目的:探究脊髓减压联合电针对急性上颈段重度脊髓压迫损伤大鼠的治疗效果和可能的作用机制.方法:SPF级Wistar大鼠30只随机分为5组(对照组A、B,实验组C、D、E),每组6只,采用经寰枕间隙置入球囊导管加压造成脊髓压迫损伤的方法构建脊髓损伤模型.A组无任何干预,空白对照,B组置入球囊导管后不加压,做假手术对照,C、D、E组加压48 h后松球囊脊髓减压,C组取百会、大椎穴进行电针干预,连续波,频率2 Hz,治疗时间15 min,持续治疗14d,D组于大鼠尾静脉注射甲强龙进行甲强龙冲击治疗,E组不再行任何治疗干预.14d后5组大鼠全部行腹主动脉取血和脊髓损伤组织取材,采用BBB评分法对5组大鼠的运动功能进行评价,ELISA法检测损伤组织及血清中血小板活化因子(platelet-activating factor,PAF)的含量,Western blot法检测损伤组织中Caspase-9的表达.结果:BBB评分:对照组A、B在实验组压迫后1、48 h,实验组治疗后24 h,3、7、14 d等6个时间点上均为(21.000±0.000)分,实验组评分始终低于对照组,C、D组评分显著高于E组(P＜0.05),C、D组评分相近(P＞0.05).ELISA法测PAF结果显示:A、B、D、E组血清中PAF浓度相近(P＞0.05),C组血清中PAF浓度较其余4组低(P＜0.05),A、B组组织中PAF浓度结果相近(P＞0.05),C组组织中PAF浓度较A、B组高(P＜0.05),D组组织中PAF浓度较A、B、C组高(P＜0.05),E组组织中PAF浓度较其余4组高(P＜0.05);Western blot法检测结果显示:A、B组Caspase-9的表达量相近(P＞0.05),C组表达较A、B组高(P＜0.05),D组表达量较A、B、C组高(P＜0.05),E组表达较A、B、C、D组高(P＜0.05).结论:脊髓减压联合电针治疗急性上颈段重度脊髓压迫损伤较脊髓减压联合甲强龙和单纯脊髓减压效果更佳,其作用机制可能与降低脊髓损伤组织中PAF的含量与下调其Caspase-9蛋白的表达有关.%Objective:To explore the effect and underlying mechanism of decompression (DE)combined with Governor Vessel (GV)electro-acupuncture (EA) on rats with acute severe upper cervical spinal cord compression injury.Methods:Thirty SPF rats were randomly divided into 5 groups (control group A,B and experiment group C,D,E),6 rats in each group.The model of acute severe upper cervical spinal cord compression injury were made by forcing a balloon catheter put in atlas pillow clearance.The group A was blank one,the group B put balloon catheter in atlas pillow clearance without forcing,and the group C,D,E sustained compressed for 48 h.The group C received electric acupuncture intervention,selecting the Baihui and Dazhui point,having the continuous wave and frequency of 2 Hz,with the treatment time of 15 min and continuous treatment for 14 d;the group D received methylprednisolone intervention,injected by caudal vein;the group E did not received any intervention again.The arterial blood and injured spinal cord tissue of all the rats were obtained after 14 days' treatment,and BBB score was used to evaluate the change of each group hind limbs motor function,the contents of platelet activating factor (PAF) in injured spinal cord tissue and blood serum were assess by ELISA method;the Caspase-9 expression for each group after 14 days' treatment was assess by Western blot method.Results:BBB scores were (21.000±0.000) points at the 6 time points,that was,1 h,48 h after forcing in control group,24 h,3 d,7 d,14 d after treating in experiment group;the score of experimental groups (group C,D,E) were always lower than control groups (group A,B);compared with group E,group C and D were significantly higher(P＜0.05);and there was no significant difference between group C and group D (P＞0.05).The results of PAF by ELISA method to measure:the concentration of serum PAF,there was no statistical difference among group A,B,D,E (P＞0.05),group C was lower than the other groups (P＜0.05);the concentration of tissue PAF,there was no significant difference between group A and group B (P＞0.05),group D was significantly higher than that of group A,B,and C (P＜0.05),group E was the highest one than that of the other groups (P＜0.05).Western blot med tests showed that the Caspase-9 protein expression in group A and B was similar (P＞0.05),group C was higher than that of group A and B(P＜0.05),group D was higher than group A,B and C (P＜0.05),group E was the highest than that of group A,B,C and D (P＜0.05).Conclusion:Decompression and Governor Vessel electro-acupuncture on acute severe upper cervical spinal cord compression injury had a better effect compare with decompression and methylprednisolone or simple decompression only,its mechanism may be related to lower the PAF levels and downregulating Caspase-9 protein expression in spinal injury tissue.
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