电针治疗脊髓损伤后神经源性膀胱作用机制的研究与思考

回顾和分析近10年来电针治疗脊髓损伤后神经源性膀胱的相关国内外实验研究文献,以探索电针治疗此病的作用机制。从临床观察指标上看,电针具有改善尿动力学参数,增大膀胱容量,降低膀胱压力,改善膀胱顺应性等作用。从作用机制上看,电针可以通过提高NGF及其受体TrkA、BDNF及其受体TrkB的表达调节膀胱的兴奋性和顺应性;通过提高α-SMA蛋白的表达而增强膀胱兴奋性;通过降低膀胱组织中Cyt-C、Apaf-1、caspase-3,9蛋白表达和促进bcl-2、抑制bax的表达而降低细胞凋亡;通过上调PACAP-cAMP-PKA信号通路蛋白的表达而改善膀胱功能。目前针刺治疗SCI后NB尚无嘌呤受体信号途径与缝隙连接蛋白的实验研究,也为今后的实验探索提供了新的途径。

Study on the Mechanism of Electroacupuncture on Neurogenic Bladder after Spinal Cord Injury

In order to explore the mechanism of electroacupuncture in the treatment of neurogenic bladder after spinal cord injury,we reviewed and analyzed the domestic and foreign experimental literature on electroacupuncture in the past 10 years. In terms of clinical observation indexes,electroacupuncture can improve urodynamic parameters,increase bladder volume,reduce bladder pressure,and improve bladder compliance. From the mechanism of action,electroacupuncture can regulate bladder excitability and compliance by improving the expression of NGF and its receptor TrkA,BDNF and its receptor TrkB. Bladder excitability w as enhanced by increasing the expression of-sma protein. By reducing the expression of cyt-c,apaf-1 and caspase-3,9 proteins in bladder tissues and promoting the expression of bcl-2 and inhibiting the expression of bax,apoptosis w as reduced. Bladder function w as improved by up-regulating the protein expression of pacap-camp-pka signaling pathw ay. At present,there is no experimental study on purine receptor signaling pathw ay and gap junction protein of NB after acupuncture therapy for SCI,w hich also provides a new w ay for future experimental exploration.