摘要
目的:观察"夹脊"电针结合神经松动术对家兔坐骨神经损伤后RhoA蛋白及mRNA表达的影响,为"夹脊"电针结合神经松动术治疗周围神经损伤提供理论依据。方法:将180只新西兰家兔随机分为正常对照组、模型对照组、神经松动术组、夹脊电针组、电针+神经松动术组,每组36只;每组再按术后干预1、2、4周分为3个亚组,每个亚组12只。钳夹法制造坐骨神经损伤模型。正常对照组不做任何干预;模型对照组术后放入笼中安静饲养;神经松动术组进行坐骨神经神经松动术治疗,每次操作时间为1 s,放松5 s,每组10次,每天1组,每周6 d;夹脊电针组取坐骨神经发出的相应脊髓节段L4～L6"夹脊"穴进行电针治疗,每天1次,每次30 min,每周6次;电针+神经松动术组先进行"夹脊"电针治疗后进行神经松动术治疗。采用趾张反射和改良Tarlov评分对损伤侧坐骨神经功能进行评价;取坐骨神经发出的脊髓相应节段(L4～L6)及坐骨神经卡压处组织,实时荧光定量PCR检测方法观察RhoA基因表达的变化;Western Blot法检测RhoA蛋白的表达。结果:①趾张反射和改良Tarlov评分:在1、2、4周时,模型对照组评分低于正常对照组(均P<0.01),神经松动术组、夹脊电针组、电针+神经松动术组各亚组评分高于模型对照组(均P<0.01),且电针+神经松动术组各亚组高于神经松动术组和夹脊电针组(均P<0.01),其中4周组恢复最好;②Rho A的mRNA及蛋白表达:脊髓节段:在1、2、4周时,模型对照组高于正常对照组(均P<0.01),神经松动术组、夹脊电针组、电针+神经松动术组各亚组低于模型对照组(均P<0.01),且电针+神经松动术组各亚组低于神经松动术组和夹脊电针组(均P<0.01),在1周和4周时,神经松动术组低于夹脊电针组(均P<0.01),在2周时,神经松动术组高于夹脊电针组(P<0.01);坐骨神经:在1、2、4周时,模型对照组均高于正常对照组(均P<0.01),神经松动术组、夹脊电针组、电针+神经松动术组各亚组低于模型对照组(均P<0.01),且在2周和4周时,电针+神经松动术组低于神经松动术组和夹脊电针组(均P<0.01);在1周时,神经松动术组低于夹脊电针组和电针+神经松动术组(均P<0.01),夹脊电针组与电针+神经松动术组比较差异无统计学意义(P>0.05);在2周时,神经松动术组高于夹脊电针组(P<0.01);在4周时,神经松动术组低于夹脊电针组(均P<0.01)。结论:神经松动术和夹脊电针均可以促进损伤的坐骨神经修复,可能与降低RhoA的表达水平有关,且两者结合效果更佳。
Objective To observe the effects of electroacupuncture(EA) at "Jiaji"(EX-B 2) points combined with nerve mobilization on protein and mRNA expression of RhoA in rabbits with sciatic nerve injury, and to provide theoretical basis for the treatment of peripheral nerve injury by EA at "Jiaji"(EX-B 2) points combined with nerve mobilization. Methods A total of180 New Zealand rabbits were randomly divided into a normal control group, a model control group, a nerve mobilization group, an EA group, an EA plus nerve mobilization group, 36 rabbits in each group. Each group was further divided into a1-week subgroup, 2-week subgroup and 4-week subgroup, 12 rabbits in each subgroup. The sciatic nerve injury model was made by clamping method. The rabbits in the normal control group did not receive any intervention. The rabbits in the model control group was normally fed after operation. The rabbits in the nerve mobilization group were treated with nerve mobilization;the manipulation lasted for 1 s and relaxed for 5 s, 10 times per day, 6 days per week. The rabbits in the EA group were treated with EA at "Jiaji"(EX-B 2) points(L4-L6), once a day, 30 min each time, 6 times per week. The rabbits in the EA plus nerve mobilization group were treated with EA at "Jiaji"(EX-B 2) points, followed by nerve mobilization. The function of sciatic nerve on the injured side was evaluated by toe tension reflex and modified Tarlov score;the tissues of corresponding segments of spinal cord L4-L6 and sciatic nerve were taken;the expression of RhoA gene was detected by real-time PCR and the expression of RhoA protein was detected by Western Blot. Results ① Toe tension reflex and modified Tarlov score: at 1, 2 and 4 weeks, the scores in the model control group were lower than those in the normal control group(all P<0.01). The scores in the subgroup of nerve mobilization group, EA group and EA plus nerve mobilization group were higher than those in the model control group(all P<0.01), and the scores in the subgroup of EA plus nerve mobilization group were higher than those in the nerve mobilization group and the EA group(all P<0.01);the recovery was the best at 4 weeks.② The mRNA and protein expression of RhoA: in segment of spinal cord, at 1, 2 and 4 weeks, the expression in the model control group was higher than that in the normal control group(all P<0.01). The expression in the subgroup of nerve mobilization group, EA group and EA plus nerve mobilization group was lower than that in the model control group(all P<0.01), and the expression in the subgroup of EA plus nerve mobilization group was lower than that in the nerve mobilization group and the EA group(all P<0.01);at 1 week and 4 weeks, the expression in the nerve mobilization group was lower than that in the EA group(all P<0.01);at2 weeks, the expression in the nerve mobilization group was higher than that in the EA group(all P<0.01). In the sciatic nerve,at 1, 2 and 4 weeks, the expression in the model control group was higher than that in the normal control group(all P<0.01). The expression in the subgroup of nerve mobilization group, EA group and EA plus nerve mobilization group was lower than that in the model control group(all P<0.01);at 2 weeks and 4 weeks, the expression in the EA plus nerve mobilization group was lower than that in the nerve mobilization group and EA group(all P<0.01);at 1 week, the expression in the nerve mobilization group was lower than that in the EA group and EA plus nerve mobilization group(all P<0.01), but the differences between the EA group and the EA plus nerve mobilization group were not significant(P>0.05);at 2 weeks, the expression in the nerve mobilization group was higher than that in the EA group(all P<0.01);at 4 weeks, the expression in the nerve mobilization group was lower than that in the EA group(all P<0.01). Conclusion The nerve mobilization and EA at "Jiaji"(EX-B 2) points could both promote the repair of injured sciatic nerve, which may be related to the down-regulation of RhoA expression, and the combination of the two methods has better effects.
作者
王艳
董传菲
徐若男
郭子楠
郑琳琳
袁一鸣
WANG Yan;DONG Chuan-fei;XU Ruo-nan;GUO Zi-nan;ZHENG Lin-lin;YUAN Yi-ming(Rehabilitation Center, the Second Affiliated Hospital of Heilongjiang University of CM, Harbin 150001,China;Graduate School of Heilongjiang University of CM)
出处
《中国针灸》
CAS
CSCD
北大核心
2019年第6期625-631,共7页
Chinese Acupuncture & Moxibustion
基金
国家自然基金面上项目:81674077
黑龙江省自然科学基金面上项目:H2017062
哈尔滨市科技局科技创新人才研究专项基金项目:2016RAXYJ106
关键词
坐骨神经损伤
夹脊电针
神经松动术
周围神经损伤
RHOA
趾张反射
改良Tarlov评分
sciatic nerve injury
electroacupuncture(EA) at Jiaji(EX-B 2) points
nerve mobilization
peripheral nerve injury
RhoA
toe reflex
modified Tarlov score
