手法加载对慢性下腰痛模型大鼠降钙素基因相关肽和神经生长因子的影响

目的:观察手法加载对慢性下腰痛(chronic low back pain,CLBP)模型大鼠的镇痛效应以及腰大肌组织相关炎性因子表达的影响,探索手法对局部炎性微环境状态的改善情况。方法:选取体质量为340～360 g的SPF级雄性SD大鼠32只,随机分为空白组、假手术组、慢性下腰痛模型组、治疗组,每组8只。模型组大鼠腰椎L4-L6植入外部链接固定系统(external link fixation system,ELFS),假手术组不植入ELFS,仅行切开缝合,空白组不作任何处理,治疗组植入ELFS后,在脊柱两侧用力量为5 N,频率为2 Hz的刺激量进行手法干预,15 min/次,1次/d,连续干预14 d,分别在造模前、干预后第1、3、7、10、14天检测四组大鼠机械刺激反应阈值(paw with drawl threshold,PWT),热刺激反应阈值(paw withdrawl latency,PWL),治疗周期结束后,酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)检测腰大肌组织中降钙素基因相关肽(calcitonin gene-related peptide,CGRP)和神经生长因子(nerve growth factor,NGF)的浓度值。结果:空白组与假手术组的PWT、PWL在造模后均无显著差异(P0.05);模型成模后,CLBP模型组和治疗组PWT、PWL明显降低(P0.01);手法加载后第1、3天,治疗组的PWT较CLBP模型组改善不明显(P0.05);手法加载后第7天,治疗组与CLBP模型大鼠相比,痛阈值呈现出升高的趋势,但二者相比无统计学意义(P=0.0560.05),至治疗第10、14天,治疗组大鼠的机械痛阈值开始上升,且与CLBP模型大鼠相比有统计学意义,分别为(P0.05,P0.01);手法治疗后第1、3天,治疗组的PWL较CLBP模型组改善同样不明显(P0.05);待第7天比较,治疗组与CLBP模型组的PWL有统计学意义(P=0.0160.05),手法加载对CLBP大鼠热痛觉过敏现象有了改善直到实验结束。CLBP模型组腰大肌中CGRP和NGF含量均高于空白组和假手术组(P0.01),治疗后两者的含量均有明显下降(P0.01)。结论:局部按揉手法加载对CLBP大鼠有镇痛作用,同时可以抑制CLBP大鼠腰大肌组织CGRP、NGF的含量,改善局部炎性微环境状态。

Effects of manual loading on calcitonin gene-related peptide and nerve growth factor in rats with chronic low back pain

Objective: To observe the analgesic effect of manipulation loading on chronic low back pain (CLBP) model rats and the expression of inflammatory factors in psoas major muscle tissue,and to explore the improvement of manipulation on local inflammatory microenvironment.Methods: Thirty two SPF male SD rats weighing 340-360g were randomly divided into blank group,sham operation group,chronic low back pain model group and treatment group,with 8 rats in each group. In the model group,L4-L6 lumbar vertebrae were implanted with external link fixation system (ELFS). After implantation of ELFS,the treatment group received manual intervention with 5N force and 2Hz frequency on both sides of the spine,15 min/time,once a day,for 14 consecutive days. Paw with drawl threshold (PWT) and paw withdrawl latency (PWL) was measured before modeling and on the 1st,3rd,7th,10th and 14th day after intervention. At the end of the treatment cycle,the concentrations of calcitonin gene-related peptide (CGRP) and nerve growth factor (NGF) in psoas muscle were detected by enzyme-linked immunosorbent assay(ELISA).Results: There was no significant difference in PWT and PWL between the blank group and the sham operation group after modeling(P>0.05);after modeling,PWT and PWL in the CLBP model group and the treatment group were significantly decreased(P<0.01);PWT in the treatment group was not significantly improved than that in the CLBP model group on the 1st and 3rd day after manual loading(P>0.05);on the 7th day after manual loading,the pain threshold value in the treatment group was higher than that in the CLBP model group,but there was no significant difference There was no significant difference between the two groups(P=0.056>0.05). On the 10th and 14th day of treatment,the mechanical pain threshold of the treatment group began to rise,and it was statistically significant compared with CLBP model rats(P<0.05,P<0.01);on the 1st and 3rd day after manual treatment,the PWL of the treatment group was not significantly improved compared with CLBP model group(P>0.05);on the 7th day,the PWL of the treatment group was significantly higher than that of CLBP model group,there was statistical significance(P=0.016<0.05). Manual loading improved thermal hyperalgesia in CLBP rats until the end of the experiment. The contents of CGRP and NGF in psoas major muscle of CLBP model group were higher than those of blank group and sham operation group(P<0.01). After treatment,the contents of CGRP and NGF decreased significantly(P<0.01).Conclusion: Local massage loading has analgesic effect on CLBP rats,at the same time,it can inhibit the content of CGRP and NGF in psoas muscle tissue of CLBP rats,and improve the local inflammatory microenvironment.