Lv Taotao, Mo Yanjun, Yu Tianyuan, Zhang Yumo, Shao Shuai, Luo Yuting, Shen Yi, Lu Mengqian, Wong Steven Gregory
School of Acupuncture, Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
Evid Based Complement Alternat Med. 2020 Jul 17;2020:5859298. doi: 10.1155/2020/5859298. eCollection 2020.
To explore the effect of tuina on the gene expression at the point of nerve injury in rats with sciatic nerve injury (SNI) and to elucidate the repair mechanism of tuina promoting the functional recovery of peripheral nerve injury.
In the Sham group, the right sciatic nerve was exposed without clamping. The SNI model was established using the sciatic nerve clamp method on the right leg and then randomly divided into the SNI group and the Tuina group. Seven days after modeling, the Tuina group was treated daily with a "massage and tuina manipulation simulator" (Patent No. ZL 2007 0187403.1), which was used daily to stimulate Yinmen (BL37), Yanglingquan (GB34), and Chengshan (BL57) with point-pressing method, plucking method, and kneading method. The stimulating force was 4N, and the stimulating frequency was 60 times per minute; each method and each point were used for 1 minute, totaling 9 minutes (1 min/acupoint/method × 3 methods × 3 acupoints). Treatment was administered for 21 days, followed by a 1-day rest after the 10th treatment, for a total of 20 times of intervention. The sciatic function index (SFI) was used to evaluate the fine movements of the hind limbs of rats in each group. The ultrastructural changes at the point of nerve injury were observed by transmission electron microscopy, and the gene changes at the point of nerve injury were detected using RNA-sequencing (RNA-seq) technology.
Compared with the baseline, the SFI of the SNI group and the Tuina group decreased significantly at the 0th intervention (7 days after molding); compared with the SNI group, the SFI of the Tuina group increased at the 10th intervention ( < 0.05) and increased significantly at the 15th and 20th intervention ( < 0.01). Compared with the Sham group, the myelin sheath integrity of the sciatic nerve in the SNI group was destroyed and the myelin sheath collapsed seriously, even forming myelin sheath ball, accompanied with severe axonal atrophy and mitochondrial degeneration. The tuina intervention could significantly improve the ultrastructure of the nerve injury point, and the nerve fiber myelin sheath in the Tuina group remained intact, without obvious axonal swelling or atrophy. Atrophic thread granules could be seen in the axon, but there were no vacuolated mitochondria. RNA-seq results showed that there were differences at 221 genes at the point of nerve injury between the Tuina group and the SNI group and the differentially expressed genes (DEGs) are enriched in the biological processes related to the regulation of myocyte. Regulations include the regulation of striated muscle cell differentiation, myoblast differentiation, and myotube differentiation.
Tuina can improve the fine motor recovery and protect the myelin integrity in rats with peripheral nerve injury, and this is achieved by changing the gene sequence at the injured point.
探讨推拿对坐骨神经损伤（SNI）大鼠神经损伤部位基因表达的影响，阐明推拿促进周围神经损伤功能恢复的修复机制。
假手术组仅暴露右侧坐骨神经，不进行夹闭。采用坐骨神经夹闭法建立右侧SNI模型，然后随机分为SNI组和推拿组。造模7天后，推拿组每日使用“按摩推拿手法模拟器”（专利号：ZL 2007 0187403.1），采用点按法、拨法、揉法每日刺激殷门（BL37）、阳陵泉（GB34）、承山（BL57）。刺激力度为4N，刺激频率为每分钟60次；每种手法、每个穴位各操作1分钟，共9分钟（1分钟/穴位/手法×3种手法×3个穴位）。治疗21天，第10次治疗后休息1天，共干预20次。采用坐骨神经功能指数（SFI）评估各组大鼠后肢的精细运动。通过透射电子显微镜观察神经损伤部位的超微结构变化，采用RNA测序（RNA-seq）技术检测神经损伤部位的基因变化。
与基线相比，SNI组和推拿组在第0次干预（造模7天后）时SFI显著下降；与SNI组相比，推拿组在第10次干预时SFI升高（P<0.05），在第15次和20次干预时显著升高（P<0.01）。与假手术组相比，SNI组坐骨神经髓鞘完整性破坏，髓鞘严重塌陷，甚至形成髓鞘球，伴有严重的轴突萎缩和线粒体变性。推拿干预可显著改善神经损伤部位的超微结构，推拿组神经纤维髓鞘完整，无明显轴突肿胀或萎缩。轴突内可见萎缩的丝状颗粒，但线粒体无空泡化。RNA-seq结果显示，推拿组与SNI组神经损伤部位有221个基因存在差异表达，差异表达基因（DEGs）富集于与心肌调节相关的生物学过程。调节包括横纹肌细胞分化、成肌细胞分化和肌管分化的调节。
推拿可改善周围神经损伤大鼠的精细运动恢复并保护髓鞘完整性，这是通过改变损伤部位的基因序列实现的。
