电针“次髎/中髎”穴对压力性尿失禁模型雌性大鼠尿道外括约肌肌电动作电位及CTGF和PGP9.5蛋白表达的影响

The Effect of Electroacupuncture at“Ciliao”(BL32)/“Zhongliao”(BL33)on EMG Action Potential of External Urethral Sphincter and Expression of CTGF and PGP9.5 Protein in Female Rats with Stress Urinary Incontinence

目的探讨电针次髎/中髎穴治疗女性压力性尿失禁(SUI)的可能作用机制。方法50只SD雌性大鼠随机分为正常组、模型组、次髎/中髎组、非经穴组、合谷组,每组10只。除正常组外其余各组大鼠采用双侧卵巢切除+阴道扩张建立SUI大鼠模型。造模成功后次髎/中髎组大鼠选取“次髎/中髎”穴,非经穴组大鼠选取非经穴,合谷组大鼠选取“合谷”穴,均采用电针疗法,频率2 Hz,疏密波,强度1 mA,每次持续20 min,每日1次,每周连续5天,停2天,干预周期均为4周。正常组、模型组大鼠不给予任何干预措施。干预结束后,记录大鼠尿动力学指标[包括腹压漏尿点压(ALPP)、尿道闭合压(MUCP)]及尿道外括约肌肌电(包括振幅、频率),检测膀胱颈尿道括约肌中结缔组织生长因子(CTGF)、蛋白基因产物9.5(PGP9.5)表达。结果与正常组比较,模型组大鼠ALPP、MUCP,尿道外括约肌肌电振幅、频率,膀胱颈尿道括约肌中PGP9.5、CTGF表达水平明显下降(P<0.01)。与模型组比较,次髎/中髎组大鼠ALPP、MUCP,尿道外括约肌肌电振幅、频率,膀胱颈尿道括约肌中PGP9.5、CTGF表达水平,非经穴组ALPP,膀胱颈尿道括约肌中PGP9.5、CTGF表达水平均明显上升(P<0.05或P<0.01)。与次髎/中髎组比较,非经穴组ALPP及合谷组大鼠ALPP、MUCP,尿道外括约肌肌电振幅、频率,膀胱颈尿道括约肌中PGP9.5、CTGF表达水平下降(P<0.05或P<0.01)。结论电针次髎/中髎穴通过改善尿道外括约肌肌电动作电位表达,提高CTGF、PGP9.5在膀胱颈尿道括约肌中的表达,从而参与骶丛副交感神经通路的神经体液调节,缓解SUI大鼠膀胱尿道功能障碍。

Objective To observe the possible mechanism of electroacupuncture(EA)at Ciliao(BL32)/Zhongliao(BL33)in the treatment of female stress urinary incontinence(SUI).Methods Fifty female SD rats were randomly divided into normal group,model group,BL32/BL33 group,non-channel point group,and Hegu(LI 4)group,with 10 rats in each group.The rats in all groups except the normal group were given bilateral ovariectomy and vaginal dilatation to establish the SUI model.After successful modeling,EA,2 Hz frequency,1 mA density dilatational wave,20 min each time,once daily was performed at the corresponding acupoints in the BL32/BL33 group,non-channel point group,and LI4 group,five consecutive days per week,two days off,for 4 weeks.Rats in the normal group and model group were not given any interventions.After the intervention,the urodynamic indicators including abdominal pressure leak point pressure(ALPP)and urethral closure pressure(MUCP),and EMG of the external urethral sphincter including amplitude and frequency were assessed,and the expression of connective tissue growth factor(CTGF)and protein gene product 9.5(PGP9.5)in the bladder neck urethral sphincter were detected.Results Compared to those in the normal group,the ALPP,MUCP,EMG amplitude and frequency of external urethral sphincter,and the expression levels of PGP9.5 and CTGF in bladder neck urethral sphincter significantly decreased in the model group(P0.01).Compared to those in the model group,the levels of ALPP,MUCP,EMG amplitude and frequency of external urethral sphincter,and the expression levels of PGP9.5 and CTGF in the BL32/BL33 group,as well as the ALPP level and the expressions of PGP9.5 and CTGF in the non-channel point group increased(P0.05 or P0.01).Compared to those in the BL32/BL33 group,the level of ALPP,MUCP,EMG amplitude and frequency of external urethral sphincter,expression levels of PGP9.5 and CTGF in bladder neck urethral sphincter significantly decreased(P0.05 or P0.01).Conclusion EA at BL32/BL33 can improve the expression of EMG action potential of external urethral sphincter,and up-regulate the expression of CTGF and PGP9.5 in urethral sphincter of bladder neck,thereby getting involved in the neurofluid regulation of sacral plexus parasympathetic pathway and relieving vesicourethral dysfunction in SUI rats.