腹部迷走神經與心臟迷走神經反應在進食後之不同表現

Varying postprandial response in abdominovagal and cardiovagal activity among normal subjects

張繼森(Chi-Sen Chang)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/博士(2010年)

https://doi.org/10.6834/CSMU.2010.00052

摘要

研究目的：早在許多年前中國人已會使用針灸來治療一些胃腸道不適之症狀，然而關於針灸治療胃腸功能性異常疾病相關之作用機轉頗為復雜，針灸治療所產生的效果與治療的對象、所使用的穴位、運針之手法、以及當時胃腸功能性異常之狀況等等條件有關。以往的研究發現使用電針刺激足三里穴位，可以增強健康受試者胃肌電波規律之程度，然而其詳細之作用機轉仍然不甚清楚，ㄧ般推論自律神經系統在其中可能扮演重要之角色。本研究首先利用心率變異分析記錄，探討針灸對健康受試者自律神經功能的影響，接者進一步同時記錄心率變異分析以及血液中與腸道相關之賀爾蒙，在進食之後所產生之變化，來比較分析腹部迷走神經系統與心臟迷走神經系統反應在進食後表現之模式是否相同。
研究方法及資料：第一部分的研究中，利用兩種不同之電針頻率（2 Hz及100Hz）分別刺激足三里以及手三里穴位，並與非穴位之對照組比較，分析15位健康受試者在5種不同條件下，應用功率頻譜分析心率變異數來研究分析自律神經系統功能的變化，其中低頻功率的大小可視為交感神經系統功能變化的指標，高頻功率的大小可視為副交感神經系統功能變化的指標，而低高頻功率比則可用以評估交感與副交感神經變化的調控狀況；接者在第二部分的研究中，利用同時記錄心率變異分析以及血液中4種與腸道自律神經功能相關之賀爾蒙，在空腹時以及在進食之後每20分鐘紀錄一次，總共記錄120分鐘， ㄧ共22位分析健康受試者在進食之後所產生之變化，來比較分析腹部迷走神經系統功能變化與心臟迷走神經系統功能反應在進食後之表現是否同步。
研究結果：在第一部分的研究中，以2 Hz頻率電針刺激足三里穴位，在針灸後之時段呈現低高頻功率比增加（表示較高之交感神經活動），然而這種變化並未達統計學差異之水準，然而在其他條件下低頻功率的大小及高頻功率的大小，在針灸後並沒有顯著之變化。在第二部分的研究中，心跳之速率在進食後顯著的增加，高頻功率（副交感神經功能的指標）在進食後40至120分鐘顯著的減少；而且低頻功率（交感神經功能的指標）在進食後60至120分鐘也呈現顯著的減少，然而低高頻功率比（表示較高之交感神經活動）在進食後20至120分鐘顯著的增加；4種與腸道自律神經功能相關之賀爾蒙，只有pancreatic polypeptide在進食後20分鐘呈現2倍以上之增加，隨後在的120分鐘當中也持續有顯著的增加。
結論與建議：以2 Hz及100Hz電針頻率刺激足三里以及手三里穴位，並不會產生顯著的心率變異變化，顯示刺激這兩個穴位對心臟迷走神經影響不顯著；而進食後高頻功率（副交感神經功能的指標）、低頻功率（交感神經功能的指標）以及低高頻功率比（表示較高之交感神經活動）之變化與腸道賀爾蒙pancreatic polypeptide在進食後之變化模式也有顯著的不同，因此推論雖然都是由迷走神經所支配，但在進食後之後，腹部迷走神經與心臟迷走神經反應在進食後之表現模式並不一致；所以當臨床上使用心率變異分析來探究各種狀況下，心臟迷走神經反應與各種疾病或治療方法的效果時，心率變異分析應該是一種非侵入性且便利之評估的方法；然而要想同時探究腹部迷走神經反應與各種疾病或治療方法的效果時，需要同時測量與腸道自律神經功能相關之賀爾蒙（如pancreatic polypeptide），才能夠真實的反應腹部迷走神經反應之變化。

關鍵字

電針針灸 ； 心率變異 ； 足三里 ； 手三里 ； 自律神經系統 ； Ghrelin ； Leptin ； Pancreatic polypeptide

並列摘要

Objective: Acupuncture has been used to treat gastrointestinal symptoms in oriental countries for many years. The impact of acupuncture on gastrointestinal function is complex, and results depend upon the species studied, the acu-points employed, the methods of manipulation, and the underlying functional activity of the gut. Electrical stimulation of St. 36 (Zusanli) has been shown to enhance the regularity of gastric myoelectrical activity in healthy subjects. However, the underlying mechanism by which acupuncture alters gastric myoelectrical activity is still not clear. To elucidate the possible role of the autonomic nervous system in mediating the effect of acupuncture, we monitored heart rate variability (HRV), a widely used index of vagal discharge at the sinoatrial node of the heart before, during and after electroacupuncture. Furthermore, several studies have supported the hypothesis of different presentations in the autonomic nervous system (ANS) between cardiac and gastric vagal activity. Due to the regionality of the ANS, different responses among different organ systems to the same stimulation (such as a meal) are quite possible.
Methods and Materials: In the first study, we applied two different frequencies (2 Hz and 100 Hz) of electrical stimulation at St. 36 (Zusanli) and LI. 10 (Shousanli) in 15 healthy volunteers. Low frequency (LF, sympathetic activity), high frequency (HF, vagal activity) and LF/HF ratio (sympathovagal balance) derived from the HRV were analyzed and compared at the two different frequencies. In the subsequent study, we monitored the postprandial changes of heart rate variability (HRV) and GI hormones to determine whether both responded in a similar pattern. Twenty-two healthy volunteers (6 males and 16 females) were enrolled. After recording a baseline ECG rhythm, further recordings were made at 20 minute intervals for 120 minutes after a test meal. Serum human pancreatic polypeptide (PP), leptin, and total and active ghrelin levels were measured. Results: The results of the first study showed an increase in the LF/HF ratio (indicating greater sympathetic activity) during the post-acupuncture period using 2 Hz of electrical stimulation at St. 36 (Zusanli). However, the overall change was not statistically significant. In addition, the power of LF and HF did not change significantly with electroacupuncture at St. 36 (Zusanli) and LI. 10 (Shousanli). In the subsequent study, after the meal, HR increased significantly from baseline at each time point, except for 20 minutes after the meal. The high frequency (HF) power decreased significantly from 40 minutes to 120 minutes after the meal. In addition, the low frequency (LF) power also decreased significantly from 60 minutes to 120 minutes. However, the LF/HF ratio increased significantly from 20 minutes to 120 minutes. There was a marked increase (> 2 fold) of PP at 20 minutes after the meal, and the increase was sustained throughout the test period. Conclusion and Suggestion: In conclusion, applying 2 Hz or 100Hz electroacupuncture at St. 36 (Zusanli) or LI. 10 (Shousanli) did not affect cardiovagal activity in normal volunteers. This phenomenon might be due to a difference in presentation in the autonomic nervous system between cardiac and abdominal vagal activity. In addition, the results of the subsequent study suggested that HRV reflects cardiac, but not equivalently, abdominovagal activity. Therefore, HRV as an abdominovagal activity measurement in patients with GI functional problems should be used with caution, and other markers such as PP should be included.

並列關鍵字

Electro-acupuncture ； Zusanli ； Shousanli ； Autonomic nervous system ； Ghrelin ； Leptin ； Pancreatic polypeptide

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