低能量雷射治療應用於背根神經節壓迫損傷之效應

Efficacy of Low Level Laser Therapy on Chronic Compression of Dorsal Root Ganglion

陳怡媜(Yi-Jen Chen)

指導教授 ： 郭柏麟

共同指導教授 ： 陳嘉炘(Chia-Hsin Chen)

高雄醫學大學/醫學院/臨床醫學研究所/碩士(2013年)

摘要

研究背景：下背痛是臨床很常見的問題，常因為椎間盤疾患導致椎間神經孔狹窄，背根神經節受到壓迫，引起神經根疼痛的症狀，導致活動上的限制。本研究欲探討低能量雷射治療對於背根神經節壓迫的治療效應。
研究方法：將36隻大鼠分成實驗組和對照組。實驗組的大鼠接受背根神經節壓迫手術後，分成沒有雷射治療以及8J/cm2低能量雷射治療兩組。於4天和8天後評估大鼠對於溫痛刺激的閾值。於第8天將大鼠犧牲後，取出受壓迫背根神經節收取RNA，測量TNF-α、IL-1β和GAP43的mRNA表現量。以免疫組織化學染色法比較實驗組和對照組TNF-α以及GAP43的染色結果。
研究結果：背根神經節壓迫會增加發炎物質的表現量。接受低能量雷射治療的大鼠，對於溫痛刺激的閾值均有增加，亦即對於痛覺的忍受度有顯著改善。背根神經節細胞的TNF-α和IL-1β mRNA表現量在雷射治療後有顯著下降。免疫組織化學染色分析雷射治療後TNF-α染色有顯著下降，GAP43染色有顯著增加。
結論：低能量雷射治療能減少背根神經節發炎反應物質的表現量，促進損傷神經之修復，也可改善因疼痛所造成的活動異常。臨床常見的腰椎疾患，如椎間盤突出、椎間孔狹窄等導致背根神經節壓迫所造成的臨床症狀，可藉由低能量雷射治療使症狀緩解。

關鍵字

背根神經節 ； 低能量雷射 ； 發炎物質 ； 神經修復

並列摘要

Background: The dorsal root ganglia (DRG) are vulnerable to physical injuries within the intervertebral foramen. Chronic compression over the dorsal root ganglia (CCD) results in nerve root damage, causing unrelenting morbidity. The purpose of this study was to evaluate the effect of low level laser therapy (LLLT) application over the DRG in a CCD model.
Methods: Thirty six adult Sprague–Dawley rats were divided into the sham control without CCD and experimental groups with CCD. The CCD rats were subjected to 0J/cm2 or 8J/cm2 of LLLT for consecutive 4 and 8 days. The pain and heat stimuli were used to reflect the condition of hyperalgesia. Messenger RNA (mRNA) expression of TNF-α and IL-1β, and growth-associated protein-43 (GAP-43) were measured by real time PCR. The protein expressions of TNF-α and GAP-43 were further determined by immunohistochemistry analysis.
Results: The LLLT significantly improved the tolerable sensitivity of pain and heat stimuli in CCD groups. The proinflammatory cytokine expressions of TNF-α and IL-1β were generated after CCD, but significantly reduced by LLLT application. Moreover, the expression of neuro-regenerative gene, GAP-43, was increased after LLLT.
Conclusion: The LLLT could facilitate neural regeneration in rats after the CCD and promote the rat ambulatory behavior. The therapeutic effects of LLLT on the DRG in the CCD may be exerted through the suppression of inflammatory reaction and induction of nerve repair-associated gene. Common clinical disorders, such as vertebral injury, intervertebral disc herniation or intervertebral foramen stenosis, resulting from the damaged DRG might benefit from LLLT.

並列關鍵字

Dorsal root ganglia ； Low level laser therapy ； Inflammatory cytokines ； Neural regeneration

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