| ObjectiveTo observe the efficacy and safety of electroacupuncture at ’sacral four points’ in the treatment of NB after SCI,so as to provide a safer and more effective treatment scheme for clinic.Through experimental research,we observed the expression of TRPV1 and p2x2/p2x3 in the DRG and bladder tissue of rats with electroacupuncture at ’sacral four points’ in treating neurogenic bladder after spinal cord injury,and discussed the mechanism of electroacupuncture at ’sacral four points’ in the treatment of NB after SCI.MethodsClinical research:60 patients with neurogenic bladder after spinal cord injury were randomly divided into control group and experimental group with 30 cases in each group.The patients in the control group were treated with intermittent catheterization and bladder training for 4 weeks.On the basis of the treatment of the control group,the patients in the experimental group were treated with electroacupuncture at ’sacral four points’,which were bilateral BL49 and BL35,connected with electroacupuncture for 60min,using continuous wave,frequency of 2Hz,pulse width of 0.2ms,output intensity to the patient’s comfort,once a day,5 days a week,for 4 weeks.We observed the differences of micturition function,urodynamic indexes,quality of life score and lower urinary tract symptoms score(LUTS)between the two groups before and after treatment,and evaluated the safety.Experimental research:Healthy SPF male SD rats were randomly divided into sham operation group,model group and electroacupuncture group,with 8 rats in each group,a total of 24 rats.Rats in model group and electroacupuncture group were injured T10 spinal cord by modified Allen’s method to prepare neurogenic bladder model after spinal cord injury.After modeling,the sham operation group did not receive any intervention and was fed routinely.The model group was not given any intervention,routine postoperative nursing and feeding.On the basis of routine postoperative nursing and feeding,the electroacupuncture group began electroacupuncture treatment one day after the operation,needle at BL49 and BL35,connected with electroacupuncture for 30min,using continuous wave,frequency of 2Hz,pulse width of 0.2ms,output intensity measured by the regular contraction of both hind limbs,once a day,for 14 days.The scores of Basso,Beattie and Bresnahan locomotor rating scale(BBB),urodynamic indexes and morphological changes of bladder tissue were observed.The mRNA and protein expression of TRPV1 and P2X2/P2X3 in the DRG and bladder tissue were detected by Western blot(WB)and real-time fluorescent quantitative polymerase chain reaction(PCR).ResultsClinical research:There was no significant difference between the two groups at urination times,urination volume and catheterization times in urination diary before treatment(all P>0.05);Compared with before treatment,the times of urination and catheterization in the urination diary of the control group and the experimental group after treatment were significantly reduced,and the difference was statistically significant(P<0.01);Compared with the control group,the times of urination and catheterization of the experimental group after treatment were significantly reduced,and the difference was statistically significant(P<0.01);Compared with before treatment,the urination volume in the urination diary of the control group and the experimental group increased significantly after treatment,and the difference was statistically significant(P<0.01);Compared with the control group,the urination volume of the experimental group increased significantly after treatment,and the difference was statistically significant(P<0.01);There was no significant difference at maximum bladder volume,maximum urinary flow rate,maximum detrusor systolic pressure and residual urine volume in urodynamics between the two groups before treatment(P>0.05).Compared with before treatment,the maximum bladder volume of urodynamics in the control group and the experimental group decreased significantly after treatment,and the difference was statistically significant(P<0.05,P<0.01).Compared with the control group,the maximum bladder volume in the experimental group decreased significantly after treatment,and the difference was statistically significant(P<0.01).Compared with before treatment,the maximum flow rate and the maximum detrusor systolic pressure in the control group had no significant change after treatment,and the difference was not statistically significant(P>0.05),while the maximum flow rate and the maximum detrusor systolic pressure in the experimental group increased significantly after treatment,and the difference was statistically significant(P<0.01).Compared with the control group,the maximum flow rate and the maximum detrusor systolic pressure in the experimental group increased significantly after treatment,and the difference was statistically significant(P<0.01).Compared with before treatment,the urodynamic residual urine volume in the control group and the experimental group decreased significantly after treatment,and the difference was statistically significant(P<0.01).Compared with the control group,the urodynamic residual urine volume in the experimental group decreased significantly after treatment,and the difference was statistically significant(P<0.01).There was no significant difference in the quality of life score between the two groups before treatment(P>0.05).Compared with before treatment,the quality of life score of the control group had no significant change after treatment,and the difference was not statistically significant(P>0.05).The quality of life score of the experimental group decreased significantly after treatment,and the difference was statistically significant(P<0.01).Compared with the control group,the score of quality of life in the experimental group decreased significantly after treatment,and the difference was statistically significant(P<0.05).There was no significant difference in LUTS scores between the two groups before treatment(P>0.05).Compared with before treatment,the LUTS score of the control group and the experimental group decreased significantly after treatment,and the difference was statistically significant(P<0.01).Compared with the control group,the LUTS score of the experimental group decreased significantly after treatment,and the difference was statistically significant(P<0.01).After treatment,the significant efficiency,effective rate,ineffective rate and total effective rate of the control group were 10.3%,72.4%,17.3%and 82.7%respectively;In the experimental group,the cure rate was 7.1%,the effective rate was 28.6%,the effective rate was 60.7%,the ineffective rate was 3.6%,and the total effective rate was 96.4%.The total effective rate of the experimental group was higher than that of the control group,and the difference between the two groups was statistically significant(P<0.05).Experimental research:There was no significant difference in BBB scores among the three groups before modeling(P>0.05);Compared with before modeling.except for the sham operation group,the BBB score of rats in the other two groups decreased significantly after modeling(P<0.01).Compared with after modeling,the BBB score of rats in the electroacupuncture group increased significantly(P<0.01),and the BBB score of rats in the model group also increased significantly(P<0.01);After treatment,the BBB score of rats in the electroacupuncture group was significantly higher than that in the model group(P<0.01).Compared with the sham operation group,the model group and electroacupuncture group had significantly higher he maximal urodynamic bladder volume,leakage point pressure and bladder compliance(P<0.01);Compared with the model group,the maximal urodynamic bladder volume,leak point pressure and bladder compliance in the electroacupuncture group were significantly reduced(P<0.01).The results of light microscope showed that in the sham operation group,many folds were formed on the cavity surface of the bladder tissue of the rats.The bladder wall was composed of mucosa,muscular layer and adventitia,and the rest were connective tissue,and no obvious pathological changes were found.In the model group,the bladder tissue was edematous,the morphology of the mucosal cells was damaged,the mucosal transition epithelium was necrotic and exfoliated,a few epithelial cells were loose and lightly stained,the lamina propria was infiltrated by neutrophils,and the structure of muscular layer and adventitia was clear without obvious abnormalities.In the electroacupuncture group,no obvious edema was found in the bladder tissue,and the morphology of mucosal cells was basically normal.A small amount of mucosal transformation and watery degeneration of epithelial cells were visible.Congestion was occasionally seen in the lamina propria,and the structure of muscular layer and adventitia was clear without obvious abnormalities.Compared with the sham operation group,the mRNA and protein expression of TRPV1 and P2X2/P2X3 in DRG and bladder tissue of the model group decreased significantly(P<0.01),and the mRNA and protein expression of TRPV1 and P2X2/P2X3 in DRG and bladder tissue of the electroacupuncture group increased significantly(P<0.01,P<0.05)compared with the model group.ConclusionElectroacupuncture at ’sacral four points’ can effectively improve micturition function and reduce urinary retention in patients with neurogenic bladder after spinal cord injury,and has a definite clinical effect.Electroacupuncture at ’sacral four points’ can objectively improve the urodynamic indexes,reduce lower urinary tract symptoms and improve the quality of life for the patients.Electroacupuncture treatment has good safety and is worthy of further clinical application.Electroacupuncture at ’sacral four points’ can significantly improve the motor function of the hind limbs of rats with spinal cord injury,significantly reduce the maximum bladder volume,leak point pressure and bladder compliance of rats with neurogenic bladder after spinal cord injury,and improve the bladder morphology of the rats.The mechanism of electroacupuncture at ’sacral four points’ in the treatment of neurogenic bladder after spinal cord injury may be related to regulating TRPV1/P2X pathway,improving the excitability of bladder sensory nerve and activating micturition reflex. |
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