Comparison of the Local Tissue Milieu in Normal Muscle a

初步数据表明，与那些没有肌筋膜触发点或具有潜伏性（无症状）肌筋膜触发点的患者相比，具有活动性肌筋膜触发点（MTrP）的患者在肌筋膜触发点的局部环境中具有显著不同的生化特征。具体而言，与潜伏组和正常组相比，活动性MTrP受试者在上斜方肌的标准化解剖位置处具有显著较低的pH值和显著较高的SP、CGRP、缓激肽、5-羟色胺、去甲肾上腺素、TNF-α和IL-1 β水平。此外，局部生化环境似乎确实随着LTR而改变。要回答的一个重要问题是，是否解剖位点，远离活跃或潜伏的MTRP具有类似的生化概况的MTRP本身。这些偏远的网站应进行评估，以帮助区分是否MTRP有当地的生化档案或与更广泛的现象。 我们根据以下特征选择了三组受试者[下文1、2、3]。然后，我们在上腓肠肌和LV-7（内侧腓肠肌上部胫骨内侧髁的后部和下部）标准化部位采集GB-21样本，用于pH、肌肉代谢物、炎症介质、花生四烯酸衍生物、神经肽等。 本研究的目的是确定是否当地的生化环境的一个活跃的MTRP是相同的生化环境在解剖部位远离MTRP。 专门选择穴位GB-21和LV-7，以标准化三个精心选择的组中采样点的位置： 1) ?正常吗？群组：无颈部疼痛的健康受试者，GB-21中通过双侧触诊未发现MTrP，LV-7中通过双侧触诊未发现MTrP 2) ?潜伏？群组：无颈部疼痛的健康受试者，其中通过触诊在上肌之一的GB-21中识别出潜伏性MTrP，并且通过触诊在LV-7中的双侧中没有识别出MTrP， 3) ?活跃？群组：健康受试者主诉颈部疼痛持续时间少于3个月，通过触诊GB-21上的一个上肌确定了活动性肌筋膜激痛点，并且通过触诊LV-7双侧没有确定肌筋膜激痛点。 方案进展描述： 我们招募了10名受试者（5名女性和5名男性），年龄从25岁到56岁不等。通过我们的微量分析采样技术，我们成功地从每例受试者的上斜方肌触发点1和小腿LV-7处采集了样本，未发生任何不良事件。 主要发现： 1)我们证实了我们先前的发现，即在上斜方肌中针刺时，“活动”组中质子、缓激肽、SP、CGRP、5-羟色胺、去甲肾上腺素、TNF-α和IL-1 α的浓度显著高于“潜伏”组和“正常”组。活性组中检测的新分析物（IL-6、IL-8和IL-12）也显著较高。 2)在“活性”组中，证实了腓肠肌和腓肠肌之间在针插入时分析物水平的显著差异，表明活性MTrP附近表现出与疼痛和炎症相关的物质的独特生物化学环境。 3)“活性”组中的腓肠肌分析物水平高于“潜伏”组或“正常”组。这表明，分析物异常可能不限于上肌中的活动（疼痛）MTRP的局部区域，但可能存在于远离活动MTRP的部位。

Preliminary data suggest that patients with active myofascial trigger points (MTrPs) have a significantly different biochemical profile within the local milieu of the MTrPs compared to those without MTrPs or those with a latent (non-symptomatic) MTrP. Specifically, subjects with an active MTrP have a significantly lower pH and significantly higher levels of SP, CGRP, bradykinin, serotonin, norepinephrine, TNF-alpha and IL-1beta at a standardized anatomical location in the upper trapezius muscle than subjects in the latent and normal groups. Furthermore, the local biochemical milieu does appear to change with a LTR. An important question to answer is whether anatomical loci, remote from active or latent MTrPs have similar biochemical profiles to the MTrP itself. These remote sites should be evaluated to help distinguish whether MTrPs have local biochemical profiles or are associated with a more widespread phenomenon. We selected three groups of subjects based on the following characteristics [1, 2, 3 below]. We then sampled GB-21 in the upper trapezius muscle and LV-7 (posterior and inferior to the medial condyle of the tibia in the upper portion of the medial gastrocnemius) standardized sites for pH, muscle metabolites, inflammatory mediators, arachidonic acid derivatives, neuropeptides, etc. The goal of this study is to determine whether the local biochemical milieu of an active MTrP is the same as the biochemical milieu at anatomical sites remote from the MTrP. The acupuncture points GB-21 and LV-7 were selected specifically to standardize the locations of a sampling point in three carefully selected groups: 1) ?Normal? group: healthy subjects without neck pain and who have no MTrPs identified by palpation bilaterally in GB-21, and who have no MTrPs identified by palpation bilaterally in LV-7 2) ?Latent? group: healthy subjects without neck pain in whom latent MTrPs are identified by palpation in GB-21 in one of the upper trapezius muscles, and who have no MTrPs identified by palpation bilaterally in LV-7, 3) ?Active? group: healthy subjects complaining of neck pain of less than 3 months duration with active MTrPs identified by palpation in GB-21 in one of the upper trapezius muscles, and who have no MTrPs identified by palpation bilaterally in LV-7. Description of protocol progress: We recruited 10 subjects (5 women and 5 men), ranging in age from 25 to 56 years old. With our microanalytical sampling technique, we have successfully collected samples at trigger point 1 in the upper trapezius muscle and LV-7 in the calf from each subject without any untoward events. Major Findings: 1) We confirmed our previous findings that at needle insertion in the upper trapezius muscle the concentrations of protons, bradykinin, SP, CGRP, serotonin, norepinephrine, TNF-a, and IL-1a were significantly higher in the "Active" group than the "Latent" and "Normal" groups. The new analytes tested (IL-6, IL-8 and IL-12) were also significantly higher in the Active group. 2) Significant differences in analyte levels at needle insertion were demonstrated between the trapezius and gastrocnemius in the "Active" group, suggesting that the vicinity of the active MTrP exhibits a unique biochemical milieu of substances associated with pain and inflammation. 3) Gastrocnemius analyte levels were higher in the "Active" group than either the "Latent" or "Normal" groups. This suggests that analyte abnormalities may not be limited to local areas of active (painful) MTrPs in the upper trapezius but may be present at sites remote from the active MTrP.