Correlation Between The Curative Effect Of Electroacupuncture On LDH And MRI Score And The Mechanism Of Inhibiting Inward Growth Of Myelinated Nerve Fibers

Objective1.To study the correlation between the clinical efficacy of electroacupuncture in the treatment of LDH and the MRI score of the responsible lesions,so as to provide accurate basis for the clinical diagnosis,treatment and prognosis evaluation of LDH.2.To clarify the key role of netrin-1 in electroacupuncture in inhibiting the inward growth of myelinated nerve fibers in degenerative intervertebral discs,and to elucidate the possible mechanism of electroacupuncture in the treatment of lumbar intervertebral disc degenerative diseases.Methods1.Clinical research: Sixty patients with LDH who met the requirements were included in the clinical study.The symptoms and signs of the patients before treatment were scored according to the Oswestry Disability Index(ODI)formed in 1980,and the MRI imaging data of the patients’ responsible lesions were collected to evaluate the MRI scores.After 2 courses of EA treatment,the ODI score of the patients after treatment was carried out to calculate the treatment improvement index and improvement rate.Finally,the correlation between ODI improvement index,improvement rate and MRI score was analyzed.2.Experiment research:(1)To study the effect of EA on the expression of DRG Netrin-1 in rabbits with degenerative lumbar intervertebral discs: the experimental rabbits were divided into 5 groups: normal group,model group,sham model group,model+EA group,model+sham EA group,each group were 4 rabbits.After the treatment in each group,the compression device was removed,and the Kirschner wire was pulled out,and the L4-5 intervertebral disc MRI scan was performed.After that,the corresponding DRG for the intervertebral disc were taken out and detected by WB to test Netrin-1 expression in corresponding DRG.(2)To study the effect of up-regulation and down-regulation of DRG netrin-1 expression on EA inhibition of inward growth of myelinated nerve fibers in degenerative intervertebral discs: After the successful up-regulation and down-regulation of Netrin-1 detected by WB,the disc degeneration model and EA treatment were performed.After the treatment,the corresponding DRG for the intervertebral disc were sacrificed and the effect of EA was observed by HE staining.The effect of DRG nerve fiber growth in rabbit degenerated lumbar intervertebral disc model is observed and studied from both positive and negative aspects to determine whether Netrin-1 participates in the effect of EA in inhibiting the inward growth of myelinated nerve fibers in the intervertebral disc.Results1.Clinical research: According to statistical analysis,the ODI improvement rate of patients with LDH treated by EA is correlated with the MRI score,showing a highly positive linear relationship(r=0.830);the ODI improvement index is correlated with the MRI score,showing a highly negative linear relationship(r=-0.848).2.Experiment research: WB results:(1)In the DRG of the corresponding segment of the intervertebral disc undergoing pressure-induced degeneration in the model group,compared with the normal group and the sham model group,the protein content of Netrin-1 in model group decreased,and the expression decreased(P<0.05);Compared with the model group and the model+EA group,EA can up-regulate the expression levels of Netrin-1 protein in 28days(P<0.05),but there was no up-regulated Netrin-1 expression in the sham EA group(P<0.05).(2)There was no significant difference in the expression of Netrin-1 between the control group and the Scr group(NS);Compared with the control group,the expression of Netrin-1 in the OV group was significantly increased(P<0.05),and the sh Netrin-1 group was inhibited(P<0.05).HE staining results:Compared with the normal group,the model group and the model+Scr carrier group showed that the nucleus shrinkage accompanied by deviation,cytoplasmic edema,morphological enlargement,axon extinction,myelin sheath decomposition,nerve fiber arrangement disorder;Compared with model group,the disorder degree of nerve fibers in model+EA group was reduced;Compared with the model group,there was no obvious cell edema in the model upregulated Netrin-1 group and the nerve fiber arrangement is relatively neat,while compared with the model+EA group,the morphology and histology are not significantly different;In model+downregulated netrin-1+EA group,compared with model+EA group,the nuclei were significantly shrunk,nuclear center was shifted to the periphery,chromatin dissolved around the nuclei,axon died out,myelin sheath decomposed,nerve fibers were arranged disorderly,and satellite cells were aggregated.Conclusion1.Clinical research: The ODI improvement rate and improvement index of LDH patients treated with EA showed a high positive correlation and a high negative correlation with the MRI score of the responsible lesions,respectively.The higher the MRI score of the lesion,the lighter the MRI performance,which may indicate the better clinical efficacy of EA therapy,while the smaller the fluctuation of the efficacy improvement index,the more stable the efficacy of EA therapy.2.Experiment research: EA can up-regulate the expression of netrin-1 protein and inhibit the inward growth of myelinated nerve fibers in intervertebral discs;The expression of DRG netrin-1 was up-regulated by myelin sheath injection,which could simulate the effect of EA and inhibit the inward growth of myelinated nerve fibers;Downregulation of DRG netrin-1 expression can reverse the effect of EA to inhibit the inward growth of myelinated nerve fibers in degenerative intervertebral discs.The key role of netrin-1 in inhibiting the inward growth of myelinated nerve fibers by EA is illustrated from both positive and negative aspects.