| Background and aims:The gastrointestinal(GI)dysmotility,inflammation and their interaction in acute pancreatitis(AP)often leads to poor prognosis.Transcutaneous electrical acupuncture(TEA),which has been applicated to improve GI motility and ameliorate inflammation,might be a safe and feasible new adjunctive therapy for AP.This prospective study was aimed to investigate the effects and possible mechanisms of TEA on the improvement of GI dysmotility and suppression of inflammation in the early stage of AP.Materials and methods:1.A total of 16 healthy controls(HC)and 44 AP inpatients were recruited in the department of gastroenterology in Wuxi No.2 People’s Hospital.AP patients were randomly divided into 2 groups(TEA group and Sham-TEA group).Besides conventional treatments,TEA at ST36 and PC6 or Sham-TEA at non-acupoints was respectively performed for 30 min twice daily for 3 days.AP patients kept fast during the whole study.2.All AP patients were recruited within 24 hours of onset(Day 0).GI-related symptom scores and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score were recorded and venous blood samples were collected at 8am before(Day 1)and after TEA/Sham-TEA treatment(Day 3)in AP patients.Then 4-channel electrogastrogram(EGG)and heart rate variability(HRV)were recorded for 30 min.3.Fasting venous blood samples were collected at 8 am in HC group and then EGG and HRV were recorded for 30 min.4.Plasma levels of ghrelin and motilin and serum levels of tumor necrosis factor-alpha(TNF-α)and interleukin(IL)-18 were assessed by enzyme linked immunosorbent assay(ELISA).Meanwhile,Blood routine and blood biochemical examination were performed,including white blood cell count(WBC)and C reactive protein(CRP).Results:1.GI-related symptoms: After treatment,the bloating score and abdominal pain score in TEA group were significantly lower than those of Sham-TEA group(bloating: 0.76±0.99 vs.5.19±1.21;abdominal pain: 1.33±1.02 vs.2.57±1.78,both P<0.05).The first bowel movement time in TEA group was significantly shorter than that in Sham-TEA group(51.38±17.19 h vs.65.79±19.51 h,P<0.05).2.Gastric slow waves: The average percentage of normal gastric slow waves(%NGSW)and dominant frequency(DF)in TEA group after treatment were notably higher than those of Sham-TEA group(%NGSW: 59.81±9.59 % vs.43.06±9.13 %;DF: 2.78±0.60 cpm vs.2.34±0.54 cpm,both P<0.05).3.Inflammatory indicators: The serum level of TNF-α in TEA group after treatment was markedly lower than that in Sham-TEA group(4.68±1.85 pg/ml vs.6.15±2.33 pg/ml,P<0.05).Compared to pre-treatment,TEA rather than Sham-TEA significantly decreased WBC and CRP(both P<0.05 in TEA group).4.AP severity: TEA significantly decreased APACHE Ⅱ score.The APACHE Ⅱ score in TEA group after treatment was significantly lower than that in Sham-TEA group(post-TEA vs.post-Sham-TEA:3.90±1.90 vs.6.29±2.63,P<0.05)5.Autonomic function: After treatment,sympathetic activity and sympathovagal balance in TEA group were markedly lower than those of Sham-TEA group by the analysis of HRV.Besides,parasympathetic activity in TEA group was significantly higher than that of Sham-TEA group(all P<0.05).6.GI hormones: TEA rather than Sham-TEA contributed to a notable increase in the plasma level of ghrelin.The plasma level of ghrelin in TEA group after treatment was notably higher than that in Sham-TEA group(2.00±1.71 ng/ml vs.0.85±0.60 ng/ml,P<0.05)and similar with that of HC(3.05±0.77 ng/ml,P>0.05 vs.post-TEA).No significant difference was noted in the plasma level of motilin between 2 AP groups after treatment(P>0.05).All the above-mentioned indicators showed no significant differences between TEA group and Sham-TEA group before treatment(all P>0.05).Conclusions:TEA at PC6 and ST36 exhibited effects including the improvement of GI dysmotility and inhibition of inflammation in the early stage of AP.The mechanism of TEA might be related to the regulation of autonomic function and ghrelin. |
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