针刀松解法对膝骨关节炎大鼠中枢镇痛作用影响的研究
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摘要
骨关节炎(Osteoarthritis, OA)是全球范围内极为常见的一种骨关节病,具有较高的致残率,因对患者生活、家庭及社会产生重要的影响而备受医疗机构的关注。2000年的世界卫生组织大会宣布2000-2010年为防治骨关节炎的十年,2002年中国卫生部、中华医学会宣布2002-2012年为“中国骨骼与关节健康十年”。膝关节是骨关节炎的好发部位,膝骨关节炎(Knee Osteoarthritis, KOA)以膝关节疼痛、僵硬、活动受限为主要特征,患者常因关节疼痛而求治。
针刀松解法在膝骨关节炎的治疗方面取得了较好的疗效,目前对针刀疗法的研究逐渐向基础研究领域深入发展,本课题依托国家重点基础研究发展计划(973计划)中医理论资助专项《针刀松解法基础研究》的研究,通过动物实验探讨针刀松解法镇痛的作用及其中枢机制,为验证针刀疗法的有效性提供客观依据。
研究目的
通过对膝骨关节炎大鼠针刀干预前后局部组织形态学的观察,痛阈的观测,中枢神经系统内疼痛相关物质的检测分析,研究寻找针刀松解法对膝骨关节炎疼痛缓解的作用机制,探求其对中枢镇痛作用的影响方式,阐释镇痛机理,为验证针刀疗法的有效性提供客观依据。
研究方法
将清洁级3月龄健康SD大鼠80只(雌雄各半)随机分为空白组、模型组、针刀组、电针组,应用木瓜蛋白酶关节内注射的方法制备膝骨关节炎模型。针刀组、电针组于造模第36d开始进行治疗干预,针刀组每周干预1次,电针组每周干预3次(隔日一次),共三周。以热辐射法测定大鼠甩尾反射潜伏期,观察大鼠痛阈变化；光镜观察大鼠局部组织的病理表现；放免法测定脊髓及脑内各水平的P物质(SP)、亮-脑啡肽(L-ENK)、p-内啡肽(p-EP)、八肽胆囊收缩素(CCK-8)含量,酶免法测定脊髓及脑内各水平的5羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)含量,观察针刀松解法对疼痛相关神经肽及单胺类神经递质的调节作用。
研究结果
1.模型组的痛阈值在各周均比正常组低且具有显著的统计学意义(P<0.01,P<0.05)；针刀组和电针组大鼠从治疗开始后痛阈有所提高且与模型组相比有显著性差异(P<0.01,P<0.05)；针刀组的痛阈在第二次治疗后明显提高,且提高幅度大于电针组,二者的差值具有极显著的统计学意义(P<0.01)
2.肉眼观察见模型组关节囊明显增厚,软骨色泽变暗、表面粗糙,可见软骨下骨裸露及骨赘形成。针刀松解法、电针干预能减轻关节囊增厚程度,抑制骨赘的生成。
3.光镜下见模型组关节结构改变、关节间隙狭窄；关节腔内可见脱落的软骨及滑膜组织；关节软骨出现明显的退变,细胞可见变性、坏死,各层细胞排列紊乱无序；滑膜组织充血水肿,毛细血管增生,可见炎性细胞浸润及血管翳。针刀松解法、电针干预能减少炎性细胞的浸润,降低软骨的破坏程度,维持关节结构的正常。
4.在脊髓及丘脑内,针刀组SP水平与空白组相比有增加明显,二者差异显著(P<0.01,P<0.05)；在下丘脑针刀组的SP水平比模型组极明显降低,二者差异有显著的统计学意义(P<0.01)。在脊髓水平,针刀组的L-ENK、β-EP含量比空白组明显增加(P<0.01),在中脑针刀组的L-ENK,β-EP含量比模型组明显降低(P<0.01)。在脊髓及中脑水平,针刀组的CCK-8含量比模型组明显降低(P<0.01,P<0.05)。电针组与针刀组的指标变化趋势大致相同,提示针刀松解法,电针干预可良性调节脊髓和脑内神经肽的水平,使其更接近正常水平。
5.与模型组相比,针刀松解法干预后大鼠脊髓及下丘脑水平的5-HT含量增加明显(P<0.05)。与模型组相比针刀松解法干预后大鼠脊髓组织的NE含量增加明显(P<0.05),而在脑内NE含量呈下降趋势。在中脑模型组DA含量较空白组明显升高(P<0.01),针刀组与空白组之间无显著性差异(P>0.05)。电针组与针刀组的指标变化趋势大致相同,提示针刀松解法、电针干预可良性调节脊髓和脑内单胺类神经递质的水平,纠正上述物质的合成和代谢失衡。
研究结论
针刀松解法具有镇痛作用,通过本次研究可以发现针刀松解法对膝骨关节炎大鼠中枢镇痛作用的影响有以下特点：①针刀松解法对中枢内的镇痛相关物质(神经肽和单胺类神经递质)均有良性调节作用；②针刀松解法的良性调节作用同时发生在脊髓及脊髓以上水平,脊髓水平的作用更为明显；③针刀松解法对疼痛的调节与其对单胺类神经递质与阿片肽系统代偿机制的影响有关。
中枢镇痛相关物质的调节方面,本次结果很难体现针刀松解法与电针疗法的区别,无法判定两种治疗方法的优劣。但在痛阈观察方面针刀组的效果要好于电针组,这不但与中枢镇痛相关物质的调节有关,更和局部炎症及组织破坏程度的抑制相关。在治疗次数上针刀治疗次数明显少于电针治疗,这更符合临床患者治疗的需要。
Osteoarthritis (OA) is a very common osteoarthropathy worldwide with high disability rate, and is of great concern to medical institutions due to the impact it has on patients' life, and social activities.2000 World Health Organization Assembly declared 2000-2010 the ten years of Osteoarthritis prevention and cure. In 2002, China Ministry of Health and Chinese Medical Association declared 2002-2012 "the ten years for healthy bones and joints of Chinese". Knee joint is susceptible to OA. Knee Osteoarthritis (KOA) is characterized mainly by knee joint pain, stiffness, and limitation to movement. Patients often seek treatment because of joint pain.
Acupotomy lysis proved eutherapeutic in the treatment of KOA. The research on acupotomy is developing toward basic fields. This project relies on Acupotomy Lysis Basic Research under Specialized Traditional Chinese Medicine Programs funded by National Basic Research Program of China (973 Program). Through animal testing, this project studies how acupotomy lysis eases pain, and its central mechanism for the purpose of providing factual evidence to confirm the effectiveness of acupotomy.
Objective
Through observing the morphology of local tissues of rats with KOA, measuring threshold of pain, and detecting and analyzing pain-related substances in central nervous system before and after acupotomy intervention, this project studies how acupotomy lysis eases KOA pain, explores how it influences central analgesia function, and elucidates its pain alleviation mechanism, for the purpose of providing factual evidence to confirm the effectiveness of acupotomy.
Methods
Divide 80 three-month-old healthy laboratory SD rats (equal between genders) randomLy into normal control group, model group, acupotomy lysis group, and electro-acupuncture group. Prepare KOA models by injecting papain solution into knee joint cavities of rats. Start treating acupotomy group and electro-acupuncture group rats on 36d after modeling. Treat acupotomy group once a week, electro-acupuncture group three times a week (once every other day), for three weeks. Measure the tail flick latency of rat using heat radiation to observe the variation of the pain threshold of rats. Observe the pathology of local tissues of rats through optical microscope. Measure the content of SP, I-ENK, (3-EP, and CCK-8 in tissues in spinal cord and brain using radioimmunOAssay. Measure the content of 5-HT, NE, and DA in tissues in spinal cord and brain using enzyme immunOAssay. Observe the regulatory function of acupotomy lysis on pain-related neuropeptide and monOAmine neurotransmitter.
Result
1. Pain threshold of model group is much lower than normal control group throughout the testing (P＜0.01, P<0.05). Pain threshold of acupotomy group and electro-acupuncture group has risen after treatment starts, and is significantly different than model group (P<0.01, P<0.05). Pain threshold of acupotomy group rises sharply after the 2nd treatment, and rises more than electro-ecupuncture group does (P<0.01)
2. There are to the naked eye noticeable thickening of articular capsule, darkening and roughness of cantilage, exposed subchondral bone, and formation of osteophyte of rats in model group. Acupotomy lysis can reduce articular capsule thickening, and inhibit the forming of osteophyte.
3. Changed joint structure and narrow joint space are seen through optical microscope. Inside joint cavity are found cartilage and synovial membrane that have come off. Joint cartilage is found with conspicuous degeneration. Denaturation and necrosis of cells is seen. Cells in different layers are in disorder. Synovial membrane is congestive and edematous. Capillary is hyperplastic. Inflammatory cell infiltration and pannus are found. Acupotomy lysis and electro-acupuncture can reduce inflammatory cell infiltration and damage to cartilage such that normal joint structure is maintained.
4. In respect of SP content in spinal cord and thalamus, acupotomy group has risen sharply compared with normal control group(P<0.01, P<0.05). In respect of SP content in hypothalamus, acupotomy group is significantly lower than normal control group (P＜0.01). In respect of I-ENK andβ-EP content in spinal cord, acupotomy group has risen sharply compared with normal control group (P＜0.01). In respect of I-ENK andβ-EP content in midbrain, acupotomy group is significantly lower than normal control group (P＜0.01). In respect of CCK-8 content in spinal cord and midbrain, acupotomy group is significantly lower than normal control group (P＜0.01, P＜0.05). The indices of acupotomy group and electro-acupuncture group change with similar trends, that shows acupotomy lysis and electro-acupuncture can adjust in a favorable way the neuropeptide content in spinal cord and brain to make them closer to normal level.
5. The 5-HT content in spinal cord and hypothalamus of rats treated with acupotomy lysis has risen sharply compared with that of normal control group rats (P＜0.05). Compared with normal control group, the NE content in spinal cord tissues of rats treated with acupotomy lysis has risen sharply (P＜0.05) NE content in brain shows a downward trend. In respect of midbrain DA content, model group has risen sharply compared with normal control group (P＜0.01). There is no significant difference between acupotomy group and normal control group The indices of acupotomy group and electro-acupuncture group change with similar trends, that shows acupotomy lysis and electro-acupuncture can adjust in a favorable way the monOAmine neurotransmitter content in spinal cord and brain to correct their anabolism imbalance.
Conclusion
Acupotomy lysis functions to ease pain. Through this project it can be found that acupotomy lysis influences pain alleviation function of the central nervous system of rats with KOA with the following characteristics:①acupotomy lysis functions to adjust in a favorable way the pain-alleviation-related substances (neuropeptide and monOAmine neurotransmitter) in central nervous system;②the favorable adjustment function of acupotomy lysis exists in both spinal cord and the tissues above it, though in spinal cord it is more conspicuous;③the adjustment by acupotomy lysis to KOA induced pain reflects compensatory mechanism of monOAmine neurotransmitter and opioid peptide system.
It is difficult to conclude from the findings of this project either of acupotomy lysis and electro-acupuncture is more effective in adjusting pain-alleviation-related substances in central nervous system, so it cannot be determined which therapy is better. Observation in this project shows that acupotomy lysis is more effective than electro-acupuncture in raising pain threshold, that might be related to the adjustment to pain-alleviation-related substances in central nervous system, and the inhibition of inflammation of and damage to local tissues. Acupotomy lysis is more convenient for patients since it is administered far less frequently than electro-acupuncture.
针刀松解法在膝骨关节炎的治疗方面取得了较好的疗效,目前对针刀疗法的研究逐渐向基础研究领域深入发展,本课题依托国家重点基础研究发展计划(973计划)中医理论资助专项《针刀松解法基础研究》的研究,通过动物实验探讨针刀松解法镇痛的作用及其中枢机制,为验证针刀疗法的有效性提供客观依据。
研究目的
通过对膝骨关节炎大鼠针刀干预前后局部组织形态学的观察,痛阈的观测,中枢神经系统内疼痛相关物质的检测分析,研究寻找针刀松解法对膝骨关节炎疼痛缓解的作用机制,探求其对中枢镇痛作用的影响方式,阐释镇痛机理,为验证针刀疗法的有效性提供客观依据。
研究方法
将清洁级3月龄健康SD大鼠80只(雌雄各半)随机分为空白组、模型组、针刀组、电针组,应用木瓜蛋白酶关节内注射的方法制备膝骨关节炎模型。针刀组、电针组于造模第36d开始进行治疗干预,针刀组每周干预1次,电针组每周干预3次(隔日一次),共三周。以热辐射法测定大鼠甩尾反射潜伏期,观察大鼠痛阈变化；光镜观察大鼠局部组织的病理表现；放免法测定脊髓及脑内各水平的P物质(SP)、亮-脑啡肽(L-ENK)、p-内啡肽(p-EP)、八肽胆囊收缩素(CCK-8)含量,酶免法测定脊髓及脑内各水平的5羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)含量,观察针刀松解法对疼痛相关神经肽及单胺类神经递质的调节作用。
研究结果
1.模型组的痛阈值在各周均比正常组低且具有显著的统计学意义(P<0.01,P<0.05)；针刀组和电针组大鼠从治疗开始后痛阈有所提高且与模型组相比有显著性差异(P<0.01,P<0.05)；针刀组的痛阈在第二次治疗后明显提高,且提高幅度大于电针组,二者的差值具有极显著的统计学意义(P<0.01)
2.肉眼观察见模型组关节囊明显增厚,软骨色泽变暗、表面粗糙,可见软骨下骨裸露及骨赘形成。针刀松解法、电针干预能减轻关节囊增厚程度,抑制骨赘的生成。
3.光镜下见模型组关节结构改变、关节间隙狭窄；关节腔内可见脱落的软骨及滑膜组织；关节软骨出现明显的退变,细胞可见变性、坏死,各层细胞排列紊乱无序；滑膜组织充血水肿,毛细血管增生,可见炎性细胞浸润及血管翳。针刀松解法、电针干预能减少炎性细胞的浸润,降低软骨的破坏程度,维持关节结构的正常。
4.在脊髓及丘脑内,针刀组SP水平与空白组相比有增加明显,二者差异显著(P<0.01,P<0.05)；在下丘脑针刀组的SP水平比模型组极明显降低,二者差异有显著的统计学意义(P<0.01)。在脊髓水平,针刀组的L-ENK、β-EP含量比空白组明显增加(P<0.01),在中脑针刀组的L-ENK,β-EP含量比模型组明显降低(P<0.01)。在脊髓及中脑水平,针刀组的CCK-8含量比模型组明显降低(P<0.01,P<0.05)。电针组与针刀组的指标变化趋势大致相同,提示针刀松解法,电针干预可良性调节脊髓和脑内神经肽的水平,使其更接近正常水平。
5.与模型组相比,针刀松解法干预后大鼠脊髓及下丘脑水平的5-HT含量增加明显(P<0.05)。与模型组相比针刀松解法干预后大鼠脊髓组织的NE含量增加明显(P<0.05),而在脑内NE含量呈下降趋势。在中脑模型组DA含量较空白组明显升高(P<0.01),针刀组与空白组之间无显著性差异(P>0.05)。电针组与针刀组的指标变化趋势大致相同,提示针刀松解法、电针干预可良性调节脊髓和脑内单胺类神经递质的水平,纠正上述物质的合成和代谢失衡。
研究结论
针刀松解法具有镇痛作用,通过本次研究可以发现针刀松解法对膝骨关节炎大鼠中枢镇痛作用的影响有以下特点：①针刀松解法对中枢内的镇痛相关物质(神经肽和单胺类神经递质)均有良性调节作用；②针刀松解法的良性调节作用同时发生在脊髓及脊髓以上水平,脊髓水平的作用更为明显；③针刀松解法对疼痛的调节与其对单胺类神经递质与阿片肽系统代偿机制的影响有关。
中枢镇痛相关物质的调节方面,本次结果很难体现针刀松解法与电针疗法的区别,无法判定两种治疗方法的优劣。但在痛阈观察方面针刀组的效果要好于电针组,这不但与中枢镇痛相关物质的调节有关,更和局部炎症及组织破坏程度的抑制相关。在治疗次数上针刀治疗次数明显少于电针治疗,这更符合临床患者治疗的需要。
Osteoarthritis (OA) is a very common osteoarthropathy worldwide with high disability rate, and is of great concern to medical institutions due to the impact it has on patients' life, and social activities.2000 World Health Organization Assembly declared 2000-2010 the ten years of Osteoarthritis prevention and cure. In 2002, China Ministry of Health and Chinese Medical Association declared 2002-2012 "the ten years for healthy bones and joints of Chinese". Knee joint is susceptible to OA. Knee Osteoarthritis (KOA) is characterized mainly by knee joint pain, stiffness, and limitation to movement. Patients often seek treatment because of joint pain.
Acupotomy lysis proved eutherapeutic in the treatment of KOA. The research on acupotomy is developing toward basic fields. This project relies on Acupotomy Lysis Basic Research under Specialized Traditional Chinese Medicine Programs funded by National Basic Research Program of China (973 Program). Through animal testing, this project studies how acupotomy lysis eases pain, and its central mechanism for the purpose of providing factual evidence to confirm the effectiveness of acupotomy.
Objective
Through observing the morphology of local tissues of rats with KOA, measuring threshold of pain, and detecting and analyzing pain-related substances in central nervous system before and after acupotomy intervention, this project studies how acupotomy lysis eases KOA pain, explores how it influences central analgesia function, and elucidates its pain alleviation mechanism, for the purpose of providing factual evidence to confirm the effectiveness of acupotomy.
Methods
Divide 80 three-month-old healthy laboratory SD rats (equal between genders) randomLy into normal control group, model group, acupotomy lysis group, and electro-acupuncture group. Prepare KOA models by injecting papain solution into knee joint cavities of rats. Start treating acupotomy group and electro-acupuncture group rats on 36d after modeling. Treat acupotomy group once a week, electro-acupuncture group three times a week (once every other day), for three weeks. Measure the tail flick latency of rat using heat radiation to observe the variation of the pain threshold of rats. Observe the pathology of local tissues of rats through optical microscope. Measure the content of SP, I-ENK, (3-EP, and CCK-8 in tissues in spinal cord and brain using radioimmunOAssay. Measure the content of 5-HT, NE, and DA in tissues in spinal cord and brain using enzyme immunOAssay. Observe the regulatory function of acupotomy lysis on pain-related neuropeptide and monOAmine neurotransmitter.
Result
1. Pain threshold of model group is much lower than normal control group throughout the testing (P＜0.01, P<0.05). Pain threshold of acupotomy group and electro-acupuncture group has risen after treatment starts, and is significantly different than model group (P<0.01, P<0.05). Pain threshold of acupotomy group rises sharply after the 2nd treatment, and rises more than electro-ecupuncture group does (P<0.01)
2. There are to the naked eye noticeable thickening of articular capsule, darkening and roughness of cantilage, exposed subchondral bone, and formation of osteophyte of rats in model group. Acupotomy lysis can reduce articular capsule thickening, and inhibit the forming of osteophyte.
3. Changed joint structure and narrow joint space are seen through optical microscope. Inside joint cavity are found cartilage and synovial membrane that have come off. Joint cartilage is found with conspicuous degeneration. Denaturation and necrosis of cells is seen. Cells in different layers are in disorder. Synovial membrane is congestive and edematous. Capillary is hyperplastic. Inflammatory cell infiltration and pannus are found. Acupotomy lysis and electro-acupuncture can reduce inflammatory cell infiltration and damage to cartilage such that normal joint structure is maintained.
4. In respect of SP content in spinal cord and thalamus, acupotomy group has risen sharply compared with normal control group(P<0.01, P<0.05). In respect of SP content in hypothalamus, acupotomy group is significantly lower than normal control group (P＜0.01). In respect of I-ENK andβ-EP content in spinal cord, acupotomy group has risen sharply compared with normal control group (P＜0.01). In respect of I-ENK andβ-EP content in midbrain, acupotomy group is significantly lower than normal control group (P＜0.01). In respect of CCK-8 content in spinal cord and midbrain, acupotomy group is significantly lower than normal control group (P＜0.01, P＜0.05). The indices of acupotomy group and electro-acupuncture group change with similar trends, that shows acupotomy lysis and electro-acupuncture can adjust in a favorable way the neuropeptide content in spinal cord and brain to make them closer to normal level.
5. The 5-HT content in spinal cord and hypothalamus of rats treated with acupotomy lysis has risen sharply compared with that of normal control group rats (P＜0.05). Compared with normal control group, the NE content in spinal cord tissues of rats treated with acupotomy lysis has risen sharply (P＜0.05) NE content in brain shows a downward trend. In respect of midbrain DA content, model group has risen sharply compared with normal control group (P＜0.01). There is no significant difference between acupotomy group and normal control group The indices of acupotomy group and electro-acupuncture group change with similar trends, that shows acupotomy lysis and electro-acupuncture can adjust in a favorable way the monOAmine neurotransmitter content in spinal cord and brain to correct their anabolism imbalance.
Conclusion
Acupotomy lysis functions to ease pain. Through this project it can be found that acupotomy lysis influences pain alleviation function of the central nervous system of rats with KOA with the following characteristics:①acupotomy lysis functions to adjust in a favorable way the pain-alleviation-related substances (neuropeptide and monOAmine neurotransmitter) in central nervous system;②the favorable adjustment function of acupotomy lysis exists in both spinal cord and the tissues above it, though in spinal cord it is more conspicuous;③the adjustment by acupotomy lysis to KOA induced pain reflects compensatory mechanism of monOAmine neurotransmitter and opioid peptide system.
It is difficult to conclude from the findings of this project either of acupotomy lysis and electro-acupuncture is more effective in adjusting pain-alleviation-related substances in central nervous system, so it cannot be determined which therapy is better. Observation in this project shows that acupotomy lysis is more effective than electro-acupuncture in raising pain threshold, that might be related to the adjustment to pain-alleviation-related substances in central nervous system, and the inhibition of inflammation of and damage to local tissues. Acupotomy lysis is more convenient for patients since it is administered far less frequently than electro-acupuncture.
引文
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