从“肾亏-督虚-脑空”探讨脑小血管病的病机
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摘要
随着脑血管病发病率的上升及人口老龄化的到来,脑小血管病的危害越来越引起人们的重视,已成为当今国内外脑卒中的研究热点。其与卒中、痴呆、抑郁等疾病的发病均存在密切的关系。督脉和肾在功能上与脑有着密切的关系,同时督脉依其循行路线,成为连接、沟通肾和脑之间的桥梁。肾、督脉和脑的阳气亏虚可能成为脑小血管病发病的重要病机。本文试从"肾亏-督虚-脑空"来探讨脑小血管病发病的病机,以期为中医药防治脑小血管病提供一种新思路。
With the rise of the incidence of cerebrovascular disease and the arrival of the aging of the population, more and more people pay attention to the harm of cerebral small vascular disease(CSVD). CSVD has become a hot research topic in the domestic and International Stroke. CSVD has a close relationship with the disease, such as stroke, dementia and depression. Dumai and kidney are closely related with brain in function. At the same time, Dumai become a bridge of communication between the brain and kidney according to its meridian line route. The deficiency of kidney, Dumai and Yangqi of the brain may be an important pathogenesis of CSVD. This paper tries to explore the incidence and pathogenesis of cerebral small vessel disease from "Kidney deficiency, Dumai deficiency and brain empty". It is expected to provide a new idea for the prevention and treatment of CSVD in Chinese medicine.
With the rise of the incidence of cerebrovascular disease and the arrival of the aging of the population, more and more people pay attention to the harm of cerebral small vascular disease(CSVD). CSVD has become a hot research topic in the domestic and International Stroke. CSVD has a close relationship with the disease, such as stroke, dementia and depression. Dumai and kidney are closely related with brain in function. At the same time, Dumai become a bridge of communication between the brain and kidney according to its meridian line route. The deficiency of kidney, Dumai and Yangqi of the brain may be an important pathogenesis of CSVD. This paper tries to explore the incidence and pathogenesis of cerebral small vessel disease from "Kidney deficiency, Dumai deficiency and brain empty". It is expected to provide a new idea for the prevention and treatment of CSVD in Chinese medicine.
引文
1 Hachinski V.World Stroke Day 2008:“little strokes,big trouble”.Stroke,2008,39(9):2407-2420.
2 Wardlaw J M,Smith C,Dichgans M.Mechanisms of sporadic cerebral small vessel disease:insights from neuroimaging.Lancet Neurol,2013,12:483-497.
3 Moran C,Phan T G,Srikanth V K.Cerebral small vessel disease:a review of clinical,radiological,and histopathological phenotype.Int JStroke,2012,7:36-46.
4 Del Brutto O H,Mera R M,Del Brutto V J,et al.Basilar artery dolichoectasia:prevalence and correlates with markers of cerebral small vessel disease in community-dwelling older adults.J Stroke Cerebrovasc Dis,2017,26(12):2909-2914.
5 Smith E E,Beaudin A E.New insights into cerebral small vessel disease and vascular cognitive impairment from MRI.Current Opinion In Neurology,2018,31(1):36-43.
6 Joutel A,Chabriat H.Pathogenesis of white matter changes in cerebral small vessel diseases:beyond vessel-intrinsic mechanisms.Clinical Science,2017,131(8):635-651.
7 Sondergaard C B,Nielsen J E.Hereditary cerebral small vessel disease and stroke.Clinical Neurology and Neurosurgery,2017,155:45-57.
8詹羽,刘煜敏.脑小血管病.卒中与神经疾病.2014,21(1):59-61.
9 Maccarrone M,Ulivi L,Giannini N,et al.Endothelium and oxidative stress:the Pandora's Box of cerebral(and non-only)small vessel disease?Current Molecular Medicine,2017,17(3):169-180.
10 Fisher M,French S,Ji P,et al.Cerebral microbleeds in the elderly:a pathological analysis.Stroke,2010,41(12):2782-2785.
11 Poels M M,Vernooij M W,Ikram M A,et al.Prevalence and risk factors of cerebral microbleeds:an update of the Rotterdam scan study.Stroke,2010,41(10Suppl):S103-S106.
12 Khan U,Porteous L,Hassan A,et al.Risk factor profile of cerebral small vessel disease and its subtypes.Journal of Neurology Neurosurgery and Psychiatry.2007,78:702-706.
13 Lyoubi-Idrissi A L,Jouvent E,Poupon C,et al.Diffusion magnetic resonance imaging in cerebral small vessel disease.Revue Neurologique,2017,137(4):201-210.
14 Koga H,Takashima Y,Murakawa R,et al.Cognitive consequences of multiple lacunes and leukoaraiosis as vascular cognitive impairment in community-dwelling elderly individuals.J Stroke Cerebrovasc Dis,2009,18(1):32-37.
15 Jokinen H,Gouw A A,Madureira S,et al.LADIS Study Group.Incident lacunes influence cognitive decline:the LADIS study.Neurology,2011,76(22):1872-1878.
16 Zhang A J,Yu X J,Wang M.The clinical manifestations and pathophysiology of cerebral small vessel disease.Neurosci Bull,2010,26(3):257-264.
17陈飞,徐运.脑小血管病的发病机制和临床特点.国际脑血管病杂志,2011,19(8):620-624
18 Staekenborg S S,van Straaten E C,van der Flier W M,et al.Small vessel versus large vessel vascular dementia:risk factors and MRI findings.J Neurol,2008,255(11):1644-1651.
19 Cai Z,Wang C,He W,et al.Cerebral small vessel disease and Alzheimer.s disease.Clin Interv Aging,2015,10:1695-1704.
20 Love S,Miners J S.Small vessel disease,neurovascular regulation and cognitive impairment:post-mortem studies reveal a complex relationship,still poorly understood.Clinical Science,2017,131(14):1579-1589.
21 Van der Flier W M,van Straaten E C Barkhof F,et al.Small vessel disease and general cognitive function in nondisabled elderly:The LADIS study.Stroke,2005,36:2116-2120.
22 Bath P M,Wardlaw J M.Pharmacological treatment and prevention of cerebral small vessel disease:a review of potential interventions.Int JStroke,2015,10:469-478.
23 Toth P,Tarantini S,Tucsek Z,et al.Resveratrol treatment rescues neurovascular coupling in aged mice:role of improved cerebromicrovascular endothelial function and down-regulation of NADPH oxidase.Am JPhysiol Heart Circ Physiol,2014,306:H299-H308.
24胡聪,曾祥国,王米渠.试论肾充于脑的物质基础.长春中医学院学报,1997,13(3):1-3.
25任继学.脑髓述要.中国中医基础医学杂志,2003,9(3):161-163.
26张俊龙.脑与五脏关系论.山西中医学院学报,2002,3(2):7-10.
2 Wardlaw J M,Smith C,Dichgans M.Mechanisms of sporadic cerebral small vessel disease:insights from neuroimaging.Lancet Neurol,2013,12:483-497.
3 Moran C,Phan T G,Srikanth V K.Cerebral small vessel disease:a review of clinical,radiological,and histopathological phenotype.Int JStroke,2012,7:36-46.
4 Del Brutto O H,Mera R M,Del Brutto V J,et al.Basilar artery dolichoectasia:prevalence and correlates with markers of cerebral small vessel disease in community-dwelling older adults.J Stroke Cerebrovasc Dis,2017,26(12):2909-2914.
5 Smith E E,Beaudin A E.New insights into cerebral small vessel disease and vascular cognitive impairment from MRI.Current Opinion In Neurology,2018,31(1):36-43.
6 Joutel A,Chabriat H.Pathogenesis of white matter changes in cerebral small vessel diseases:beyond vessel-intrinsic mechanisms.Clinical Science,2017,131(8):635-651.
7 Sondergaard C B,Nielsen J E.Hereditary cerebral small vessel disease and stroke.Clinical Neurology and Neurosurgery,2017,155:45-57.
8詹羽,刘煜敏.脑小血管病.卒中与神经疾病.2014,21(1):59-61.
9 Maccarrone M,Ulivi L,Giannini N,et al.Endothelium and oxidative stress:the Pandora's Box of cerebral(and non-only)small vessel disease?Current Molecular Medicine,2017,17(3):169-180.
10 Fisher M,French S,Ji P,et al.Cerebral microbleeds in the elderly:a pathological analysis.Stroke,2010,41(12):2782-2785.
11 Poels M M,Vernooij M W,Ikram M A,et al.Prevalence and risk factors of cerebral microbleeds:an update of the Rotterdam scan study.Stroke,2010,41(10Suppl):S103-S106.
12 Khan U,Porteous L,Hassan A,et al.Risk factor profile of cerebral small vessel disease and its subtypes.Journal of Neurology Neurosurgery and Psychiatry.2007,78:702-706.
13 Lyoubi-Idrissi A L,Jouvent E,Poupon C,et al.Diffusion magnetic resonance imaging in cerebral small vessel disease.Revue Neurologique,2017,137(4):201-210.
14 Koga H,Takashima Y,Murakawa R,et al.Cognitive consequences of multiple lacunes and leukoaraiosis as vascular cognitive impairment in community-dwelling elderly individuals.J Stroke Cerebrovasc Dis,2009,18(1):32-37.
15 Jokinen H,Gouw A A,Madureira S,et al.LADIS Study Group.Incident lacunes influence cognitive decline:the LADIS study.Neurology,2011,76(22):1872-1878.
16 Zhang A J,Yu X J,Wang M.The clinical manifestations and pathophysiology of cerebral small vessel disease.Neurosci Bull,2010,26(3):257-264.
17陈飞,徐运.脑小血管病的发病机制和临床特点.国际脑血管病杂志,2011,19(8):620-624
18 Staekenborg S S,van Straaten E C,van der Flier W M,et al.Small vessel versus large vessel vascular dementia:risk factors and MRI findings.J Neurol,2008,255(11):1644-1651.
19 Cai Z,Wang C,He W,et al.Cerebral small vessel disease and Alzheimer.s disease.Clin Interv Aging,2015,10:1695-1704.
20 Love S,Miners J S.Small vessel disease,neurovascular regulation and cognitive impairment:post-mortem studies reveal a complex relationship,still poorly understood.Clinical Science,2017,131(14):1579-1589.
21 Van der Flier W M,van Straaten E C Barkhof F,et al.Small vessel disease and general cognitive function in nondisabled elderly:The LADIS study.Stroke,2005,36:2116-2120.
22 Bath P M,Wardlaw J M.Pharmacological treatment and prevention of cerebral small vessel disease:a review of potential interventions.Int JStroke,2015,10:469-478.
23 Toth P,Tarantini S,Tucsek Z,et al.Resveratrol treatment rescues neurovascular coupling in aged mice:role of improved cerebromicrovascular endothelial function and down-regulation of NADPH oxidase.Am JPhysiol Heart Circ Physiol,2014,306:H299-H308.
24胡聪,曾祥国,王米渠.试论肾充于脑的物质基础.长春中医学院学报,1997,13(3):1-3.
25任继学.脑髓述要.中国中医基础医学杂志,2003,9(3):161-163.
26张俊龙.脑与五脏关系论.山西中医学院学报,2002,3(2):7-10.
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