【摘要】 目的 探究早期推拿对坐骨神经损伤（SNI）模型大鼠腓肠肌肌肉状态及Myod、Myog、Mef2c表达的影响。方法 将30只SPF级雄性SD大鼠随机分为假手术组、模型组和推拿O、T、F组，每组各6只。假手术组仅暴露右侧坐骨神经，不做夹持；模型组和推拿组建立坐骨神经夹持损伤模型。推拿O组在造模后第1天开始干预，总共干预7次；推拿T组在造模后第3天开始干预，总共干预5次；推拿F组在造模后第5天开始干预，总共干预3次。干预方法为每天以4 N的按摩力度，揉、拨、点法刺激大鼠术侧阳陵泉、殷门、委中穴，每法每穴1 min，每天1次。上述手法采用按摩推拿手法模拟仪进行操作。假手术组和模型组每天抓取，不作推拿干预。使用MyotonPRO数字化肌肉功能评估系统评估患侧腓肠肌振动频率（F）、对数衰减值（D）及动态刚度（S）3个生物机械力学特性参数；HE染色观察患侧腓肠肌肌纤维的形态学变化；Real-Time PCR法检测Myod mRNA、Myog mRNA、Mef2c mRNA表达水平；Western blotting法检测腓肠肌中Myod、Myog蛋白表达。结果 治疗后，与假手术组相比，模型组、推拿F组的动态频率、对数衰减、动态刚度及推拿T组的动态刚度升高，差异具有统计学意义（P <0.05）；与模型组相比，推拿O、T组振动频率、对数衰减、动态刚度及推拿F组动态刚度降低，差异具有统计学意义（P <0.05）。HE染色显示，假手术组大鼠患侧腓肠肌肌纤维排列致密、紧实、有序，模型组肌纤维紊乱、松散，部分组织断裂，炎细胞浸润；推拿组O、T组肌纤维排列等状态均接近假手术组，推拿F组肌纤维排列相对有序，存在部分组织断裂。PCR结果显示，与假手术组相比，模型组和推拿各组Myod mRNA、Myog mRNA、Mef2c mRNA表达升高，差异具有统计学意义（P <0.05）；与模型组相比，推拿各组Myod mRNA、Myog mRNA、Mef2c mRNA表达升高，且推拿O组高于推拿T组，推拿T组高于推拿F组，差异具有统计学意义（P <0.05）。Western blotting结果显示：与假手术相比，模型组和推拿各组Myod、Myog蛋白表达升高，差异具有统计学意义（P <0.05）；与模型组相比，推拿各组Myod、Myog蛋白表达升高，且推拿O组高于推拿T组，推拿T组高于推拿F组，差异具有统计学意义（P <0.05）。结论 早期推拿能够有效改善腓肠肌肌肉状态，预防肌肉萎缩，其作用机制可能通过改善腓肠肌中Myod、Myog、Mef2c的蛋白和基因表达实现。更多还原

【Abstract】 Objective:To explore the effects of early Tuina on the muscle condition of the gastrocnemius and the expression of Myod,Myog,and Mef2c in a rat model of sciatic nerve injury(SNI). Methods:30 SPF-grade male SD rats were randomly divided into:sham group(n = 6),model group(n = 6),Tuina O group(n = 6),Tuina T group(n = 6),and Tuina F group(n = 6). The sham group had the right sciatic nerve exposed without clamping;the model group and Tuina groups established the sciatic nerve clamping injury model. The Tuina O group received intervention from the first day after modeling,with a total of seven sessions;the Tuina T group received intervention from the third day after modeling,with a total of five sessions;the Tuina F group received intervention from the fifth day after modeling,with a total of three sessions. The intervention involved massaging the ipsilateral Yanglingquan,Yinmen,and Weizhong acupoints with 4 N of force using rubbing,pinching,and pressing techniques,for1 minute per acupoint,once daily. These manipulations were performed using a Tuina manipulation simulator. The sham and model groups were handled daily without Tuina intervention. The MyotonPRO system was used to assess three biomechanical properties of the gastrocnemius muscle:vibration frequency(F),logarithmic decrement(D),and dynamic stiffness(S). HE staining was performed to observe morphological changes in the muscle fibers of the gastrocnemius muscle;Real-Time PCR was used to detect the expression levels of Myod mRNA,Myog mRNA,and Mef2c mRNA;and Western blotting analysis was used to detect the expression of Myod and Myog proteins in the gastrocnemius muscle. Results:After treatment,compared with the sham group,the model group and Tuina F group showed significant increases in dynamic frequency,logarithmic decrement,and dynamic stiffness,while the Tuina T group showed a significant increase in dynamic stiffness(P < 0.05). Compared with the Model group,the Tuina O and T groups showed significant decreases in vibration frequency,logarithmic decrement,and dynamic stiffness,while the Tuina F group showed a significant decrease in dynamic stiffness(P < 0.05). HE staining showed that the muscle fibers in the gastrocnemius muscle of the Sham group were densely and orderly arranged,while the model group showed disordered and loose muscle fibers,with some tissue rupture and inflammatory cell infiltration. The muscle fibers in the Tuina O and T groups were nearly as orderly arranged as those in the sham group,while the Tuina F group showed relatively orderly muscle fibers with some tissue rupture. PCR results indicated that the expression of Myod m RNA,Myog mRNA,and Mef2c m RNA in the Model and all Tuina groups was significantly increased compared to the sham group(P < 0.05). Compared with the Model group,the expression of Myod mRNA,Myog mRNA,and Mef2c m RNA was significantly increased in all Tuina groups,with the Tuina O group showing higher levels than the Tuina T group,and the Tuina T group showing higher levels than the Tuina F group(P < 0.05). Western blotting analysis showed that the expression of Myod and Myog proteins was significantly increased in the model and all Tuina groups compared with the sham group(P < 0.05). Compared with the model group,the expression of Myod and Myog proteins was significantly increased in all Tuina groups,with the Tuina O group showing higher levels than the Tuina T group,and the Tuina T group showing higher levels than the Tuina F group(P < 0.05). Conclusion:Early Tuina can effectively improve the muscle condition of the gastrocnemius muscle and prevent muscle atrophy,possibly through the enhancement of Myod,Myog,and Mef2c protein and gene expression in the gastrocnemius muscle.更多还原