针灸治疗椎间盘源性腰痛的机制研究进展
Research Progress on the Mechanism of Acupuncture in the Treatment of Discogenic Low Back Pain
DOI: 10.12677/tcm.2025.147462, PDF,   
作者: 刘曼晔*：成都中医药大学针灸推拿学院，四川 成都；李德华#：成都中医药大学针灸推拿学院，四川 成都；成都中医药大学附属医院针灸科，四川 成都
关键词: 针灸；椎间盘源性腰痛；生物力学；炎症；神经敏化；Acupuncture； Discogenic Low Back Pain； Biomechanics； Inflammation； Neural Sensitization
摘要: 椎间盘源性腰痛(Discogenic Low Back Pain, DLBP)是慢性腰痛的主要类型之一，其发病机制复杂，涉及生物力学异常、炎症及免疫反应、神经敏化与异常神经再生等多个方面。近年来，针灸作为一种安全有效的非药物治疗方法，在DLBP的临床干预中展现出显著疗效，并逐步得到现代科学研究的证实。本研究综述了DLBP的发病机制，并探讨了针灸治疗DLBP的作用机制及其研究进展，以期为DLBP的临床诊疗和机制研究提供新的思路。
Abstract: Discogenic Low Back Pain (DLBP) is one of the most common types of chronic low back pain, with a complex pathogenesis involving biomechanical abnormalities, inflammation and immune responses, neural sensitization, and aberrant nerve regeneration. In recent years, acupuncture has emerged as a safe and effective non-pharmacological treatment for DLBP, demonstrating significant clinical efficacy and gaining increasing support from modern scientific research. This study reviews the pathogenesis of DLBP and explores the mechanisms of acupuncture in the treatment of DLBP and its research progress, aiming to provide new insights into both the clinical diagnosis and treatment and mechanistic research of DLBP.
文章引用：刘曼晔, 李德华. 针灸治疗椎间盘源性腰痛的机制研究进展[J]. 中医学, 2025, 14(7): 3135-3140. https://doi.org/10.12677/tcm.2025.147462

参考文献

[1] (2020) Global Burden of 369 Diseases and Injuries in 204 Countries and Territories, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019. The Lancet, 396, 1204-1222.
[2] (2023) Global, Regional, and National Burden of Low Back Pain, 1990-2020, Its Attributable Risk Factors, and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5, e316-e329.
[3] Peng, B. (2013) Pathophysiology, Diagnosis, and Treatment of Discogenic Low Back Pain. World Journal of Orthopedics, 4, 42-52. [Google Scholar] [CrossRef] [PubMed]
[4] Kim, G., Kim, D., Moon, H., Yoon, D., Lee, S., Ko, S., et al. (2022) Acupuncture and Acupoints for Low Back Pain: Systematic Review and Meta-Analysis. The American Journal of Chinese Medicine, 51, 223-247. [Google Scholar] [CrossRef] [PubMed]
[5] Baroncini, A., Maffulli, N., Eschweiler, J., Molsberger, F., Klimuch, A. and Migliorini, F. (2022) Acupuncture in Chronic Aspecific Low Back Pain: A Bayesian Network Meta-Analysis. Journal of Orthopaedic Surgery and Research, 17, Article No. 319. [Google Scholar] [CrossRef] [PubMed]
[6] Park, W.M., McCall, I.W., O’Brien, J.P. and Webb, J.K. (1979) Fissuring of the Posterior Annulus Fibrosus in the Lumbar Spine. The British Journal of Radiology, 52, 382-387. [Google Scholar] [CrossRef] [PubMed]
[7] Newell, N., Little, J., Christou, A., Adams, M., Adam, C. and Masouros, S. (2017) Biomechanics of the Human Intervertebral Disc: A Review of Testing Techniques and Results. Journal of the Mechanical Behavior of Biomedical Materials, 69, 420-434. [Google Scholar] [CrossRef] [PubMed]
[8] Song, C., Liu, F., Wu, X., Zhou, D., Mei, Y., Yang, C., et al. (2025) Molecular Mechanism of Macrophage Polarization Regulating the Cell Senescence of Nucleus Pulposus during Intervertebral Disc Degeneration. International Immunopharmacology, 149, Article ID: 114131. [Google Scholar] [CrossRef] [PubMed]
[9] Jacobsen, H.E., Khan, A.N., Levine, M.E., Filippi, C.G. and Chahine, N.O. (2020) Severity of Intervertebral Disc Herniation Regulates Cytokine and Chemokine Levels in Patients with Chronic Radicular Back Pain. Osteoarthritis and Cartilage, 28, 1341-1350. [Google Scholar] [CrossRef] [PubMed]
[10] Haro, H., Kato, T., Komori, H., Osada, M. and Shinomiya, K. (2002) Vascular Endothelial Growth Factor (VEGF)‐Induced Angiogenesis in Herniated Disc Resorption. Journal of Orthopaedic Research, 20, 409-415. [Google Scholar] [CrossRef] [PubMed]
[11] Wang, L., He, T., Liu, J., Tai, J., Wang, B., Zhang, L., et al. (2021) Revealing the Immune Infiltration Landscape and Identifying Diagnostic Biomarkers for Lumbar Disc Herniation. Frontiers in Immunology, 12, Article ID: 666355. [Google Scholar] [CrossRef] [PubMed]
[12] Yu, P., Mao, F., Chen, J., Ma, X., Dai, Y., Liu, G., et al. (2022) Characteristics and Mechanisms of Resorption in Lumbar Disc Herniation. Arthritis Research & Therapy, 24, Article No. 205. [Google Scholar] [CrossRef] [PubMed]
[13] Djuric, N., Lafeber, G.C.M. and Vleggeert-Lankamp, C.L.A. (2019) The Contradictory Effect of Macrophage-Related Cytokine Expression in Lumbar Disc Herniations: A Systematic Review. European Spine Journal, 29, 1649-1659. [Google Scholar] [CrossRef] [PubMed]
[14] Peng, Y., Chen, X., Rao, Z., Wu, W., Zuo, H., Chen, K., et al. (2023) Multifunctional Annulus Fibrosus Matrix Prevents Disc-Related Pain via Inhibiting Neuroinflammation and Sensitization. Acta Biomaterialia, 170, 288-302. [Google Scholar] [CrossRef] [PubMed]
[15] Wang, D., Gao, Q., Schaefer, I., Moerz, H., Hoheisel, U., Rohr, K., et al. (2022) TRPM3-Mediated Dynamic Mitochondrial Activity in Nerve Growth Factor-Induced Latent Sensitization of Chronic Low Back Pain. Pain, 163, e1115-e1128. [Google Scholar] [CrossRef] [PubMed]
[16] Chang, W., Jenkins, L.C., Humburg, P. and Schabrun, S.M. (2023) Human Assumed Central Sensitization in People with Acute Non‐Specific Low Back Pain: A Cross‐Sectional Study of the Association with Brain‐Derived Neurotrophic Factor, Clinical, Psychological and Demographic Factors. European Journal of Pain, 27, 530-545. [Google Scholar] [CrossRef] [PubMed]
[17] Mohd Isa, I.L., Teoh, S.L., Mohd Nor, N.H. and Mokhtar, S.A. (2022) Discogenic Low Back Pain: Anatomy, Pathophysiology and Treatments of Intervertebral Disc Degeneration. International Journal of Molecular Sciences, 24, Article No. 208. [Google Scholar] [CrossRef] [PubMed]
[18] 王雷生, 杨勇. 经膀胱经腧穴透刺关节突关节温针灸治疗腰椎关节突关节源性腰痛的临床研究[J]. 中医正骨, 2018, 30(5): 6-9+19.
[19] 俞晓杰, 张琳, 陆文誉, 等. 电针结合骶裂孔注射对腰椎间盘突出症患者功能康复的影响[J]. 针刺研究, 2021, 46(7): 605-609.
[20] 吕莹, 戴德纯, 姜慧娜, 等. 电针对腰椎间盘突出症患者多裂肌特性的影响[J]. 中国针灸, 2022, 42(10): 1103-1107.
[21] 刘高峰, 钟伟兴, 黄小力, 等. 针灸治疗腰椎间盘突出症的基础研究概况[J]. 海南医科大学学报, 2025, 31(10): 793-800.
[22] 曾密, 缑磊, 廖业昌, 等. 针灸联合腰背肌康复训练在腰椎间盘突出症患者中的应用及对腰椎活动度的影响[J]. 世界复合医学(中英文), 2025, 11(3): 133-137.
[23] 王国峰. 乔氏手法联合电针治疗LDH非急性期的临床疗效及影像学分析[D]: [硕士学位论文]. 长沙: 湖南中医药大学, 2023.
[24] 徐玉琴, 程建华, 李爱君. 温针灸联合整脊手法治疗老年腰椎间盘突出症效果及对炎症因子和ET-1、PGE2、β-EP水平的影响[J]. 中国老年学杂志, 2024, 44(22): 5480-5483.
[25] Zhang, L., Xie, W., Zhang, J., Shanahan, H., Tonello, R., Lee, S.H., et al. (2021) Key Role of CCR2-Expressing Macrophages in a Mouse Model of Low Back Pain and Radiculopathy. Brain, Behavior, and Immunity, 91, 556-567. [Google Scholar] [CrossRef] [PubMed]
[26] 王宜栋. 电针治疗对腰椎间盘突出症患者血清炎症因子和血浆血栓素B2水平的影响[J]. 中外医学研究, 2024, 22(15): 139-141.
[27] 王树东, 张寒, 关红阳, 等. 针刺对腰椎间盘突出症大鼠脊髓和下丘脑中P物质及其受体表达的影响[J]. 中华中医药杂志, 2021, 36(5): 2530-2534.
[28] 田辉. 齐刺环跳穴调节坐骨神经损伤大鼠痛觉敏化机理研究[D]: [博士学位论文]. 沈阳: 辽宁中医药大学, 2023.
[29] 蒋滨键, 蔡美意, 李燎原, 等. 基于任务态功能性磁共振成像研究针刺时丘脑功能连接的性别差异[J]. 安徽中医药大学学报, 2025, 44(2): 49-53.
[30] 华丽博. 电针对疼痛小鼠前扣带回皮层神经元影响的研究[D]: [硕士学位论文]. 广州: 广州中医药大学, 2023.
[31] 顾益枭, 陈敏娟, 陈潇男, 等. 电针对炎性痛小鼠前扣带回皮层N-甲基-D-天冬氨酸受体2B亚基和磷酸酶2A表达的影响[J]. 上海针灸杂志, 2025, 44(5): 605-612.
[32] Lian, J., Jiang, Y., Kong, L. and Zhou, M. (2025) Comparative Efficacy of Various Acupuncture-Related Therapies for Post-Stroke Sleep Disorders: A Network Meta-Analysis of Randomized Controlled Trials. Nature and Science of Sleep, 17, 1217-1229. [Google Scholar] [CrossRef] [PubMed]
[33] Li, J., Wu, X., Yan, S., Shen, J., Tong, T., Aslam, M.S., et al. (2024) Understanding the Antidepressant Mechanisms of Acupuncture: Targeting Hippocampal Neuroinflammation, Oxidative Stress, Neuroplasticity, and Apoptosis in CUMS Rats. Molecular Neurobiology, 62, 4221-4236. [Google Scholar] [CrossRef] [PubMed]
[34] 高佳佳, 刁志君, 袁伟, 等. 电针通过调节小鼠腹外侧眶皮层中谷氨酸能神经元缓解神经病理性疼痛诱发的焦虑和抑郁样行为[J]. 针刺研究, 2025, 50(1): 3-13.