“以筋代骨”点穴法对膝骨关节炎慢性痛伴抑郁大鼠的治疗作用及机制  

Therapeutic effects and mechanisms of“tendons instead of bone”acupoint-pressing manipulation on knee osteoarthritis rats with chronic pain and depression

作　　者：刘志凤 于长禾[1] 王锡友[1] 张洋[1] 李凤林 王彦华 张明阳 孙博奥 LIU Zhifeng;YU Changhe;WANG Xiyou;ZHANG Yang;LI Fenglin;WANG Yanhua;ZHANG Mingyang;SUN Boao(Tuina and pain management department,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院推拿疼痛科,北京100700

出　　处：《北京中医药》2025年第3期283-288,共6页Beijing Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(82305427);北京市自然科学基金资助项目(7252232);中央高水平中医医院临床科研业务费资助项目(CZ015)。

摘　　要：目的 观察“以筋代骨”点穴法对膝骨关节炎(KOA)慢性痛伴抑郁大鼠的治疗作用及机制。方法 用随机数字表法将大鼠分为空白组、模型组、点穴组各6只。模型组和点穴组采用右膝关节腔注射单碘乙酸钠(MIA)造模,空白组大鼠右膝关节腔内注入50μL生理盐水。造模后第28天,点穴组用智能推拿手法模拟仪模拟“以筋代骨”点穴,连续干预7 d。分别于造模前1天、干预前及干预后测定各组大鼠机械缩足反射阈值(PWT),进行强迫游泳实验(FST);尼氏染色观察前扣带回(ACC)区神经元及尼氏小体变化;Western blotting法检测ACC中突触后致密物95(PSD95)和突触前膜蛋白突触素(Syn)蛋白表达;实时荧光定量PCR(qPCR)法检测ACC中PSD95、Syn mRNA表达。结果 造模前,各组大鼠PWT比较差异无统计学意义(P>0.05);干预前模型组和点穴组PWT较空白组降低(P<0.01);干预后点穴组PWT较模型组升高(P<0.01)。FST结果:造模前,各组大鼠5 min内累计静止时间比较差异无统计学意义(P>0.05);干预前模型组和点穴组5 min内累计静止时间较空白组延长(P<0.01);干预后点穴组5 min内累计静止时间较模型组缩短(P<0.01)。空白组神经元及尼氏小体正常;模型组神经元固缩,胞质消失,尼氏小体崩解,呈现深染状态;点穴组神经元及尼氏小体大致正常,偶见神经元固缩,尼氏小体较模型组增加。与空白组比较,模型组PSD95、Syn蛋白表达低(P<0.01);与模型组比较,点穴组PSD95、Syn蛋白表达高(P<0.05,P<0.01)。与空白组比较,模型组PSD95、Syn mRNA表达低(P<0.01);与模型组比较,点穴组PSD95、Syn mRNA表达高(P<0.01)。结论 “以筋代骨”点穴法可以明显改善KOA大鼠疼痛和抑郁状态,同时促进PSD95、Syn表达,保护ACC区神经元和突触。Objective To observe the therapeutic effects and mechanisms of the“tendons instead of bone”acupoint-pressing manipulation on chronic pain accompanied by depression in knee osteoarthritis(KOA)rats.Methods A total of 18 rats were randomly divided into the blank group,model group,and acupoint-pressing group according to a random number table,with 6 rats in each group.The model and acupoint-pressing groups were induced by injecting monosodium iodoacetate(MIA)into the right knee joint cavity,while the blank group received 50μL of physiological saline in the right knee joint cavity.On the 28th day after modeling,the acupoint-pressing group was treated with the“tendons instead of bone”acupoint-pressing manipulation using an intelligent Tuina simulation device,with continuous intervention for 7 days.Mechanical paw withdrawal threshold(PWT)was measured one day before modeling,before intervention,and after intervention.The forced swimming test(FST)was conducted.Nissl staining was used to observe neuronal changes and Nissl body alterations in the anterior cingulate cortex(ACC).Western blotting was used to measure the expression of postsynaptic density 95(PSD95)and synaptophysin(Syn)proteins in the ACC,and real-time quantitative PCR(qPCR)was used to detect PSD95 and Syn mRNA expression in the ACC.Results Before modeling,there was no significant difference in PWT among the groups(P>0.05).Before intervention,compared with the blank group,the model and acupointpressing groups had lower PWT(P<0.01).After intervention,compared with the model group,the acupoint-pressing group had higher PWT(P<0.01).FST results showed that before modeling,there was no significant difference in the cumulative immobility time within 5 min among the groups(P>0.05).Before intervention,compared with the blank group,the model and acupointpressing groups had longer cumulative immobility time within 5 min(P<0.01).After intervention,the acupoint-pressing group had a shorter cumulative immobility time than the model group(P<0.01).Nissl staining show

关 键 词：推拿 点穴 膝骨关节炎 疼痛 抑郁 突触可塑性 大鼠 

分 类 号：R245.9[医药卫生—针灸推拿学]