的。对此我们进行了相关的研究，并探讨其神经作用机制：方法采用同步实验，电生理学的方法，在电针足三里穴、上巨虚穴及非经非穴等穴位的情况下以及在离断迷走神经和坐骨神经条件下电针刺激足三里穴，观察延髓中与胃运动密切相关的孤束核(NTS)及迷走神经背运动核(DMV)中神经元细胞放电的变化情况，同时采用浆膜法检测胃电的变化。结果电针刺激足三里穴，在中枢延髓的孤束核(NTS)及迷走神经背运动核(DMV)中神经元细胞放电频率的变化以及胃电的变化情况均较明显，与电针刺激胃经其它穴位存在着显著差异。而在离断迷走神经或坐骨神经条件下，胃电未产生明显的变化。结论胃经穴位电针对胃运动具有调节作用。这种调节作用的实现，与孤束核(NTS）及迷走神经背运动核(DMV)的激活密切相关。而且，这种调节作用的完成依据于完整的神经途径。     

功能性消化不良患者体表胃电参数与血胃肠激素变化的关系

目的探讨功能性消化不良(FD)患者体表胃电变化与血浆胃肠激素变化的关系以及胃肠激素在 FD 发病中的可能作用及其临床意义。方法对58例 FD 患者与15例健康对照者进行体表胃电图检测;应用放免法测定患者空腹血浆胃动素、生长抑素及胆囊收缩素含量;观察20例 FD 患者西沙比利治疗前后胃电图(主频和振幅)及血浆胃肠激素变化。结果 FD 患者体表胃电参数示主频(Fp)与平均振幅(Ap)均较对照组降低(P<0.01);FD 患者基础血浆胃动素(MTL)低于对照组(p<0.01),胆囊收缩素(CCK)与生长抑素(SS)均高于对照组(P<0.01);FD 患者胃电参数 Ap 和 Fp 与 MTL 呈正相关(p<0.01),与 CCK 及 SS 呈负相关(p<0.01);西沙比利治疗后 Ap 及 Fp 提高,MTL 上升。总有效率90％(18/20)结论功能性消化不良患者体表胃电变化与血浆胃动素降低,胆囊收缩素和生长抑素增高相关。胃肠激素可能参与了功能性消化不良的发病或病理生理过程。     

Effects and probable mechanisms of electroacupuncture at the Zusanli point on upper gastrointestinal motility in rabbits

BACKGROUND AND AIM: The purposes of this study were to investigate the regulative effect of acupuncture on gastrointestinal motility in rabbits and to explore the probable mechanism of electroacupuncture. METHODS: The experiment was performed on 30 rabbits implanted with three pairs of electrodes, which were equally divided into three groups: the control group, the Zusanli group, and the non-acupuncture point group. The gastrointestinal myoelectrical activity of each conscious rabbit was recorded when acupuncture was applied. Motilin in plasma, cholecystokinin (CCK) in serum, the activity of acetylcholine esterase, nitric oxide synthase (NOS), and the vesicle of nerve endings in the stomach tissue and jejunum were investigated. RESULTS: It was found that electroacupuncture did not exert much influence on the slow wave of gastrointestinal myoelectrical activity, but significantly increased the number and amplitude of spikes. In the Zusanli group, the concentration of motilin and CCK was much higher at the post-acupuncture stage than at the pre-acupuncture stage. Electroacupuncture significantly enhanced the activity of acetylcholine esterase. Moreover, we found out that in the Zusanli group, the number of vesicles without granula was significantly fewer than in the control group. The activity of NOS was less in the Zusanli group than in the control group. CONCLUSIONS: Acupuncture may enhance the gastrointestinal myoelectrical activity of conscious rabbits. The cholinergic nerve, nitric oxide, motilin, and CCK may contribute to acupuncture mechanisms.     

银杏叶提取物对大鼠应激性溃疡的保护作用

目的　探讨银杏叶提取物（ＥＧｂ） 对大鼠应激性胃溃疡发生的保护作用．方法　♂ Ｗｉｓｔａｒ 大鼠,随机分成对照组、模型组和ＥＧｂ 处理组;通过胃窦部埋置电极记录束缚水浸应激过程胃平滑肌电活动变化,同时测定血浆和胃粘膜组织中丙二醛（ ＭＤＡ） 水平及观察胃粘膜的病理改变情况．结果　应激模型组大鼠胃电活动节律明显紊乱、慢波振幅和峰电位发放率较对照组显著增加,ＭＤＡ 显著升高（ Ｐ＜ ０－０５） ,并伴有胃粘膜广泛充血、溃疡;ＥＧｂ １５ ｍ ｇ／ ｋｇ 腹腔注射预处理可显著压抑（ Ｐ＜ ０－０１） 应激过程的胃电紊乱、降低 ＭＤＡ 水平和胃粘膜溃疡指数．结论　ＥＧｂ 对束缚水浸应激引起的胃运动功能障碍和胃粘膜溃疡有明显地保护作用,其机制可能是通过调整平滑肌电活动和对自由基的清除．     

Gastric myoelectric activity changes following open abdominal surgery in humans

We examined the postoperative changes in fasting gastric myoelectric activity in 11 patients undergoing nongastric surgery (colon surgery) via celiotomy. Recordings were performed on postoperative days (POD) 1, 2, 3, 5, and 7+ (7–35) for 1–1.5 hr after overnight fasting. Patients had placement of bipolar seromuscular recording electrodes on the proximal (N= 9) and distal (N=11) antrum at the time of surgery. Data were analyzed visually and analysis of variance or tests of proportion were used for statistical analysis. Although there was a trend of decreasing slow wave frequency from POD 1 to 7+ in the proximal and distal antrum, no significant differences were observed in slow wave amplitude or in the percentage of slow waves with spike activity between postoperative day. In a few of the patients, several types of gastric dysrhythmias were infrequently observed. We conclude that certain parameters of fasting gastric myoelectric activity do not change sufficiently following open abdominal surgery to adequately reflect clinical recovery from postoperative ileus.     

肠内、肠外营养对胃大部切除术后患者胃肠激素水平的影响

背景：术后早期肠内营养（EN）越来越受到临床医师的重视，但早期EN对胃大部切除术后患者胃肠激素水平的影响研究较少。目的：通过对胃大部切除术后患者胃肠激素水平的检测．为术后早期应用EN提供依据。方法：将41例拟择期行胃大部切除术的患者随机分为EN组（n=20）和肠外营养组（PN组，n=21），术后第1～7d分别给予EN或PN支持治疗。于术前、术后第1、7d清晨分别测定患者血清胃泌素（GAS）、血浆胃动素（MTL）、血浆胆囊收缩素（CCK）水平。结果：41例胃大部切除患者术后第1d血清GAS、血浆MTL和CCK水平较术前显著下降（P〈0．01），术后第7d恢复至术前水平。EN组术后第7d血浆MTL、CCK水平显著高于PN组（P〈0．05和P〈0．01），而两组血清GAS水平无显著差异（P〉0．05）。结论：胃大部切除术后应用EN制剂能增加患者血浆MTL和CCK水平，有助于促进残胃动力功能的恢复，促进胃肠道消化和吸收，促进胆囊收缩，预防胆汁淤积等胆囊疾病的发生。     

Trans-cutaneous electrogastrographic study of gastric myoelectric activity in transposed intrathoracic stomach after esophagectomy

We examined the feasibility of trans-cutaneous electrogastrography (EGG) in recording myoelectric activity of the transposed thoracic stomach after esophagectomy. Nineteen patients who had Ivor-Lewis esophagectomy were studied. The EGG signal was recorded using cutaneous electrodes placed over the lower sternum. Eleven patients who underwent total gastrectomy served as controls. Normal rhythm pattern (2.4-3.6 cpm > or = 70%) and power ratio (PR > or = 2) was observed in five and 12 patients, respectively, after esophagectomy. The observation of normal gastric rhythm was more frequent in the postprandial period in the esophagectomy group (median 42.6%vs. 7.4%, P = 0.01), and the PR was significantly higher (median 2.27 vs. 1.38, P = 0.013) than the gastrectomy group. Feeding further increased the prevalence of normal gastric slow wave in the esophagectomy group (median 14.8% to 42.6%, P = 0.002) and improved the stability of dominant frequency (median 78% to 67%, P = 0.015). We conclude that gastric myoelectric activities of thoracic transposed stomach can be detected from cutaneous sternal electrodes. This represented a preservation of gastric motility even when the stomach is pulled up to the thorax as a substitute for the esophagus.     

Electroacupuncture may relax the sphincter of Oddi in humans

BACKGROUND: This study was designed to evaluate the effects of electroacupuncture on sphincter of Oddi (SO) motility in humans and to associate the manometric findings with cholecystokinin (CCK) plasma levels. METHODS: Eleven patients (M:F = 5:6) with various kinds of biliary disorders were enrolled. SO motility was monitored with conventional low-compliance, continuous perfusion technique at ERCP (n = 9) or via percutaneous transhepatic cholangioscopy (n = 2). After baseline monitoring for phasic wave contractions of SO, electroacupuncture was applied at a specific acupoint GB 34. A nonspecific acupoint 5 cm away from GB 34 was selected as a control. Manometric parameters of the SO were also measured in 6 subjects during stimulation of the control acupoint. CCK plasma levels were measured during electroacupuncture stimulation. RESULTS: All manometric parameters including basal pressure, amplitude, frequency, and duration of phasic wave contractions of the SO were significantly decreased (p < 0.05) during electroacupuncture stimulation. The inhibition of SO contractility was accompanied by increased CCK plasma levels. After discontinuation of electroacupuncture stimulation, restoration of amplitude and duration to basal conditions was noted. A tendency toward return of SO basal pressure and contractile frequency to baseline was also observed. Stimulation of the control acupoint did not affect SO contractility. CONCLUSION: Electroacupuncture stimulation of acupoint GB 34 resulted in reversible inhibition of SO contraction in humans. The response of SO to electroacupuncture stimulation may be mediated by some neurohormonal mechanisms including CCK release.