| Objective the clinical the effect of acupuncture on intestinal flora in patients with persistent vegetative state(PVS)and observe the curative effect on nutritional status.The relationship between acupuncture therapy,intestinal flora,metabolites and nutritional status was preliminarily expounded from the mechanism level,so as to find new theoretical and practical basis for the treatment of persistent vegetative state(PVS).Methods A total of 76 patients with PVS treated in our hospital from December 2017 to December 2019 were randomly divided into two groups: the experimental group(n = 38)and the control group(n = 38).Both groups received routine treatment(basic disease treatment and drug awakening therapy)and rehabilitation therapy(mainly including exercise and physical factor therapy)combined with enteral nutrition suspension(TPF).On this basis,the experimental group was treated with acupuncture 1.Nutritional status assessment: the levels of serum albumin,prealbumin and hemoglobin of all subjects were detected before and after treatment.All subjects were assessed by nutritional risk screening table(nutrition risk screening 2002 and NRS 2002)before and after treatment and on the 30 th and 90 th day of follow-up.2.Detection of intestinal flora and metabolites: the fecal samples of all subjects were collected before and after treatment,and the nucleic acids from the fecal samples were extracted and purified for PCR amplification and sequencing based on the variable region of 16 s r RNA gene.Finally,the bacteria identification and bioinformatics analysis were carried out to analyze the changes of intestinal microflora structure.The metabolites of stool samples of all subjects were detected by high performance liquid chromatography-mass spectrometry(HPLC-MS),and the contents of short-chain fatty acids(short-chain fatty acids,SCFAs)(acetic acid,propionic acid,butyric acid and pentanoic acid)were analyzed.3.determination of serum brain-derived neurotrophic factor(BDNF): the level of BDNF in peripheral blood of all subjects was detected before and after treatment.5.Evaluation of brain function: the resting state functional magnetic resonance(resting-state functional magnetic resonance imaging,rsf MRI)imaging technique was used before and after treatment,and the diseased brain areas were observed before and after treatment.The rs-f MRI data were processed by SPM8 image analysis software based on Matlab,and fractional amplitude of low frequency fluctuation(f ALFF),local consistency(regional homogeneity,Re Ho),gray matter and white matter volume were compared to analyze the difference of brain function before and after the two treatments.Results 1.characteristics of TCM symptoms: according to the information of the four diagnoses,six types of symptoms were finally identified,including qi deficiency and blood stasis type(61.84%),blood deficiency(39.47%),phlegm-heat closed orifice type(30.26%),heart-spleen deficiency type(25.00%),phlegm-dampness type(17.11%),kidney essence deficiency type(11.84%).From the perspective of deficiency and reality,64.47% of the patients are mainly deficiency syndrome,and 35.53% of the patients are mainly empirical.88.16% of the patients were single syndrome type and 2 syndrome type combination,and the most of 2 syndrome type combination was 59.21%.The main symptoms of physical signs are dazed,open eyes,swelling of hands and feet,apraxia of limb,defecation and ignorance.In terms of tongue appearance,the proportion of pale tongue in patients with PVS was higher,accounting for 63.16%;the coating was thin and white,accounting for 64.47% and 52.63%,respectively.From the pulse point of view,the pulse is thin,deficient,t thin and slippery,weak,accounting for 88.16%,53.59% and 26.32% respectively,and the pulse string,number weak and stringslippery account for 23.68%,18.42% and 9.21%,respectively.2.Nutrition status: there was no significant difference in the levels of serum albumin,prealbumin and hemoglobin between the two groups before treatment(P>0.05).After treatment,the above-mentioned serum nutritional indexes in the two groups were significantly higher than those before treatment in this group(P<0.05),and those in the test group were significantly higher than those in the control group(P<0.05).There was no significant difference in NRS2002 scores between the two groups before treatment,and the NRS2002 scores of both groups were more than 3,so nutritional support should be given.After treatment,the NRS2002 score in the experimental group was significantly lower than that before treatment,while the NRS2002 score in the control group was lower than that before treatment,but there was no significant difference between the two groups.The NRS2002 score in the experimental group was significantly lower than that in the control group.At the 30 th day of follow-up,the NRS2002 scores of the two groups were significantly lower than those before and after treatment in the two groups,and the scores in the test group were significantly lower than those in the control group(P<0.05).At the 90 th day of follow-up,the NRS2002 score of the two groups was significantly lower than that before treatment,after treatment and on the 30 th day of follow-up,and the score in the test group was significantly lower than that in the control group(P<0.05).3.Structure of intestinal flora: there was no significant difference in Alpha diversity between the two groups before treatment(P>0.05).After treatment,the Chao index,Ace index and Shannon index in the test group and the control group were significantly higher than those before treatment(P<0.05).The Simpson index decreased significantly(P<0.05).The Chao index,Ace index and Shannon index of fecal flora in the test group were significantly higher than those in the control group,while the Simpson index in the test group was significantly lower than that in the control group.There was no significant difference in the relative abundance of Bacteroides(Bacteroides),(Prevotella)and Clostridium tenuiformis(Faecalibacterium)between the two groups before treatment.After treatment,the relative abundance of Bacteroides,Prevotella,Faecalibacterium and Clostridium in the experimental group was significantly higher than that before treatment,while the relative abundance of Enterobacteriaceae,Pseudomonas and Rawstonia decreased significantly(P<0.05).The relative abundance of Bacteroides,Prevotella,Faecalibacterium and Clostridium in the control group after treatment was significantly higher than that before treatment(P<0.05).The relative abundance of),Enterobacteriaceae,Pseudomonodaceae and Ralstonia in the control group decreased significantly(P<0.05).After treatment,there was significant difference in the relative abundance of intestinal microflora between the experimental group and the control group(P<0.05).4.Metabolites of intestinal flora: there was no significant difference in acetic acid,propionic acid,butyric acid and valeric acid between the two groups before treatment(P>0.05).After treatment,the contents of acetic acid,butyric acid and valeric acid in the experimental group were significantly higher than those before treatment(P<0.05),while the content of propionic acid was significantly decreased(P<0.05).After treatment,the contents of acetic acid,butyric acid and valeric acid in the control group were higher than those before treatment,while the content of propionic acid decreased,but the difference was not statistically significant(P>0.05).After treatment,the metabolites of intestinal flora in the test group were significantly different from those in the control group(P<0.05).Conclusion Compared with the control group,acupuncture treatment of PVS patients in acupoint compatibility group has better clinical efficacy,which can significantly improve the nutritional status of patients,regulate the structure of intestinal flora and its metabolites.The mechanism may be that acupuncture may regulate the function of spleen and stomach,and then adjust the structure of intestinal flora and affect the level of SCFAs,so as to improve the nutritional status of patients. |
PDF Full Text Request