电针对骶上脊髓损伤后神经源性膀胱患者尿动力学及NLRP3炎症小体的影响OA

Objective:To investigate the effects of electro-acupuncture(EA)on bladder function in patients with neurogenic bladder following suprasacral spinal cord injury(SCI)and to explore the potential mechanism by which EA modulates the expression of NOD-like receptor family pyrin domain-containing 3(NLRP3).Methods:A total of 40 patients with neurogenic bladder following suprasacral SCI were randomly assigned to the EA group(n=18;2 dropouts)and the sham acupuncture(SA)group(n=19;1 dropout).Both groups received standard medical treatment and conventional rehabilitation therapy.In the EA group,EA was applied at Ciliao(BL32),Zhongji(RN3),and Sanyinjiao(SP6)using a dense-disperse wave at 10/50 Hz,with the stimulation intensity adjusted to each patient's tolerance.In the SA group,sham acupuncture was performed at non-acupoints distant from the therapeutic acupoints,using the same stimulation parameters as those in the EA group.Both groups received 30-minute treatment sessions once daily,6 days per week,for 4 consecutive weeks.Before and after the intervention,voiding diary parameters,including voiding frequency,voided volume per micturition,and episodes of urinary incontinence,were recorded.Urodynamic parameters,including maximum cystometric capacity,storage-phase intravesical pressure,maximum urethral closure pressure,maximum urinary flow rate,and postvoid residual urine volume,were also assessed.In addition,blood samples were collected before and after the treatment to determine the expressions of NLRP3 inflammasome and its downstream inflammatory cytokines of IL-1β and IL-18.Results:Compared with baseline,both the SA group and the EA group showed significant improvements in voiding diary parameters and urodynamic outcomes after the treatment.In addition,the expressions of NLRP3 inflammasome and its downstream inflammatory cytokines of IL-1[3 and IL-18 were significantly reduced in both groups after the treatment(P＜0.05).Compared with the SA group,the EA group demonstrated significantly greater improvements in the above parameters,with statistically significant differences(P＜0.05).Conclusion:EA effectively improves bladder function and alleviates voiding dysfunction in patients with neurogenic bladder following suprasacral SCI.The therapeutic effects may be associated with the modulation of NLRP3 inflammasome and the expression of its downstream inflammatory cytokines.