| Background:The earliest human understanding of pruritus ani can be traced back to the ancient Egyptian period.At present,it is the second major symptoms of anorectal surgery,which is next to than hematochezia.Although there are many reasons for causing pruritus ani,most of the pruritus ani is primary.We know very little about its pathophysiology.For this ancient disease,what causes the perianal leakage to stimulate the sensory nerve endings of the perianal skin,forming an itch-scratch vicious cycle?In addition to the factors of perianal flora,what is the essential cause of causing perianal skin moisture and leakage?No one can give a definitive answer,and much of the current literature is focused on evaluating the clinical efficacy of pruritus ani,with few studies on its etiology and pathogenesis.Early studies suggested that the occurrence of pruritus ani was related to fecal leakage and rectal sensory dysfunction by anorectal manometry.According to the later literature,no relevant report has been found.However,the data analysis instrument for anorectal pressure measurement in the early stage was a traditional water perfusion system,which could not accurately reflect the correlation between the pressure difference of various parts of the anorectal and balloon discharge time.High-resolution anorectal manometery has the advantages of simple operation,high patient comfort,repeatable results and more accurate measurement data.It can dynamically evaluate the structural and functional abnormalities of pelvic floor muscles,especially the pubrectalis muscle of levator ani muscles and anal internal and external sphincter and the sensory function of rectal mucosa,Not only defecation disorders but also some routine anorectal diseases can provide pathophysiological basis and guide clinical practice through high resolution of anorectal pressure data.many reasons cause pruritus ani which increases the difficulty of treatment Since ancient times,acupuncture has an advantage in treating various itchy skin diseases.In the previous research,through orthogonal experiments,it was found that mild moxibustion treats pruritus ani has good effect.This study compares smoke moxibustion and smokeless moxibustion to treat pruritus ani,further explores the effects of moxa smoke and moxibustion related factors on the treatment of pruritus ani,and finds the best treatment for the disease.The treatment plan provides objective interpretation for the treatment of this disease by Chinese medicine.Objective1.Observe the changes of anorectal motility and sensory functions among pruritus ani,normal population and constipation,and preliminarily discuss the relationship between the etiology and pathogenesis of patients with pruritus ani in anorectal motility,rectal compliance and rectal mucosal sensory threshold;2.Differences in the expression of 5-HT,TRPV1 and P2X2 in the rectal mucosa between the pruritus ani and the normal population were determined,and the relationship between the rectal mucosa-related receptors on the intestinal mucosal sensation and the occurrence and development of pruritus ani was investigated;3.Observe the role of smoking moxibustion and smokeless moxibustion in the treatment of pruritus ani with moxibustion instrument,and study whether moxibustion cigarette participates in the anti-pruritic effect of moxibustion.Methods1.All cases were from outpatients and inpatients of anorectal surgery and gastroenterology in the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2017 to June 2019.There were 32 patients with pruritus ani,33 patients with functional constipation,and 29 healthy controls.For example,all patients included in the study first performed an instrument using the GIVEN(Medtronics)high-resolution anorectal manometer to quantitatively analyze anorectal rectal dynamics,rectal compliance,rectal sensory function,rectoanal inhibitory reflex,and transient sphincter relaxations.2.The normal group of patients with pruritus ani included in the study were subjected to proctoscope,and a mucosal biopsy was taken 3 cm above the dentate line.The mRNA and protein of TRPV1,5-HT,and P2X2 were detected by fluorescent quantitative PCR and immunohistochemistry to find the express differences between normal crowd and pruritus ani patients.3.From January 2017 to June 2019,62 patients with pruritus ani treated in the anorectal outpatient department of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine were selected and divided into group one of cases receiving moxibustion treatment and group two of 30 cases receiving smokeless moxibustion treatment.The patient uses a homemade moxibustion treatment instrument to place in the toilet,divides the moxa sticks into 3-4 cm long,ignites them and puts them in the moxibustion treatment device,adjusts the position of moxibustion treatment,and points the moxa pillars to the anus For the treatment of GV1,20 minutes each time,2 times a day,2 weeks as a course of treatment,and 2 courses of treatment.Results:Clinical Study of Anorectal Motility and Sensory Function in Patients with Pruritus ani1.There is a stastical difference in among the normal group,pruritus ani group,constipation group comparision of anal resting pressure and rectoanal gradient,the anal canal resting group in pruritus ani group was lower than the normal group(P<0.05).The pairwise comparison results showed that the length of the anal canal function in the pruritus ani group was shorter than that in the constipation group(P<0.05),and the rectoanal gradient in the pruritus ani group was higher than that in the normal group.(P<0.05),the rectoanal gradient in the constipation group was higher than the normal group(P<0.05),the residual anal pressure in the constipation group was higher than the normal group(P<0.05);2.There was statistically significant difference among Normal group,pruritus ani group,constipation group in first channel sensation,defecation sensation,maximum tolerance,maximum rectal compliance,minimal rectal compliance.the pairwise comparison results showed that the initial sensory threshold pairwise comparison The pruritus ani group was lower than the normal group(P<0.05),the pruritus ani group was lower than the constipation group(P<0.05),and the normal group was lower than the constipation group(P<0.05);the initial defecation was compared pairwise,and the pruritus ani group was lower In the normal group(P<0.05),the pruritus ani group was lower than the constipation group(P<0.05),and the normal group was lower than the constipation group(P<0.05).The rectal maximum tolerance was compared in pairs,and the pruritus ani group was lower than the normal group.(P<0.05),the pruritus ani group was lower than the constipation group(P<0.05),there was no significant difference between the constipation group and the normal group(P>0.05);compared with the two groups with maximum rectal compliance,the pruritus ani group was lower than the normal group(P<0.05),the pruritus ani group was lower than the constipation group(P<0.05),there was no significant difference between the constipation group and the normal group(P>0.05);compared with the two groups with minimal rectal compliance,the pruritus ani group was lower than the normal group(P<0.05),the pruritus ani group was lower than the constipation group P<0.05),no significant difference(P constipation and normal groups>0.05).3.There was no statistical difference in the number of rectal anal inhibitory reflexes among the three groups.The frequency of transient sphincter relaxations was not statistically different among three group(P>0.05);the transient sphincter relaxations time in the pruritus ani group was longer than that in the constipation group and the normal group,There was significant statistical difference(P<0.05);Study on rectal mucosal sensory receptors in patients with pruritus ani1.The results of real-time quantitative PCR showed that the mRNA expression of TRPV1 gene and 5-HT gene in rectal tissues of patients with pruritus ani increased.Compared with the healthy group,the difference was statistically significant(P<0.05);2.Compared with the healthy control group,the HIS score and MOD value of TPRV1 in the rectal mucosa of the pruritus group increased,and the differences were statistically significant(P<0.05).Compared with the healthy control group,the HIS score and MOD value of 5-HT increased,and the difference was statistically significant(P<0.05).There was no significant difference in the HIS score and MOD value of P2X2 between the two groups;Clinical efficacy of smoked and smokeless moxibustion for pruritus ani1.Comparison of baseline data between the treatment group and the control group.There was no significant difference in gender,age,and course of disease after statistical processing(P>0.05).There was no significant difference in the quality of life score,itching frequency score,and itching degree score before treatment(P>0.05);after treatment,the frequency of pruritus in the treatment group was better than that in the control group(P<0.001),the degree of pruritus in the treatment group was better than the control group(P<0.001),After 4 weeks of treatment,the quality of life of the treatment group was better than that of the control group(P<0.001);2.Comparison of the frequency of itching before and after treatment in the 2 group,compared with before treatment,the frequency of itching were all improve in the 2 groups,and the difference was statistically significant(P<0.001).The scores of itching degree were all reduced after treatment,and the difference was statistically significant(P<0.001);3.Repeated measure analysis of variance before and after treatment.The quality of life scores between the two groups before and after treatment were compared.The effect between groups was F=6.23,P=0.015.There was significant statistical difference(P<0.05);Compared with the two groups before treatment,F=2.356,P=0.13.The two groups are comparable.After two weeks of treatment,the two groups are compared,F=16.43,P<0.001,and there is a statistical difference between the two groups.After four weeks of treatment,the two groups are compared,F=41.23,P<0.001,There was a statistical difference between the two groups.The time effect F=931.574,P<0.001.With the extension of time between the two groups,the quality of life of pruritus patients can be improved.Conclusion:1.patients with pruritus ani have lower anal resting pressure,lower rectal compliance,and increased rectal sensory thresholds.one of the pathological mechanism cause of dampness leakness and anal swelling related to decreased anal resting pressure,prolonged sphincter relaxation time,and abnormal rectal mucosal sensory threshold.2.The expression of rectal mucosal receptors TRPV1 and 5-HT in patients with pruritus ani is higher than that in the normal group.Rectal compliance in patients with pruritus ani is reduced,and sensory dysfunction with an elevated rectal sensory threshold may be related to the expression of TRPV1 and serotonin,It may be due to sensitization or phenotypic changes in the sensory transmission of rectal mucosa.3.In the treatment of pruritus ani,both smoked moxibustion and smokeless moxibustion can improve the symptoms of pruritus ani,both of which improve the frequency of itching,reduce the degree of itching before and after treatment,and improve the quality of life before and after treatment.However,moxibustion with smoke is better than smokeless moxibustion group in improving itching degree,frequency of itching,and quality of life.Moxibustion products are also one of the factors that exert moxibustion effect in stop itching. |
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