| Diabetes mellitus(DM) is the commonest endocrinal metabolic disease. This disease is caused by the decrease in the synthesis and excretion of insulin, or the insulinreceptor and post-receptor defects. Epidemiological survey found that the incidence rate of diabetes is showing rising tendency. It is progressively becoming a serious public health problem because of its highly morbidity and extensive complications. The recent researches make it clear that the complications of the stomach and intestines also can be seen commonly, and , the satisfied method of treatment haven' t been found yet.Acupuncture for Diabetic gastroparesis have some advantages because of convenience, availability, efficient and cheapness, that can cure and improve the symptoms of Diabetic gastroparesis and reduce blood sugar. In order to study the curative effect and the mechanism of Electroacupuncture in treating Diabetic gastroparesis more systematically and comprehensively, the article will study from the following three aspects, literature, clinic and experiment. 1.Literature researchDiabetic gastroparesis(DGP) is a common and chronic complication of diabetes. It has a high incidence rate , and its pathological character mainly refers to delayed gastric emptying. Clinical situation may include the symptoms of diabetes, the symptoms in digestive tract such as epigastric discomfort, early satiety, and postprandial epigastric distention, constipation even nausea, paroxysmal retching, and vomiting etc. It is manifested by not only dyspeptic symptoms, but also the delayed gastric emptying will affect the absorption of oral medicine, that lead to the difficulty of control to blood sugar and metabolic disorder. All of them will do harm to the organ of heart, brain, and kidney. The pathogenesis of the malfunction of stomach dynamic and paresis of diabetes is likely linked withthe pathological changes of autonomic neuropathy, the disturbance of gastrointestinal hormones, hyperglycemia , the impairment of stomach smooth muscle, stomach microvascular pathological changes etc. In addition, the damages or functional disorders of Interstitial Cells of Cajal (ICC) are probably one of the mechanisms of the Diabetic gastroparesis.The literature of traditional Chinese medicine(TCM) had no the name of Diabetic Gastroparesis. According to the main clinical symptom of stuffness, anorexia, belching, vomiting and nausea, abdominal distention etc, Diabetic gastroparesis was discussed by "fullness sensation in the chest and abdomen" , "gastric fullness" , "vomit" , "tardy stomach" in the ancient books and records of Traditional Chinese Medicine. The diabetes mellitus and gastroparesis has close relationship.Its basic pathogenesis is that the long diabetes mellitus result in spoilage of yin and qi, that furthermore lead to spleen-asthenia and malfunction of transportation and transformation, abnormal ascending and descending of the qi, inability of the descending of stomach-qi that causes qi stagnation, damp obstruction or stagnation of food. Besides, qi-deficiency often causes qi-stagnancy and blood stasis. Blood stasis promotes deficiency conversely, which is a vicious cycle. As a result, Diabetic gastroparesis belongs to root-deficient and branch-sufficient syndrome.Under the direction of the principle of the integral view and differentiation of TCM, to treat this disease with the method of Chinese medicine, acupuncture and moxibustion and combination of traditional Chinese medicine and western medicine can cure or relieve the symptoms of stomach paresis, and the side effect is very light, at the same time it can lower blood sugar, and serve a dual purpose.2. Clinical studyA single-blind randomized clinical trial was made for a rough test and verifying. 60 patients with diabetic Diabetic gastroparesis were divided randomly into treatment group (n=30) and control group (n=30). Blood glucose of both groups are under the control of routine western medicine, Treatment group was treated by Electro-acupuncture , 5 times a week, while control group was administered with Mosapride, 5 mg once, three times a day. All patients was treated for 3 weeks, clinical symptoms, "gastric fullness" level, Barium meal examination will be measured before and after treatment, the resultsshowed that (1)In treatment group the total effective rate was 93. 33%, and cure rate was 43. 33%, in control group the total effective rate was 90%, and cure rate was 40%. There was no statistically significant difference between the two groups(p>0. 05). (2)Electro-acupuncture and Mosapride can promote gastric emptying, after treatment has significant difference in comparison with the before treatment (P<0.01), and there was no statistically significant difference between the two groups(p>0.05). (3) The main symptoms and complications of both group were improved greatly after treatment. The efficiency of two group was similar(p>0. 05). (4)To treatment group, the total effective rate and cure rate in the three type have no difference. ?The blood glucose was lowered significantly after treatment(P<0.01). There was no significant difference between the two groups on lowering the blood glucose. The above results demonstrate that Electroacupuncture and Mosapride are similar in curative effect to treat Diabetic gastroparesis. Electro-acupuncture can be regarded as an effective therapy without obvious side-effect for Diabetic gastroparesis. 3. Experimerits study60 SD common class male rats were chose as experimental rats , after they was measured blood sugar and urine glucose, we chose randomly 42 rats to make diabetic mellitus model. Those rats was injected streptozotocin (STZ)(0.1mol/L), which was made up freshly by sodium citric buffer ,into their' s abdominal cavities with a 60 mg/kg dosage one time .The rest 18 rats were taken as control group. Rats made DM model successfully were divided randomly into two groups including diabetic model group (abbr. DM), diabetic model group treated by Electroacupuncture group (abbr. DM+ACU)which were treated by Electroacupuncture after 10 week, one time per day, 5 days for one couse of treatment, rest 2 days between two course, lasted 4 courses. During the experiment, the rats' common condition, such as appetite, the volume of urine and excrement, activity, weight, blood glucose were observed and noted on schedule. After test weight, blood glucose the day before the last day, Fasting 24h after the last feeding, each group fed carbo-powde suspension by orally taking (activated carbon and acacia each contains 10%), lOml/kg. put rats to death by stretching their' s collum after 30 minutes. Calculating the stomach-intestine driving marker. The gastric antrum was divided into three parts. One is to make HE Staining and immunohistochemistry of c-kit mark, onepart for examining gene express of c-kit by fluorescent quantitative polymerase chain reaction(FQ-PCR).Other gastric antrum tissues is to make samples for the observation by transmission electron microscope, the results showed that(1)The rats of the DM group and the DM+ACU group compared with the control group, blood sugar significantly increased(P<0.01). The DM+ACU group rats' blood sugar were lower than that of DM group, but there is no difference between them, it state that Electroacupuncture can drop blood sugar, but no effective to treat Diabetes mellitus. (2)The rats of the DM group and the DM+ACU group compared with the control group, gastric emptying significantly decreased(P<0. 01). The DM+ACU group rats' gastric emptying were much more than that of DM group(P<0.01). It state that Rats made DM model were successful;Electroacupuncture can promote gastric emptying. (3) Under observation of optic microscope and electronic microscope, we found that the arrangement of smooth muscle cells in control group rats is in good order, the distance among cells is moderate, and there are plenty of organelles in muscle cells. The cell nucleus in intermuscular plexus is clear, having plenty of organelles and great deal of mitochondria and rough endoplasmic reticulum. The electron density is well-distributed in neuraxon and neurodendron end-brushes, and there are many synaptic vesicles inside neurotic varicosities. Neighboring to intramuscular neurons, The ICC can be seen, its cells contain plentiful mitochondria, endoplasmic reticulum, well developed Golgi apparatus, intramembrane caveolae, vacuoles, and abundant ribosomes. The cell protuberance form incomplete sheath structure surrounding neurotic fasciculus. The inside-wall nerve and ICC protuberances combine mutually and form a nexus, and is well-distributed. This group of rats has smooth capillary dissepiments, and complete endothelial cell. In DM group rats , the arrangement of smooth muscle cell disordered, the distance among cells change wider clearly, there were many vacuolation and lysis in cytoplasm of muscle cells, mitochondria were swellimg, vacuolating and lysing. The nucleus of infra-muscles Plexus Neuron lyse and necrose, and cytoplasm part lysing, mitochondrion swelling, crest lysiing, and rough endoplasmic reticulum expanding.There were swelling, lysis, vacuolation and disequilibrium of electric density in the neuraxon, neurodendron and end-brush.The content of synaptic vesicle in neurotic varicosity notable decreased. And the number of ICC in DM group decreased compared to the control group rats. The ICC is wither and cell project...
|
PDF Full Text Request