To observe the effects of acupoint catgut embedding (ACE) on gut microbiota and fecal short-chain fatty acids (SCFAs) levels in patients with Parkinson's disease (PD) with constipation.

A total of 80 PD patients with constipation were randomly divided into an observation group and a control group, 40 cases in each group. Additionally, 40 healthy individuals were recruited as a healthy control group. The control group received conventional Western medical treatment for PD combined with polyethylene glycol (PEG), once daily for eight weeks. The observation group received additional ACE treatment at bilateral Tianshu (ST25), Zusanli (ST36), and Shangjuxu (ST37), once every two weeks for eight weeks. The healthy control group received no intervention. The spontaneous bowel movements (SBMs) per week and patient assessment of constipation quality of life (PAC-QOL) scores were assessed at baseline and after treatment in the two groups. Fecal samples were collected at the end of treatment for the observation and the control groups and at baseline for the healthy control group. Gut microbiota composition and diversity were analyzed using 16S rRNA method, and SCFA levels were measured using high-performance liquid chromatography (HPLC)

Compared before treatment, the observation group showed a significant increase in SBMs (P＜0.01), and PAC-QOL scores including physical discomfort, psychosocial discomfort, worry and concern, and total score were significantly reduced (P＜0.01) after treatment; the control group also showed a reduction in PAC-QOL total score after treatment (P＜0.01). After treatment, the observation group had significantly more SBMs (P＜0.01), and lower PAC-QOL physical discomfort, psychosocial discomfort, worry and concern scores, and total score (P＜0.01), and higher PAC-QOL satisfaction score (P＜0.01) than the control group. Compared with the healthy control group, the control group showed decreased Chao1 and Ace indices (P＜0.01). Compared with the healthy control group, the relative abundance of Prevotella and Roseburia was increased (P＜0.05), while that of Enterobacter and Ruminococcus torques (six species in total) was decreased (P＜0.05) in the control group. Compared with the control group, the observation group had increased relative abundance of Dialister, Parabacteroides, and Ruminococcus torques (P＜0.05), and decreased relative abundance of Prevotella and Eubacterium ruminantium (P＜0.05). Compared with the healthy control group, the control group had increased fecal SCFA levels (P＜0.05); compared with the control group, the observation group had reduced fecal SCFA levels (P＜0.05). Compared with the healthy control group, acetic acid, propionic acid, and butyric acid levels were elevated in the control group (P＜0.05); compared with the control group, acetic acid, propionic acid, and butyric acid levels were decreased in the observation group (P＜0.05).

ACE could increase spontaneous bowel movements and improve the quality of life in PD patients with constipation, which may be related to the regulation of gut microbiota composition and SCFA levels.