电针对改善大鼠脊髓损伤后下尿路功能障碍机制探讨

A study on the mechanism of electroacupuncture in improving lower urinary tract dysfunction caused by spinal cord injury

目的 观察电针对大鼠脊髓损伤后下尿路功能障碍、尿流动力学及膀胱组织中沉默调节蛋白1(Sirt1)和转化生长因子β1 (TGF-β1)的变化,探讨其可能的作用机制。方法 50只大鼠按随机数字表法分为对照组、模型组、电针组,每组10只,除对照组外,脊髓损伤后神经源性膀胱模型采用改良的脊髓横断法复制,电针刺激大椎、次髎、中极、三阴交穴进行干预,连续14 d;观察大鼠一般活动情况;检测大鼠膀胱的尿流动力学;HE染色观察膀胱病理改变;采用RT-PCR和Western blot法检测膀胱组织中Sirt1、TGF-β1 mRNA和蛋白表达。结果 与对照组比较,模型组大鼠膀胱基础压力、漏尿点压力、膀胱最大压力均升高(P<0.01);膀胱顺应性、膀胱最大容量均降低(P<0.01);膀胱逼尿肌纤维层次、数量均增加,部分细胞结构被破坏,有炎性细胞浸润;膀胱细胞凋亡增加(P<0.01);膀胱组织Sirt1 mRNA、蛋白表达降低,TGF-β1 mRNA、蛋白表达升高(P<0.01);与模型组比较,电针型组大鼠膀胱基础压力、漏尿点压力、膀胱最大压力均降低(P<0.05);膀胱顺应性、膀胱最大容量均升高(P<0.01);膀胱组织中逼尿肌纤维化程度减轻,结构被破坏细胞数减少;膀胱细胞凋亡减少(P<0.01);膀胱组织Sirt1 mRNA、蛋白表达升高,TGF-β1 mRNA、蛋白表达降低(P<0.05)。结论 电针刺激可能是通过调控TGF-β1/Sirt1改善脊髓损伤引起的下尿路功能障碍。

Objective This paper aims to observe the effect of electroacupuncture on urinary tract dysfunction,urinary flow mechanics,and the changes of Sirt1 and TGF-β1 in bladder tissue after spinal cord injury in rats,and to explore its possible mechanism.Methods Fifty rats were divided into control group,model group,the electric acupuncture group according to random number table method,with 10 cases in each group.Except for the control group,the neurogenic bladder model after spinal cord injury was replicated by modified spinal cord transection.Electroacupuncture was used to stimulate Dazhui,Ciliao,Zhongji and Sanyinjiao points for intervention for 14 days.The general activity of rats was observed.The urinary flow dynamics of rat bladder were detected.The pathological changes of bladder were observed by HE staining.The expression of Sirt1 and TGF-β1 mRNA and protein in bladder tissues were detected by RT-PCR and Western blot.Results Compared with the control group,the basal bladder pressure,urine leakage point pressure and maximum bladder pressure in model group were increased(P<0.01).Bladder compliance and maximum bladder volume were decreased(P<0.01).The level and number of detrusor muscle fibers increased.Some cell structures were destroyed and inflammatory cells infiltrated.The apoptosis of bladder cells was increased(P<0.01).The Sirt1 mRNA and protein expression in bladder were decreased,while the TGF-β1 mRNA and protein expression were increased(P<0.01).Compared with model group,the basal bladder pressure,urine leakage point pressure and maximum bladder pressure in electroacupuncture group were decreased(P<0.05).Bladder compliance and maximum bladder volume were increased(P<0.01).The degree of detrusor fibrosis decreased and the number of damaged cells decreased.The apoptosis of bladder cells was decreased(P<0.01).The Sirt1 mRNA and protein expression in bladder were increased,while the TGF-β1 mRNA and protein expression were decreased(P<0.05).Conclusion Electroacupuncture can improve lower urinary tract dysfunction caused by spinal cord injury,which may be achieved by regulating the TGF-β1/Sirt1 pathway.