"治痿独取阳明"调控肌萎缩侧索硬化症家系靶蛋白的经穴效应研究

The reason why acupuncture could play a specific adjustment and therapeutic role in clinical practices lies in the specificity of the acupoint effect, and the specificity theory of the acupoint effect is deemed as the cardinal foundation in guiding clinical practices of acupuncture. The preliminary result of the earlier study named "A Study on Controlling Migraineurs' Gene Expression Profiles by Choosing the Acupoint on the Ailing Meridian" (National Science Foundation) showed that acupoint effect plays a significant role in adjusting genetic transcription. Guided by the classical theory of "treating flaccidity by treating Yang-ming first", the present study will make a research on an amyotrophic lateral sclerosis family, starting with the protein expression of the effective organs treated by Yang-ming. Based on the hypothesis that the information of acupoint effect can be traced in translation level, the study, making use of the technological advantage of protein group to find out all the protein expression in the samples, integrates disciplines including science of acupuncture and moxibustio, macular informatics，bio-informatics and computer science to find out the target protein involved in acupoint effect, hence explore the biochemical pathway of the acupoint effect in translation level. It is hoped that by overall and systematic observation of the related expression of target protein of the patients suffered from familial amyotrophic lateral sclerosis after being acupunctured in Yang-ming, the study could provide reliable experimental evidence for the biological basis of acupoint effect.

针灸能在临床上发挥特异性的调整和治疗作用，其关键在于经穴效应的特异性，而经穴效应的特异性理论是指导针灸临床的重要基础。前期的基础研究（国家自然科学基金）"本经取穴调控偏头痛患者的基因表达谱的研究"初步结果显示经穴效应在基因转录水平有明显的调节作用。基于此，本课题将在"治痿独取阳明"的经典理论指导下，以一个肌萎缩侧索硬化症家系为研究载体，从阳明经穴干预痿症的效应器官的蛋白表达入手，密切围绕"经穴效应的信息在翻译水平有征可寻"的研究假说，利用蛋白质组学研究可以大通量、平行条件下分离和鉴定组织细胞所表达的所有蛋白质的技术优势，整合针灸学、分子信息学、生物信息学、计算机科学等多种技术，整体、系统的观察针刺阳明经穴后，家族性肌萎缩侧索硬化症患者相关蛋白表达情况，拟发现参与经穴效应体现的靶蛋白，探寻经穴效应在翻译水平体现的生化途径，为揭示经穴效应的生物学基础提供切实可靠的实验依据。

本实验是以一个完整的二代同在的肌萎缩侧索硬化症家系为天然疾病研究载体，在蛋白表达层面探讨“治痿独取阳明”治则体现的经穴效应。共有4例患病者，5例未患病者，5例正常者，全部完成试验，治疗前后共获得28份蛋白质组学数据，所有受试者针刺经穴为：肩髃、合谷、曲池、伏兔、足三里、解溪。三组均留针30分钟，留针过程中每10分钟行针1次，共行针2次。每日1次，10日为一个疗程，连续3个疗程，疗程间休息2天。观察指标包括各组治疗前后受试者骨间肌的蛋白表达谱；患病组4例治疗前后ALSFRS-R量表、ALSAQ-40量表、改良Norris评分量表积分变化情况。 .整个临床试验过程中，病例分组均衡，基线状况良好，可比性强，在性别、年龄、病变性质、严重程度等方面，三组均无统计学意义（P﹥0.05） ,研究结果发现：（1）经穴效应的特异性在蛋白水平具有明显的靶向性。（2）“治痿独取阳明”治疗家族性肌萎缩侧索硬化症（FALS）患者的效应机制是通过调控某种蛋白的表达来体现的。（3）在蛋白质表达方面发现了8种蛋白与家族性肌萎缩侧索硬化症高度相关。6种蛋白可能与家族性肌萎缩侧索硬化症相关。（4）针刺阳明经穴对FALS具有较好的近期临床疗效，可延缓疾病发展、维持患者稳定生活质量和运动功能。