反复电针对慢性痛的累加治疗作用及其机制研究

本研究从基础和临床两方面观察了反复电针对慢性痛的累加治疗作用,并结合疼痛患者及慢性痛动物模型中几种神经肽的放射免疫测定及相应受体拮抗剂的药理学研究结果,探讨了产生累加效应的可能机制。结果表明,在临床脊髓损伤性痉挛患者,１００Ｈｚ穴位体表电刺激有效地缓解痉挛并有累加效应;在临床慢性痛患者,２／１５Ｈｚ变频ＴＥＮＳ刺激有效地治疗疼痛并具有累加效应。在关节炎模型大鼠,电针刺激能产生明显的镇痛并具有累加效     

DREAM是痛觉调制中重要的转录抑制子

慢性痛的治疗是医学上一大难题。深入了解痛觉过程的机理才能推动其治疗。实验表明一种转录抑制子ＤＲＥＡＭ参与痛觉的调制。ｄｒｅａｍ- /- 小鼠在急性热刺激、机械刺激和内脏痛模型中反应明显减弱。ｄｒｅａｍ- /- 小鼠在慢性神经性痛和炎症痛中也表现出痛阈下降。然而 ,ｄｒｅａｍ- /- 小鼠在运动能力或学习记忆方面并没有受到损害。在ＤＲＥＡＭ缺乏小鼠的脊髓中强啡肽原ｍＲＮＡ和强啡肽Ａ的水平都增加 ,实验还表明ｄｒｅａｍ- /- 小鼠的痛阈下降是由强啡肽选择性激活ｋａｐｐａ阿片受体所介导的。因此 ,ＤＲＥＡＭ被认为是痛觉过程中…     

电针镇痛时人脑脊液中β-内啡肽样免疫活性物质的含量与痛阈的关系

用β-内啡肽放射免疫分析法测定10例无疼痛主诉的患者电针前后侧脑室脑脊液中B-内啡肽样免疫活性物质(B-EPIS)的含量,其中6例用弹簧棒测定了痛阈和耐痛阈。结果表明,每 ml 脑脊液中β-EPIS 的含量比针前增加126.7 fmol/ml(P<0.02),病人的痛阈比针前升高29.5%,耐痛阈升高28.1%(P<0.05)。β-EPIS 含量的增加量与痛阈、耐痛阈的升高值呈直线相关,r_1=0.776,r_2=0.741(P<0.05)。表明电针能促使脑内释放β-内啡肽,释放增加的β-内啡肽参与镇痛作用,这可能是电针镇痛机制的重要环节之一。     

氟氏佐剂诱导大鼠慢性前列腺炎疼痛模型中L5-S2脊髓中枢小胶质细胞的活化

目的:观察大鼠慢性前列腺炎疼痛模型中L5-S2脊段背角小胶质细胞活化的变化.方法:通过前列腺完全弗氏佐剂注射制作大鼠慢性前列腺炎疼痛模型,对照组注射生理盐水,观察时间为0、4、12、24d,用热辐射痛阈测定法和前列腺病理进行疼痛模型鉴定,采用实时荧光定量RT-PCR检测L5-S2脊段后角中小胶质细胞标志物IBA-1的表达.结果:成功建立慢性前列腺炎疼痛大鼠模型,并观察到L5-S2脊髓背角中存在小胶质细胞的活化.结论:慢性前列腺炎疼痛可以引起L5-S2脊髓中枢小胶质细胞活化,小胶质细胞异常活化可引起神经炎性疼痛,有可能与慢性前列腺炎疼痛的持续和泛化有密切关系.     

阿片肽及有关因素在脊髓损伤中的作用

本文主要述及:(1)脊髓损伤后局部组织中的强啡肽含量升高,免疫活性增强,κ受体结合力也增强。纳洛酮可明显减轻脊髓外伤造成的后果,促进神经功能的恢复;(2)预先给予κ受体特异性拮抗剂nor-BNI可显著减轻鞘内给予强啡肽A(1—17)所致的损伤;缺乏阿片样活性的强啡肽A(2—17)致脊髓损伤的剂量大于强啡肽A(1—17),且其效应不为nor-BNI所拮抗;(3)预先给予抗强啡肽A的抗血清,显著改善脊髓外伤的程度,促进功能恢复;(4)预先给予强啡肽可加重脊髓外伤,κ-受体拮抗剂可减轻之;(5)NMDA受体和Ca~(2+)在强啡肽致脊髓损伤中可能起着重要作用。以上资料说明强啡肽在脊髓损伤中有重要作用。     

甲醛炎性痛及痛过敏诱导大鼠脊髓后角环氧化酶-2表达的变化

目的:观察甲醛炎性痛及痛过敏过程中脊髓后角环氧化酶-2 (COX-2)表达的变化及其时间特征.方法:采用大鼠甲醛疼痛模型,用免疫组化法观察脊髓COX-2表达的变化.结果:与对照组相比,注射甲醛后4 h,1 d及3 d组脊髓后角Ⅰ-Ⅵ板层COX-2免疫反应阳性细胞的数目及染色深度均显著增加,以1 d组增加最为明显.结论:脊髓后角COX-2参与甲醛炎性痛及痛过敏.     

cAMP反应元件结合蛋白介导磷酸化细胞外信号调节激酶在神经病理性痛形成中的作用

采用行为学、免疫组织化学和Western blot方法,观察鞘内注射细胞外信号调节激酶(extracellular signal-regulate kinase,ERK)信号转导通路阻滞剂对慢性压迫性损伤(chronic constriction injury,CCI)大鼠痛行为及脊髓背角内磷酸化cAMP反应元件结合蛋白(phosphorylated cAMP response-element binding protein,pCREB)和Fos表达变化的影响,探讨ERK／CREB转导通路在神经病理性疼痛中的作用。结果表明,CCI可明显增加双侧脊髓背角pCREB、损伤侧脊髓背角浅层Fos阳性神经元表达,以CCI后3与5d时尤为显著。鞘内沣射促分裂原活化蛋白激酶激酶(mitogen-activated protein kinase kinase,MEK)阻滞剂U0126及ERK反义寡核苷酸在减轻大鼠痛行为的同时,能明显抑制双侧脊髓背角内pCREB的表达,同时,Fos阳性神经元的表达也明显减少。大鼠痛行为及脊髓背角pCREB和Fos的表达在时相上一致。上述结果提示pCREB参与pERK介导的神经病理性疼痛。     

脊髓细胞外调节激酶1/2在大鼠后足切割痛中的表达和作用

目的：探讨大鼠后足切割后脊髓ERK的表达情况。方法：以大鼠右后足切割作为急性疼痛模型;用免疫组织化学法测试脊髓磷酸化ERK（pERK）表达情况。ERK抑制剂U0126（1μg）在切割前20min或切割后20min鞘内注射。用von Frey纤维测试大鼠机械性痛敏。结果：大鼠后足切割后1min,在切割侧L4-L5脊髓浅层背侧角（板层Ⅰ和板层Ⅱ）ERK被迅速地激活,并在5min达到峰值,随后恢复到基础值。切割前鞘内给予U0126能显著减轻机械性痛敏,然而,切割后鞘内给予U0126对机械性痛敏的作用并不明显。结论：脊髓ERK在大鼠后足切割痛中产生机械性痛敏发挥了重要的作用。     

结核性脑膜脑炎并结核性脊髓炎的2例临床分析

目的：总结结核性脑膜脑炎并结核性脊髓炎的临床特点、治疗方法及预后。方法：对2例结核性脑膜脑炎并结核性脊髓炎患者的临床资料、实验室检查、影像学资料、组织病理学、治疗方法及预后进行分析。结果：2例患者均有头痛、颅神经麻痹、脑膜刺激征、双下肢乏力、感觉障碍;脑脊液中蛋白明显升高;MRI检查显示有脑膜强化、颅内强化灶及相应节段脊髓肿胀;全身抗痨联合鞘内注射异烟肼和地塞米松治疗有效。结论：结核性脑膜脑炎患者如出现脊髓受损表现或脑脊液蛋白明显增高,而腰穿压力正常或降低等应考虑合并结核性脊髓炎的可能性。早期全身抗痨联合鞘内给药疗效确切。     

大鼠侧脑室注射精氨酸加压素对针刺镇痛的影响

以钾离子透入法引起大鼠甩尾反应为指标,测定动物的痛阈。由侧脑室注射精氮酸加压素(AVP)后,大鼠痛阈升高33.6％～68.5％,针刺镇痛效应明显加强,痛阈提高202.4％～302.7％。脑室注射抗精氨酸加压素血清,动物痛阈虽无明显变化,但针刺镇痛效应明显削弱,痛阈仅增加41.6％～71.0％。注射抗β-内啡肽血清和抗强啡肽A血清并不阻断AVP增强针刺镇痛效应。本工作的结果提示,脑内AVP参与针刺镇痛,这种作用与脑内内源性β-内啡肽和强啡肽的关系不甚密切。     

Investigation on cerebrospinal fluid opioids and neurotransmitters related to spinal cord stimulation

The purpose of this study was to assess the biochemical mechanisms underlying spinal cord stimulation (SCS). Seventeen patients with chronic pain were investigated by measuring cerebrospinal fluid concentrations of endogenous opioids and biogenic amines before and during dorsal column stimulation. Basal cerebrospinal fluid beta-endorphin levels were below the normal range. No significant change of norepinephrine, epinephrine, dopamine, beta-endorphin, beta-lipotropin, or adrenocorticotropic hormone levels were found after SCS. A 50% increase of cerebrospinal beta-endorphin and beta-lipotropin levels occurred in 6 out of 16 patients, namely those where SCS gave the major pain relief. These data confirm the derangement of the endogenous opioid system in chronic pain conditions and suggest that the beta-endorphin response to SCS could have clinical value in predicting the success of treatment.     

Substance P and Acute Pain in Patients Undergoing Orthopedic Surgery

Objective

There is a limited information about the role of Substance P (SP) in acute pain nociception following surgical stimulation in patients with a chronic inflammatory state not to mention the link between this neuropeptide level changes and intensity of pain. The goal of the research was to find the correlation between SP level changes and acute pain intensity in patients with rheumatoid arthritis undergoing elective orthopedic surgery.

Material and Methods

Patients with rheumatoid arthritis (RA) were enrolled in the study. The correlation between acute pain intensity and concentration of SP in serum as well as in drainage fluid from postoperative wound was assessed in patients with RA who underwent Total Knee Replacement (TKA) under spinal anesthesia.

Results

In patients with RA a correlation between intensity of acute pain and serum SP was found postoperatively, whereas there was no correlation between intensity of acute pain and concentration of SP in drainage fluid.

Conclusions

1. The correlation between acute pain intensity and SP serum concentration was found postoperatively in patients with RA. 2. The correlation between acute pain intensity and SP concentration in drainage fluid was not found postoperatively in patients with RA.     

Opioid receptor blockade in rat nucleus tractus solitarius alters amygdala dynorphin gene expression

It has been suggested that an opioidergic feeding pathway exists between the nucleus of the solitary tract (NTS) and the central nucleus of the amygdala. We studied the following three groups of rats: 1) artificial cerebrospinal fluid (CSF) infused in the NTS, 2) naltrexone (100 microg/day) infused for 13 days in the NTS, and 3) artificial CSF infused in the NTS of rats pair fed to the naltrexone-infused group. Naltrexone administration resulted in a decrease in body weight and food intake. Also, naltrexone infusion increased dynorphin, but not enkephalin, gene expression in the amygdala, independent of the naltrexone-induced reduction in food intake. Gene expression of neuropeptide Y in the arcuate nucleus and neuropeptide Y peptide levels in the paraventricular nucleus did not change because of naltrexone infusion. However, naltrexone induced an increase in serum leptin compared with pair-fed controls. Thus chronic administration of naltrexone in the NTS increased dynorphin gene expression in the amygdala, further supporting an opioidergic feeding pathway between these two brain sites.     

γ-Aminobutyric Acid Concentration in Cerebrospinal Fluid in Schizophrenia

Abstract: γ-Aminobutyric acid (GABA) concentration was determined in cerebrospinal fluid (CSF) of acute and chronic schizophrenic patients, in persons with psycho-organic or personality disorders, and in nonpsychiatric controls. The mean CSF GABA level in the chronic schizophrenic patients was found to be significantly higher than in any of the other groups. No other statistically significant differences were found. Statistical analysis revealed that the elevated CSF GABA concentration in the chronic schizophrenic patients was unlikely to be caused by medication. These results are interpreted as evidence for possible primary or secondary GABAergic overactivity in the brain in chronic schizophrenia.     

Studies of specificity and inhibition of human cerebrospinal fluid dynorphin converting enzyme.

Dynorphin-converting activity was recently discovered in human cerebrospinal fluid. This enzyme (hCSF-DCE) cleaves dynorphin A, dynorphin B and alpha-neoendorphin to release Leu-enkephalin-Arg6. To characterize the enzyme further we used several protease inhibitors, including N-peptidyl-O-acyl hydroxylamines which are known to act as potent irreversible inhibitors of serine and cysteine proteinases. No irreversible inactivation occurred but strong, reversible effects on the dynorphin-converting activity by some of the inhibitors tested could be observed. Although, hCSF-DCE binds its substrates (dynorphin A and B) in the microM-mM concentration range, it exhibits high specificity in recognizing and cleaving the linkage between the two basic amino acids in the substrate sequence.     

Region-specific bioconversion of dynorphin neuropeptide detected by in situ histochemistry and MALDI imaging mass spectrometry

Brain region-specific expression of proteolytic enzymes can control the biological activity of endogenous neuropeptides and has recently been targeted for the development of novel drugs, for neuropathic pain, cancer, and Parkinson’s disease. Rapid and sensitive analytical methods to profile modulators of enzymatic activity are important for finding effective inhibitors with high therapeutic value.Combination of in situ enzyme histochemistry with MALDI imaging mass spectrometry allowed developing a highly sensitive method for analysis of brain-area specific neuropeptide conversion of synthetic and endogenous neuropeptides, and for selection of peptidase inhibitors that differentially target conversion enzymes at specific anatomical sites. Conversion and degradation products of Dynorphin B as model neuropeptide and effects of peptidase inhibitors applied to native brain tissue sections were analyzed at different brain locations. Synthetic dynorphin B (2 pmol) was found to be converted to the N-terminal fragments on brain sections whereas fewer C-terminal fragments were detected. N-ethylmaleimide (NEM), a non-selective inhibitor of cysteine peptidases, almost completely blocked the conversion of dynorphin B to dynorphin B(1–6; Leu-Enk-Arg), (1–9), (2–13), and (7–13). Proteinase inhibitor cocktail, and also incubation with acetic acid displayed similar results.Bioconversion of synthetic dynorphin B was region-specific producing dynorphin B(1–7) in the cortex and dynorphin B (2–13) in the striatum. Enzyme inhibitors showed region- and enzyme-specific inhibition of dynorphin bioconversion. Both phosphoramidon (inhibitor of the known dynorphin converting enzyme neprilysin) and opiorphin (inhibitor of neprilysin and aminopeptidase N) blocked cortical bioconversion to dynorphin B(1–7), wheras only opiorphin blocked striatal bioconversion to dynorphin B(2–13).This method may impact the development of novel therapies with aim to strengthen the effects of endogenous neuropeptides under pathological conditions such as chronic pain. Combining histochemistry and MALDI imaging MS is a powerful and sensitive tool for the study of inhibition of enzyme activity directly in native tissue sections.     

Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.

OBJECTIVE: To review the effectiveness and safety of topical non-steroidal anti-inflammatory drugs in acute and chronic pain conditions. DESIGN: Quantitative systematic review of randomised controlled trials. DATA SOURCES: 86 trials involving 10,160 patients. MAIN OUTCOME MEASURES: Measures of treatment success approximating at least 50% reduction in pain, local and systemic adverse effects. Analysis at 1 week for acute and 2 weeks for chronic conditions with relative benefit and number needed to treat. RESULTS: In acute pain conditions (soft tissue trauma, strains, and sprains) placebo controlled trials had a relative benefit of 1.7 (1.5 to 1.9), the number needed to treat was 3.9 (3.4 to 4.4). With analysis by drug (at least three trials), ketoprofen (number needed to treat 2.6), felbinac (3.0), ibuprofen (3.5), and piroxicam (4.2) had significant efficacy. Benzydamine and indomethacin were no different from placebo. In chronic pain conditions (osteoarthritis, tendinitis) placebo controlled trials had a relative benefit of 2.0 (1.5 to 2.7); the number needed to treat was 3.1 (2.7 to 3.8). Small trials (< 40 treated patients) exaggerated effectiveness of topical non-steroidals by 33% in acute conditions but not in chronic conditions. There was no relation between trial quality and treatment effect. In both acute and chronic pain local and systemic adverse events and withdrawal from the study related to the drug had a low incidence and were no different from placebo. CONCLUSION: Topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.     

慢性腹痛患儿C~(13)-尿素呼气试验与胃镜检查的临床意义

目的了解慢性腹痛患儿幽门螺杆菌(H.pylori)的感染状态及幽门螺杆菌感染患儿内镜下表现的特点。方法应用C13尿素呼气试验,对905例以慢性腹痛为主要症状的患儿进行检测,对C13呼气试验阳性者进行电子胃镜检查。结果905例慢性腹痛患儿中H.pylori呈阳性185例(20.44%),随年龄增长,其H.pylori阳性率升高,学年组已达高峰。对H.pylori阳性者进行胃镜检查结果显示十二指肠隆起病变47例占25.40%,结节性胃炎41例占22.1%,慢性浅表性`胃炎38例占20.5%,结节性胃炎伴十二指肠隆起病变23例占12.43%,十二指肠球部溃疡23例占12.4%。胃溃疡7例,占3.7%(其中包括1例复合性溃疡),结节性胃炎伴十二指肠炎6例,占3.2%。结论H.pylori感染为小儿慢性腹痛的主要原因之一,也是导致慢性胃炎及消化性溃疡的主要原因之一。C13尿素呼气试验方便,快速,无痛苦,无放射性,是一较好的H.pylori检测方法;对既有消化道症状同时C13呼气试验阳性者进行胃镜检查能够协助临床诊断及治疗。     

Little change in cerebrospinal fluid amino acids in subtypes of multiple sclerosis compared with acute polyradiculoneuropathy.

Levels of free amino acids were determined in randomised, blinded samples of cerebrospinal fluid (CSF) from patients with relapsing-remitting or chronic progressive multiple sclerosis (MS), all in the active phase of disease. The levels were compared with amino acid amounts in patients with an acute polyradiculoneuropathy (Guillain-Barré syndrome (GBS)) and a control population of patients with no known neurological disease or deficit. The data did not indicate any significant changes in amino acid levels between MS subgroups. The only significant differences between MS patients and controls were a modest reduction in glutamate and a slight increase in taurine, but the changes were so small that the biological relevance is dubious. These results contrasted with the marked increases for many amino acids in CSF from patients with acute polyradiculoneuropathy compared with controls. The amino acid profile in cerebrospinal fluid (CSF) does not appear to provide evidence of differential pathology in multiple sclerosis (MS). The increase in hydrophobic amino acids and lysine in CSF from patients with acute polyradiculoneuropathy is consistent with transudation over the blood-CSF barrier following an infection. The increases in glutamine and alanine may reflect increased nitrogen removal from brain.