推拿对坐骨神经慢性压迫性损伤模型鼠脊髓背角胶质纤维酸性蛋白和N-甲基-D-天冬氨酸受体2B亚基表达的影响  

Effect of Tuina on pain behavior and synaptic plasticity in CCI model rats

作　　者：官乾 刘志凤 于天源[1] 王厚融 张英琦 徐亚静 杨震杰 萨出拉 张润龙 陈金平 GUAN Qian;LIU Zhifeng;YU Tianyuan;WANG Hourong;ZHANG Yingqi;XU Yajing;YANG Zhenjie;SA Chula;ZHANG Runlong;CHEN Jinping(School of Acupuncture-Moxibustion and Tuina,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学针灸推拿学院,100029 [2]北京中医药大学东直门医院推拿疼痛科

出　　处：《环球中医药》2023年第6期1084-1090,共7页Global Traditional Chinese Medicine

基　　金：国家自然科学基金(82074573)。

摘　　要：目的通过观察推拿对坐骨神经慢性压迫性损伤(chronic constriction injury of the sciatic nerve,CCI)模型鼠脊髓背角胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)、N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体2B亚基(NR2B)表达的影响,探讨推拿治疗神经病理性疼痛的镇痛机制。方法建立CCI模型,将大鼠分为假手术组、模型组、推拿组,每组12只,采用按摩推拿手法模拟仪定性、定量模拟点法、拨法、揉法,对推拿组大鼠右侧的殷门、承山、阳陵泉穴进行干预,通过机械缩足反射阈值和累计疼痛评分评价大鼠机械痛敏反应和疼痛强度变化;通过透射电镜对大鼠脊髓背角突触超微结构进行观察;采用免疫荧光双重标记法观察脊髓背角GFAP、NR2B的共定位表达。结果推拿可以提高CCI模型鼠机械缩足反射阈值、降低累计疼痛评分(P<0.01);同时也能改变大鼠脊髓背角突触的形态结构:与模型组相比,推拿组脊髓背角突触形态结构恢复,膜较完整、线粒体肿胀程度轻、突触后致密区变长。干预20天后,与模型组比较,推拿组大鼠脊髓背角GFAP、NR2B平均荧光强度显著降低(P<0.05)。结论推拿可以改善大鼠的行为学和形态学结果,改变脊髓背角突触可塑性来抑制痛觉敏化;还可以通过抑制星型胶质细胞活化,降低脊髓背角GFAP和NR2B的表达来镇痛。Objective To investigate the analgesic mechanism of NPP treated by Tuina by observing the effects of Tuina on the expression of GFAP and NR2B in the dorsal horn of the spinal cord in rats with chronic compression injury of sciatic nerve(CCI)model.Methods The CCI model was established,and the rats were divided into sham-operated group,model group,and Tuina group,12 rats in each group.Massage manipulation simulator was used to intervene in Yinmen(B37),Chengshan(B57)and Yanglingquan(G34)of CCI model rats,evaluating the changes of mechanical pain sensitization response and pain intensity were evaluated by the paw mechanical withdraw threshold and cumulative pain score.The ultrastructure of dorsal horn synapses of rats was observed by transmission electron microscopy.The co-localized expression of GFAP,NR2B in the dorsal horn of the spinal cord was observed using the immunofluorescence dual-labeling method.Results The three methods and acupoints could improve the reflex threshold of the CCI model rats and reduce the cumulative pain score(P<0.01);it could also change the morphological structure of the rat spinal cord dorsal horn synapses:compared with the model group,the three methods and acupoints group restored the morphological structure of the spinal cord dorsal horn synapses,with more intact membranes,less swollen mitochondria,and longer post-synaptic dense areas.After 20 days of intervention,the mean of fluorescence intensity of GFAP and NR2B in the dorsal horn of the spinal cord was significantly decreased in the pushed rats compared with the model group(P<0.05).Conclusion Tuina can improve behavioural and morphological outcomes in rats by altering synaptic plasticity in the dorsal horn of the spinal cord to inhibit nociceptive sensitization;it can also reduce the expression of GFAP and NR2B in the dorsal horn of the spinal cord by inhibiting astrocyte activation and analgesia.

关 键 词：坐骨神经损伤 推拿 痛觉敏化 突触可塑性 背角胶质纤维酸性蛋白 N-甲基-D-天冬氨酸受体2B亚基 

分 类 号：R244.1[医药卫生—针灸推拿学]