EphrinB2在肌筋膜扳机点的作用机制研究

发布时间：2018-04-10 11:43

本文选题：肌筋膜扳机点 + 注射　；参考：《山东大学》2015年硕士论文

【摘要】：背景及目的：肌筋膜疼痛综合征是一种以存在肌筋膜扳机点为特征的局部肌肉疼痛综合征,严重影响了患者的生活质量,其病理生理机制尚不清楚。本研究通过活检获取扳机点组织,旨在研究斜方肌扳机点组织的病理形态学改变并探讨ephrinB2在肌筋膜扳机点中的作用机制,观察斜方肌扳机点活检复合注射疗法治疗肌筋膜疼痛综合征的疗效是否优于单纯注射治疗疗法。从而为寻找新的有效的治疗肌筋膜疼痛综合征的方法奠定基础。方法：1,临床研究：选择肌筋膜疼痛综合征患者60例,随机分为扳机点活检复合镇痛液注射治疗组(BI组)和单纯镇痛液注射治疗组(IT组),每组30例。BI组患者行扳机点活检,活检组织置于4%多聚甲醛液中备用,并于活检处行镇痛液注射疗法；IT组患者仅于扳机点处行镇痛液注射治疗。评定患者治疗前和治疗后即刻、7、14、21及28天疼痛视觉模拟评分,治疗后3个月的临床有效率以及和治疗有关的不良反应。2,基础研究：以无肌筋膜疼痛综合征的手术患者斜方肌组织作为正常对照组(Control组),上述扳机点活检组织为活检组(Biopsy组),各30例。组织标本行组织切片,HE染色和MASSON染色观察其组织病理学改变。免疫组织化学方法检测ephrinB2蛋白的表达,原位杂交技术检测ephrinB2 mRNA的表达。结果：1,临床研究：与治疗前比较,两组治疗28天内VAS评分均降低(P0.05)。两组间比较,治疗后28天BI组VAS评分低于IT组(P0.05)。治疗三个月后BI组有效率高于IT组(P0.05)。2,基础研究：Biopsy组中肌肉细胞形态不规则,与Control组肌肉相比较,坏死细胞、中央核细胞、膨大肌细胞、未分类细胞和再生细胞数目均增加(P均0.05),部分肌细胞出现异常收缩结节,组织深染,而在异常收缩结节增厚部以外的肌纤维变细。与Control组比较,Biopsy组中ephrinB2蛋白阳性细胞数目增加(P0.05),主要位于细胞膜或胞浆中,且于再生肌细胞和异常收缩结节中着色较深。Biopsy组中部分肌纤维中ephrinB2 mRNA显色较深,主要位于细胞浆中。与Control组相比,Biopsy组中ephrinB2 mRNA染色阳性细胞数目增加(P0.05)。结论：1,扳机点活检复合注射疗法是治疗肌筋膜疼痛综合征有效的方法,且长期疗效优于单纯注射疗法,但是活检本身毕竟是一种有创的方法,如要运用的话尚需要进一步的临床研究。2, EphrinB2可能通过直接刺激扳机点处伤害性感受器产生疼痛感觉,参与扳机点处组织肌细胞的再生并与异常收缩结节的形成有关。
[Abstract]:Background and objective: myofascial pain syndrome is a kind of local muscle pain syndrome characterized by the existence of myofascial trigger, which has seriously affected the quality of life of patients, and its pathophysiological mechanism remains unclear.The aim of this study was to study the pathomorphological changes of trapezius trigger tissue and to explore the mechanism of ephrinB2 in myofascial trigger.To observe the efficacy of trapezius trigger point biopsy combined with injection therapy in the treatment of myofascial pain syndrome.So as to find a new and effective treatment of myofascial pain syndrome.Methods: one, clinical study: 60 patients with myofascial pain syndrome were randomly divided into two groups: trigger point biopsy combined with analgesic fluid injection group (BI group) and simple analgesic fluid injection group (IT group).The biopsy tissue was placed in 4% paraformaldehyde solution and the patients in IT group were treated with analgesic fluid injection only at the trigger point.The visual analogue scores of pain were evaluated before and immediately after treatment.Clinical efficacy 3 months after treatment and adverse reactions related to treatment. Basic study: trapezius muscle tissue of patients without myofascial pain syndrome was used as control group.Biopsy group, 30 cases each.Histopathological changes were observed by HE staining and MASSON staining.The expression of ephrinB2 protein was detected by immunohistochemistry and the expression of ephrinB2 mRNA was detected by in situ hybridization.Results 1. Clinical study: compared with before treatment, the VAS scores of the two groups decreased within 28 days after treatment (P 0.05).The VAS score in BI group was lower than that in IT group 28 days after treatment (P 0.05).After 3 months treatment, the effective rate of BI group was higher than that of IT group (P 0.05). The basic study showed that muscle cells in the group of two groups were irregular in shape. Compared with Control group, necrotic cells, central nucleus cells, and enlarged muscle cells were found in BI group.The number of unclassified cells and regenerated cells increased by 0.05%, and some of the myocytes showed abnormal contractile nodules and deep staining of tissues, while the muscle fibers outside the thickening part of abnormal contractile nodules became thinner.Compared with Control group, the number of ephrinB2 protein positive cells in Biopsy group was increased (P 0.05), mainly located in cell membrane or cytoplasm, and in regenerated muscle cells and abnormal contractile nodule. The ephrinB2 mRNA in some muscle fibers in Biopsy group was deeper than that in Control group, mainly in the cytoplasm.Compared with Control group, the number of ephrinB2 mRNA positive cells was increased in Biopsy group (P 0.05).If further clinical research is needed, EphrinB2 may be involved in the regeneration of muscle cells and the formation of abnormal contractile nodules by directly stimulating the nociceptive receptors at the trigger point.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R686.3

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