Study On The Neurological Mechanism Of Functional Anorectal Pain Based On Brain-Gut Axis And Clinical Study Of TCM Intervention

ObjectiveRectal cerebral evoked potential(RCEP)were used to observe the difference of RCEP between normal people and functional anorectal pain(FAP)patients,and to explore the possible neurological mechanism of FAP.The oral Yi-qi-yang-xue decoction was chosen for FAP patients to evaluate the clinical efficacy in treating functional anorectal pain,and to explore the important value of Yi-qi-yang-xue decoction in regulating the brain-gut-microbiota axis(BGMA).Contents and methods(1)We recruitted 60 healthy volunteers for RCEP test,the characteristics of each wave and the relationship between wave parameters and age,sex,body mass index(BMI)were analyzed.(2)Clinically collected 33 patients with FAP for RCEP testing,and the characteristics of the changes between RCEP parameters and sensory thresholds in 60 healthy volunteers were analyzed and compared.(3)Forty FAP patients were divided into observation group and control group,20 cases in each group.The observation group was treated with Yi-qi-yang-xue decoction combined with warm water sitz bath.The control group was only treated with warm water sitz bath.Oral Yi-qi-yang-xue decoction 1 dose a day,warm water sitz bath,once a day.Two weeks is a course,a total treatment of two courses.The pain visual analogue scale(VAS),self-rating anxiety scale and self-rating depression scale(SAS&SDS),SF-36 quality of life score and therapeutic effect evaluation were analyzed and compared between the two groups before and after treatment.SPSS 24.0 software was used for statistical analysisResults(1)The range of wave parameters in the RCEP test results of 60 nonnal adults were as follows:the parameters ranged from 45.55±3.26ms for P1 wave latency,101.71±15.71ms for N1 wave.198.35±27.70ms for P2 wave,5.62±1.58?v for P1/N1 wave and 8.26±2.48)?v for N1/P2 wave.There was no significant difference in RCEP latency and amplitude between 60 normal adults and sex and age groups(P>0.05).Multivariate analysis showed that the latency of P1,N1 and P2 wave had no difference with age,sex and BMI(P>0.05).After controlling age group and sex,the amplitude decreased with BMI increasing.For per unit increase of BMI,the amplitude of P1/N1 decreased by an average of 0.234?V(P<0.05).The amplitudes of N1/P2 decreased by 0.320?V(P<0.05).(2)The parameters of RCEP in 33 FAP patients were as follows:the latency of P1 wave 43.05±4.05ms,N1 wave 106.70±12.38ms,P2 wave 206.3 7±23.19ms),P1/N1 wave 4.14±1.69)?V and N1/P2 wave 5.72±2.21?V.Compared with 60 normal adults,33 FAP patients had earlier latency of RCEP P1 wave and lower amplitudes of P1/N1 and N1/P2(P<0.05);there was no significant difference in latency of N1 and P2 waves(P>0.05).RCEP sensory threshold of 33 FAP patients was significantly lower than that of 60 volunteers(P<0.05).(3)Forty FAP patients were treated with Yi-qi-yang-xue decoction.The total effective rate of the observation group was 85.00%higher than that of the control group(55.00%)(P<0.05);the VAS score of the observation group was significantly lower than that of the control group and before treatment(P<0.05);the SAS and SDS scores of the observation group and the control group after treatment were significantly lower than those before treatment,but the score of the observation group was lower(P<0.05);The SF-36 quality of life score after treatment was significantly higher than that before treatment,but the observation group had a higher score(P<0.05).Conclusion(1)Rectal electrical stimulation cerebral evoked potential is easy to detect.It is a simple and effective method to evaluate the sensory nerve pathway from rectum to cerebral cortex.This method has important value for further understanding brain-gut interaction(2)Compared with normal volunteers,the latency of PI wave was earlier and the amplitudes of PI/NI and N1/P2 were lower in FAP patients,suggesting abnormal rectal-to-cerebral nerve conduction pathway,which may be related to abnormal brain-gut interaction.(3)Yi-qi-yang-xue decoction oral treatment of FAP can achieve good clinical efficacy,improve the prognosis of patients,give full play to the characteristics of traditional Chinese medicine in the treatment of FAP is worth exploring,considering that traditional Chinese medicine in regulating brain-gut-microbiota axis has important value.