中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
2014年
11期
823-827
,共5页
神经病理性疼痛%重复经颅磁刺激%疼痛测定%痛阈%一氧化氮合酶
神經病理性疼痛%重複經顱磁刺激%疼痛測定%痛閾%一氧化氮閤酶
신경병이성동통%중복경로자자격%동통측정%통역%일양화담합매
Neuropathic pain%Repetitive transcranial magnetic stimulation%Pain measurement%Pain threshold%Neuronal nitric oxide synthase
目的 观察不同频率的重复经颅磁刺激(rTMS)治疗神经病理性疼痛的疗效,同时通过测定神经病理性疼痛大鼠背根神经节(DRG)内神经型一氧化氮合酶(nNOS)的表达,探讨rTMS治疗神经病理性疼痛的作用机制.方法 共28只雄性SD大鼠,随机分为假手术组和手术组,假手术组7只大鼠仅暴露和游离坐骨神经,不予结扎;手术组21只大鼠经手术结扎坐骨神经制作神经病理性疼痛模型,造模成功后又随机分为假治疗组、低频rTMS组(1 Hz)、高频rTMS组(20 Hz),每组7只.术后第3天开始进行rTMS治疗,连续10d,刺激疼痛对侧大脑初级运动皮质(M1).治疗前及治疗10d后,对大鼠疼痛行为学表现及DRG内nNOS表达进行测量比较.结果 造模后第3天,手术组大鼠均出现明显的疼痛行为学表现,机械痛缩爪阈值较假手术组均明显降低(P＜0.05).rTMS治疗后,高频rTMS组机械痛缩爪阈值较假治疗组升高(P＜0.05),而低频rTMS组无明显变化.与假手术组比较,假治疗组和低频rTMS组损伤侧DRG内nNOS阳性表达明显增加,且主要位于中、小细胞,少量表达于大细胞.与假治疗组比较,高频rTMS组DRG内nNOS阳性表达显著下调(P＜0.05),而低频rTMS组无此改变.高频rTMS组大鼠疼痛改善程度与相应水平DRG内nNOS的表达呈负相关关系.结论 外周神经损伤后引起的神经病理性疼痛伴有DRG内nNOS的表达增加;高频rTMS可以通过降低DRG内nNOS的表达而缓解疼痛,低频rTMS则无明显效果.
目的 觀察不同頻率的重複經顱磁刺激(rTMS)治療神經病理性疼痛的療效,同時通過測定神經病理性疼痛大鼠揹根神經節(DRG)內神經型一氧化氮閤酶(nNOS)的錶達,探討rTMS治療神經病理性疼痛的作用機製.方法 共28隻雄性SD大鼠,隨機分為假手術組和手術組,假手術組7隻大鼠僅暴露和遊離坐骨神經,不予結扎;手術組21隻大鼠經手術結扎坐骨神經製作神經病理性疼痛模型,造模成功後又隨機分為假治療組、低頻rTMS組(1 Hz)、高頻rTMS組(20 Hz),每組7隻.術後第3天開始進行rTMS治療,連續10d,刺激疼痛對側大腦初級運動皮質(M1).治療前及治療10d後,對大鼠疼痛行為學錶現及DRG內nNOS錶達進行測量比較.結果 造模後第3天,手術組大鼠均齣現明顯的疼痛行為學錶現,機械痛縮爪閾值較假手術組均明顯降低(P＜0.05).rTMS治療後,高頻rTMS組機械痛縮爪閾值較假治療組升高(P＜0.05),而低頻rTMS組無明顯變化.與假手術組比較,假治療組和低頻rTMS組損傷側DRG內nNOS暘性錶達明顯增加,且主要位于中、小細胞,少量錶達于大細胞.與假治療組比較,高頻rTMS組DRG內nNOS暘性錶達顯著下調(P＜0.05),而低頻rTMS組無此改變.高頻rTMS組大鼠疼痛改善程度與相應水平DRG內nNOS的錶達呈負相關關繫.結論 外週神經損傷後引起的神經病理性疼痛伴有DRG內nNOS的錶達增加;高頻rTMS可以通過降低DRG內nNOS的錶達而緩解疼痛,低頻rTMS則無明顯效果.
목적 관찰불동빈솔적중복경로자자격(rTMS)치료신경병이성동통적료효,동시통과측정신경병이성동통대서배근신경절(DRG)내신경형일양화담합매(nNOS)적표체,탐토rTMS치료신경병이성동통적작용궤제.방법 공28지웅성SD대서,수궤분위가수술조화수술조,가수술조7지대서부폭로화유리좌골신경,불여결찰;수술조21지대서경수술결찰좌골신경제작신경병이성동통모형,조모성공후우수궤분위가치료조、저빈rTMS조(1 Hz)、고빈rTMS조(20 Hz),매조7지.술후제3천개시진행rTMS치료,련속10d,자격동통대측대뇌초급운동피질(M1).치료전급치료10d후,대대서동통행위학표현급DRG내nNOS표체진행측량비교.결과 조모후제3천,수술조대서균출현명현적동통행위학표현,궤계통축조역치교가수술조균명현강저(P＜0.05).rTMS치료후,고빈rTMS조궤계통축조역치교가치료조승고(P＜0.05),이저빈rTMS조무명현변화.여가수술조비교,가치료조화저빈rTMS조손상측DRG내nNOS양성표체명현증가,차주요위우중、소세포,소량표체우대세포.여가치료조비교,고빈rTMS조DRG내nNOS양성표체현저하조(P＜0.05),이저빈rTMS조무차개변.고빈rTMS조대서동통개선정도여상응수평DRG내nNOS적표체정부상관관계.결론 외주신경손상후인기적신경병이성동통반유DRG내nNOS적표체증가;고빈rTMS가이통과강저DRG내nNOS적표체이완해동통,저빈rTMS칙무명현효과.
Objective In order to explore the mechanism of repetitive transcranial magnetic stimulation rTMS) on neuropathic pain,we observed the effect of different frequencies of rTMS on neuropathic pain and the expression of neuronal nitric oxide synthase (nNOS) in the dorsal root ganglion (DRG).Methods A total of 28 male Sprague-Dawley rats were used and divided into a control group,in which sham-operation was performed,and an experimental group which was further divided into a sham-rTMS group,a 1 Hz group and a 20 Hz group after successful neuropathic pain model was established by operation to ligate the left sciatic nerves,with 7 rats in each group.Three days after the operation,rTMS was applied to the primary motor cortex (M1) contralateral to the pain once dai ly for 10 consecutive days.The pain behavior and nNOS expression in the DRG were measured before and after 10 days of rTMS intervention.Results All the neuropathic pain model rats demonstrated pain-related behaviors 3 days postoperation,the mechanical pain thresholds were significantly lower than those in the control group (P ＜ 0.05).After rTMS treatment,the mechanical hyperalgsia was significantly relieved in 20 Hz group but not 1 Hz group as demonstrated by a comparison with the sham-rTMS group (P ＜ 0.05).The expression of nNOS in DRG ipsilateral to the neuropathic pain was significantly increased in sham-rTMS group and 1 Hz group (P ＜ 0.05) when compared with the control group.Meanwhile,it was shown that expression of nNOS was down-regulated in 20 Hz group but not 1 Hz group (P ＜ 0.05).The degree of pain relief in 20 Hz group was negatively correlated with the expression of nNOS in DRG (P ＜0.05).Conclusions Neuropathic pain induced by peripheral nerve injury is associated with elevated expression of nNOS in the DRG.High-frequency rTMS can relieve neuropathic pain through down-regulating the overexpression of nNOS in the DRG,but the low-frequency rTMS has no such effect.
