单次胸椎冲击复位对腰背肌筋膜炎患者致痛因子的影响

Effect of unique thoracic manipulation on inflammatory factor levels in patients with back myofascial pain syndrome

目的探讨单次胸椎冲击复位手法疗法对腰背肌筋膜炎患者致痛因子的影响。方法将88例诊断为腰背肌筋膜炎的患者分为复位组、假复位组及空白对照组。在干预前、干预后15 min和干预后1 h取受试者全血及全清样本,全血样本用LPS制造炎性反应存放24 h后,通过ELISA分别测定TNF-α、IL-1β、COX-2的浓度,β-内啡肽和SP浓度则直接测定。结果与初始水平比较,在研究期间内TNF-α、IL-1β、COX-2水平在假复位组和空白对照组中明显升高(P<0.001),P物质水平无明显变化(P> 0.05),而在胸椎复位组随着研究时间推移,TNF-α、IL-1β、COX-2和P物质水平逐渐降低(P<0.05或P<0.001);组间比较,假复位组和空白对照组TNF-α、IL-1β、COX-2和P物质增高水平相比胸椎复位组有显著差异(P<0.05或P<0.001),而胸椎复位组TNF-α、IL-1β、COX-2和P物质水平在浓度LPS刺激相对假复位组和空白对照组显著性降低(P<0.001)。另外,β-内啡肽水平在假复位组和空白对照组中无显著差异(P> 0.05),而胸椎复位组随着研究时间推移则显著增高(P<0.001),组间比较有统计学差异(P<0.001)。结论单次胸椎冲击复位手法有助于炎性因子TNF-α、IL-1β、COX-2和神经递质P物质表达下调,并提高了β-内啡肽水平。

Objective To examine the effect of unique thoracic manipulation on the in vitro production of pain related cytokines in patients with back myofascial pain syndrome(MPS).Methods Eighty-eight MPS patients were assigned to manipulation,sham manipulation,and blank control groups.Blood and serum samples were obtained from these subjects before intervention and at15 minutes and 1 hour after intervention.Whole-blood cultures were activated with lipopolysaccharide(LPS) for 24 hours.Cytokine production in culture supernatants and serum SP and β-endorphin levels were assessed by enzyme linked immunosorbent assays.Results During this study,progressive increases were observed in the synthesis of TNF-α、IL-1β and COX-2 in patients of the sham and control groups(P<0.001).Conversely,in manipulation group,the production of both cytokines decreased gradually(P<0.001).One hour after intervention,the production of both cytokines increased significantly(P<0.05 or P<0.001) in both sham and control groups.In contrast,a significant(P<0.05 or P<0.001) reduction of proinflammatory cytokine secretion was observed in cultures from manipulation subjects.In addition,in manipulation group,serum levels of SP decreased while β-endorphin was elevated within 1 hour after intervention(P>0.05).Conclusions Unique thoracic manipulation can help downregulate TNF-α,IL-1β,COX-2 and SP,but upregulate β-endorphin via an unknown mechanism.