目的:通过观察电针对骶上脊髓损伤后逼尿肌反射亢进型神经源性膀胱模型大鼠尿流动力学,膀胱逼尿肌组织形态学, 逼尿肌内垂体腺苷酸环化酶激活肽(PACAP)及其受体PAC1R蛋白与mRNA表达及环腺苷酸(cAMP)含量, 从PACAP-cAMP信号通路角度探讨电针治疗骶上脊髓损伤后神经源性膀胱的效应及其生物学机制.方法:雌性SD大鼠72只, 按随机数字表法分为正常组,假手术组各12只, 其余48只用来制备骶上脊髓损伤后神经源性膀胱大鼠模型.造模成功后将其随机分为模型组,电针组及电针+ PACAP6-38组, 每组各12只, 其余造模未成功大鼠用于探索性观察, 实验结束前断颈处死并解剖.电针组对“次髎”“中极”“三阴交”进行电针干预, 电针+ PACAP6-38组电针干预前腹腔脉注射PACAP受体拮抗剂PACAP6-38, 连续7 d, 治疗结束后检查大鼠尿流动力学, 并采用HE染色观察大鼠膀胱逼尿肌组织形态, 取膀胱逼尿肌组织, 采用免疫组化和Western blot 法检测PACAP-38及受体PAC1R的表达, RT-PCR法检测PACAP-38 mRNA及受体PAC1R mRNA表达, ELISA法检测cAMP含量.结果: (1) 与假手术组比较, 模型大鼠膀胱的移行上皮细胞排列紊乱,细胞间隙明显增大,伴有炎性浸润,组织水肿明显, 大鼠膀胱基础压,漏尿点压均高 (P<0.01) , 膀胱最大容量,膀胱顺应性均低 (P<0.01) , 膀胱逼尿肌内PACAP-38和受体PAC1R蛋白及mRNA表达水平均低 (P<0.05) , cAMP含量低 (P<0.05) . (2) 与模型大鼠比较, 电针组逼尿肌组织的炎症反应程度较轻,单核细胞浸润数量少,组织的水肿程度轻, 膀胱平滑肌细胞完整性较强,细胞组织水肿程度较低,炎性细胞浸润较轻,纤维增生程度较轻, 大鼠的膀胱基础压,漏尿点压均低 (P<0.05) , 膀胱最大容量,膀胱顺应性均较高 (P<0.01) , 大鼠膀胱逼尿肌内PACAP-38和受体PAC1R蛋白及mRNA表达水平均较高 (P<0.05) , cAMP含量亦较高 (P<0.05) . (3) 与电针组比较, 电针+ PACAP6-38组逼尿肌组织肌纤维排列层次欠清晰,细胞间隙大,伴有单核细胞浸润,组织水肿明显, 大鼠的膀胱基础压,漏尿点压的改变不明显 (P>0.05) , 膀胱最大容量,膀胱顺应性均较低 (P<0.05) , 膀胱逼尿肌内PACAP-38蛋白及mRNA表达变化不明显 (P>0.05) , 受体PAC1R蛋白及mRNA表达下降 (P<0.05) , 膀胱逼尿肌内cAMP含量降低 (P<0.05) .结论:电针可通过介导PACAP-cAMP信号通路改善骶上脊髓损伤后逼尿肌反射亢进型膀胱的逼尿肌无抑制性收缩状态, 降低逼尿肌的病理损害程度, 改善膀胱的功能. To elucidate the underlying mechanism and effect of electroacupuncture (EA) on the neurogenic bladder following suprasacral spinal cord injury (SSCI). A rat model of detrusor hyperreflexia after SSCI was established to examine the urodynamics, detrusor muscle tissue morphology, the protein and mRNA expression levels of pituitary adenylate cyclase activating peptide (PACAP) and its receptor PAC1R, and cyclic adenosine monophosphate (cAMP) content in the detrusor muscle with a focus on the PACAP-cAMP signaling pathway. A total of 72 female SD rats were randomized into control group and sham operation group (n=12 per group) by using a random number table. The remaining 48 rats were established into the model of detrusor hyperreflexia after SSCI. After successful modeling, these rats were randomly assigned to model, EA, and EA + PACAP6-38 groups (n=12 per group). The unsuccessful modeled rats were used for exploratory observation. For the rats in EA group, “Ciliao (BL32)” “Zhongji (CV3)”, and “Sanyinjiao (SP6)” were needled and stimulated by EA. The PACAP receptor antagonist PACAP6-38 was administered intraperitoneally in the EA + PACAP6-38 group before EA, and EA was applied for seven consecutive days. After treatment, the urodynamics of the rats were analyzed, and hematoxylin and eosin staining was used to examine rat bladder detrusor tissue morphology. The expressions of PACAP-38 and PAC1R were detected by immunohistochemistry and Western blot. The mRNA expression levels of PACAP-38 and PAC1R were examined by RT-PCR, while cAMP content was detected by ELISA. (1) Compared with sham operation group, it was exhibited disarray in the transitional epithelium cells of the bladder in the modeled rats. The intercellular space was significantly widened, accompanied by inflammatory cell infiltration and noticeable tissue edema. Both the bladder initial pressure and leak point pressure of the rats were higher (P < 0.01), whereas the maximum cystometric capacity and bladder compliance were lower (P < 0.01). The protein and mRNA expression levels of PACAP-38 and PAC1R in the detrusor muscle, together with the cAMP content, were lower (P < 0.05). (2) Compared with the model rats, the EA group showed reduced inflammatory response in the detrusor muscle tissue, with decreased monocyte infiltration and less severe tissue edema. The bladder smooth muscle cells exhibited increased integrity, and there was decreased cellular tissue edema, inflammatory cell infiltration, and fibroplasia. The bladder initial pressure and leak point pressure were lower (P < 0.05), while the maximum cystometric capacity and bladder compliance were higher (P < 0.01). The protein and mRNA expression levels of PACAP-38 and PAC1R in the detrusor muscle, along with the cAMP content, were higher (P < 0.05). (3) Compared to the EA group, the EA + PACAP6-38 group showed a less organized arrangement of muscle fibers in the detrusor muscle tissue, larger intercellular space, monocyte infiltration, and considerable tissue edema. The changes in bladder initial pressure and leak point pressure were not significant (P > 0.05), while the maximum cystometric capacity and bladder compliance were lower (P < 0.05). The changes in the protein and mRNA expressions of PACAP-38 within the detrusor muscle were not significant (P > 0.05), whereas the protein and mRNA expressions of PAC1R were reduced (P < 0.05), and the cAMP content within the detrusor muscle was lower (P < 0.05). EA can ameliorate the uninhibited contractile condition of the detrusor muscle in the bladder following SSCI. By mediating the PACAP-cAMP signaling pathway, it reduces the pathological damage to the detrusor muscle, thereby improving bladder function.
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