Correlation Between Therapeutic Effect Of EA On LDH And Degree Of Nerve Defect And Mechanism Of EA Up-regulating The Expression Of Opioid Peptides Of Netrin-1

Objective1.To investigate the effect of electroacupuncture on the improvement of clinical symptoms in patients with lumbar disc herniation,and to explore the correlation between the clinical effect and the degree of nerve defect.2.To study the effect of electroacupuncture on the content of methionine enkephalin andβ-endorphin in L2 spinal dorsal horn of model rabbits and its correlation with the expression of Netrin-1in dorsal root ganglion of model rabbits,and to explore the opioid peptide mechanism of electroacupuncture up-regulating the expression of Netrin-1.Method1.Clinical research:60 patients with lumbar disc herniation were included in the study.Before treatment,the subjects were given physical examination to identify the responsible focus.The neurological function and clinical symptoms were evaluated according to the neurological function rating scale and ODI score scale.The subjects were treated with electroacupuncture,once a day,6 times a course,every other day,for 2 courses.After the treatment,ODI score scale was used to evaluate the clinical symptoms of the subjects,and the improvement of clinical symptoms before and after treatment was compared.Linear correlation analysis was used to analyze the correlation between the improvement rate of ODI score and the degree of neurological deficit.2.Experimental study:20 healthy adult New Zealand white rabbits were randomly divided into 5 groups:normal group,model group,sham model group,electroacupuncture group and sham electroacupuncture group,with 4 rabbits in each group.The rabbits in the normal group were fed naturally for 4 weeks without any treatment;in the model group,Kirschner wires were inserted between the L4 and L5 vertebrae,and longitudinal compression was applied between the vertebrae;In the sham model group,Kirschner wire was inserted in the same way as the model group,but vertebral compression was not applied;After the L4/L5 vertebrae of the model rabbits were continuously pressurized for 4 weeks,MRI examination was performed on the experimental rabbits in each group to observe the intervertebral disc degeneration after modeling.In the electroacupuncture group,L4/L5 bilateral Jiaji points were selected for electroacupuncture treatment,once a day,6 times a course of treatment,every other day,for a total of 4 courses of treatment;The L4/L5 Jiaji points in the sham EA group were not electrified,and the other treatments were the same as those in the EA group.After 4 weeks of EA treatment,the L2 dorsal root ganglion and dorsal horn of spinal cord were taken out.Western blot was used to detect the expression of Netrin-1protein in degenerative disc dorsal root ganglion and endogenous opioid peptide protein in spinal dorsal horn.Result1.Clinical researchThe ODI score of lumbar disc herniation patients after electroacupuncture treatment was significantly lower than that before treatment(P<0.05),and the difference was statistically significant.At the same time,there was a positive linear correlation between the improvement rate of ODI score and the degree of nerve defect(R~2=0.43).2.Experimental study(1)Objective:To observe the effect of EA on the expression of Netrin-1 protein in DRG of rabbits with degenerative lumbar intervertebral disc.Netrin-1 protein was expressed in normal group and sham model group;Compared with normal group,Netrin-1 protein content in model group decreased(P<0.05).Compared with the model group,the expression level of Netrin-1 protein in EA group was increased(P<0.05).Compared with EA group,the expression level of Netrin-1protein in sham EA group was not significantly increased(P<0.05).(2)Objective:To observe the effect of EA on the expression of endogenous opioid peptide protein in spinal dorsal horn of rabbits with degenerative lumbar intervertebral disc.Methionine enkephalin andβ-endorphin were slightly expressed in normal group and sham model group.Compared with the normal group,the expression of methionine enkephalin andβ-endorphin in the model group were significantly higher than those in the normal group(P<0.05);Compared with the model group,the expression of methionine enkephalin andβ-endorphin in the spinal dorsal horn of EA group increased significantly(P<0.05);Compared with the EA group,the expression of methionine enkephalin andβ-endorphin in the sham EA group decreased significantly(P<0.05).(3)Objective:To study the correlation between endogenous opioid peptides and Netrin-1 expression.There was a positive correlation between methionine enkephalin andβ-endorphin contents in spinal dorsal horn and the expression of Netrin-1(R~2=0.66;R~2=0.51).Conclusion1.Clinical research:Electroacupuncture has a good effect on the improvement of clinical symptoms in patients with lumbar disc herniation.There is a positive correlation between the clinical efficacy of electroacupuncture in the treatment of lumbar disc herniation and the degree of neurological impairment.This suggests that the degree of neurological deficit can provide guidance for evaluating the efficacy of electroacupuncture in the treatment of Lumbar disc herniation,and it is of great significance for patients with lumbar disc herniation to choose a reasonable clinical treatment scheme and evaluate the prognosis.2.Experimental studyElectroacupuncture may induce the up-regulation of Netrin-1expression in dorsal root ganglion by promoting the release of methionine enkephalin andβ-endorphin in spinal dorsal horn,thus inhibiting the growth environment of spinal dorsal horn,there by inhibiting the inward growth of myelinated nerve fibers in intervertebral disc and improving discogenic pain.The specific mechanism is worth further exploration.