Effect Of Acupuncture To Slow Transit Consitipation: A Clinical Study And Explanation Of Its Stem Cell Factor/c-kit Receptor Signaling Expression

The pathogenesis of slow transit constipation (STC) is unknown. The interstitial cells of cajal are one of the most important factors in those correlation factors of pathogenesis. The expression of ICC is charged by c-kit signaling. In mice, naturally occurring loss-of-function mutations in the genes of the receptor protein tyrosine kinase, c-kit or the c-kit ligand, stem cell factor (SCF) result in depletion of ICC and motility disorders. It is obviously in cathartic colon. Acupuncture can treat some constipation. But weather it can charge the gene express of SCF/c-kit receptor signaling and change the depletion of ICC, is still unknown.Objective:1. Check the effect of acupuncture on STC with new prescription.2. Probe the effect of acupuncture on the expression of c-kit, SCF and c-kit mRNA, SCFmRNA.Method:1.clinical research:the patients of cathartic colon is treated by acupuncture "Zhigou (TE6), Tianshu (ST25), Zusanli (ST36), Zhaohai (KI6)". The number of per week for defecate hard sledding, bowel shape, the awareness of defecation, bowel frequency, amount of faeces, and Patient Assessment of Constipation Quality of Life (PAC-QOL), the symptom check list 90 (SCL-90) in prior treatment and post treatment is observed. The relating symptoms of STC are observed in the 4 week and 12 week after treatment.2. Empirical study:1). normal control rats are chosen by random in 1/2 adult rats. The others are used to induce cathartic colon by intragastric administration of gradually increasing doses of rhubarb. The cathartic colon rats undergo acupuncture at ST36 and KI6, cisapride treatment, or acupuncture combines with cisapride, or dummy treatment, or untreatment. Those rats which have the same speed of colon transmission with normal control rats are defined extra check rats. Treat for 14 days. The changes in copro-character, the temporal of first black stool, and c-kit, SCF, c-kit mRNA, SCF mRNA of colonic were examined.Results:1. Clinical research:The basic condition of defecation is better than before. Defecate hard sleddingχ2=46.774, P=0.000. Bowel shapeχ2=6.513, P=0.164. The awareness of defecationχ2=28.773, P=0.000. The bowel frequencyχ2= 30.283, P= 0.000. The amount of faecesχ2=25.715, P= 0.000. The degrees of quality of life and the degrees of symptom checklist before and after treatment are difference, P=0.000. The outcome of 3 courses of treatment is the best. The relapse is negative correlate with bowel shape, r=-0.469, P= 0.001; and it is positive correlate to the degrees of symptom checklist, r=0.475, P=0.001; and it is negative correlate to the course of treatment, r=-0.368, P= 0.012.2. Empirical study:The temporal of first black stool of cathartic colon rats can be improved by acupuncture, cisapride treatment, or acupuncture combines with cisapride, or dummy treatment, or untreatment. The ratio of water in stercus and the quality of fecal pellet in rats which be treated with acupuncture is same with normal control rats. The temporal of first black stool of rats with acupuncture and cisapride is faster than those with untreatment, P<0.05, but the fecal pellet is smaller, P<0.05; the ratio of water in stercus of rats with cisapride is lower than normal control rats, P<0.05; the fecal pellet is smaller too, P<0.05. The fecal pellet of rats with dummy treatment is larger than other rats, P< 0.05.Acupuncture can improve the expression of c-kit, SCF and c-kit mRNA, SCF mRNA in cathartic colon, which is lower than normal colon. The c-kit protein in rats' colon with acupuncture and the SCF protein in rats with dummy treatment are more than those in normal colon, but lower than those in extra check group. The rats in extra check group have good stercus although they have the same rhubarb with other cathartic colon rats. They have same speed of colon transmission and c-kit mRNA and SCF mRNA in colon with normal control rats, but more c-kit and SCF protein in colon than all of other rats.Conclusion:1. Acupuncture is an effective measure to STC.2. The basic course of treatment is 3 months for acupuncture to cathartic colon. One of the key factors to keep effect is good substance in sedes, the other is keeping good general symptom.3. The affection of acupuncture is better than cispride, or acupuncture combines with cispride.4. Acupuncture improves ICC through transcriptional level. This is one of the basic pathways of acupuncture treat STC, which have lower IOC in colon. The acupuncture can improve SCF, c-kit expression in colon in the range of physiology.5. Acupuncture combines with cispride can improve the speed of colon transmission of cathartic colon rats conspicuously.6. Cispride may depress the affection of acupuncture to ICC. There is other pathway to improve the speed of colon transmission of cathartic colon for acupuncture combines with cispride.7. The c-kit and SCF in colon of rats have difference reflect on rhubarb. It is rather inherent than chance.