基于脑肠轴理论探讨调理胃肠在针灸治疗失眠中的应用
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摘要
胃肠道功能与失眠关系密切,脑肠轴理论的提出为调理胃肠功能治疗失眠提供新的思路.通过分析脑肠轴影响脑功能的神经、内分泌、免疫及肠道菌群系统,结合针灸的调节效应及脑肠轴与胃肠道和失眠关系的传统理论依据,探讨基于脑肠轴理论调理胃肠在针灸治疗失眠中应用的可行性.
Gastrointestinal function is closely related to insomnia.The brain-gut axis theory provides a new way to regulate gastrointestinal function in the treatment of insomnia. By analyzing the nervous, endocrine, immune, and intestinal flora systems of the brain-gut axis that affects brain function as well as the regulatory effect of acupuncture and the traditional theoretical basis for the relationship of the brain-gut axis with the gastrointestinal tract and insomnia, we discuss the feasibility of acupuncture treatment of insomnia by regulating the gastrointestinal tract based on the brain-gut axis theory.
Gastrointestinal function is closely related to insomnia.The brain-gut axis theory provides a new way to regulate gastrointestinal function in the treatment of insomnia. By analyzing the nervous, endocrine, immune, and intestinal flora systems of the brain-gut axis that affects brain function as well as the regulatory effect of acupuncture and the traditional theoretical basis for the relationship of the brain-gut axis with the gastrointestinal tract and insomnia, we discuss the feasibility of acupuncture treatment of insomnia by regulating the gastrointestinal tract based on the brain-gut axis theory.
引文
1 Bastien CH.Insomnia:Neurophysiological and neuropsychological approaches.Neuropsychol Rev 2011;21:22-40[PMID:21249453 DOI:10.1007/s11065-011-9160-3]
2 Soldatos CR,Allaert FA,Ohta T,Dikeos DG.How do individuals sleep around the world?Results from a singleday survey in ten countries.Sleep Med 2005;6:5-13[PMID:15680289 DOI:10.1016/j.sleep.2004.10.006]
3 Rains JL,Jain SK.Oxidative stress,insulin signaling,and diabetes.Free Radic Biol Med 2011;50:567-575[PMID:21163346 DOI:10.1016/j.freeradbiomed.2010.12.006]
4 Janszky I.Insomnia is associated with risk of future cardiovascular events irrespective of comorbidities.Evid Based Med 2016;21:107[PMID:26887423 DOI:10.1136/ebmed-2015-110380]
5罗莹莹.从脾胃调治失眠的理论及临床研究.广州中医药大学,2013
6 Fass R,Fullerton S,Tung S,Mayer EA.Sleep disturbances in clinic patients with functional bowel disorders.Am JGastroenterol 2000;95:1195-2000[PMID:10811327 DOI:10.1111/j.1572-0241.2000.02009.x]
7马桂凤,华建平,张双霞,王邦茂,刘艳迪.功能性胃肠病患者不同消化道症状与睡眠质量、情绪障碍的研究.医学信息2016;29:315[DOI:10.3969/j.issn.1006-1959.2016.08.252]
8杨萍,彭磊,李捷婷,马惠芳.针刺对胃黏膜损伤大鼠睡眠时间的改变及血清和纹状体多巴胺含量的影响.针刺研究2014;39:52-57[DOI:10.13702/j.1000-0607.2014.01.010]
9高飞,刘铁钢,白辰,李卓,李旖旎,于河,谷晓红.脑肠轴与胃肠动力之间相关性的研究进展.天津中医药大学学报2018;37:520-524[DOI:10.11656/j.issn.1673-9043.2018.06.18]
10张璐,刘懿萱,段丽萍.肠道菌群与脑-肠轴功能相互影响的研究进展.胃肠病学2014;19:563-565[DOI:10.3969/j.issn.1008-7125.2014.09.013]
11 Mertz HR.Overview of functional gastrointestinal disorders:dysfunction of the brain-gut axis.Gastroenterol Clin North Am 2003;32:463-476[PMID:12858602 DOI:10.1016/S0889-8553(03)00019-0]
12 Holzer P,Farzi A.Neuropeptides and the microbiota-gutbrain axis.Adv Exp Med Biol 2014;817:195-219[PMID:24997035 DOI:10.1007/978-1-4939-0897-4_9]
13包春辉,窦传字,徐斌,刘慧荣,吴焕淦.炎症性肠病的脑肠互动及针灸干预.世界华人消化杂志2013;21:2300-2307[DOI:10.11569/wcjd.v21.i23.2300]
14 Forsythe P,Bienenstock J,Kunze WA.Vagal pathways for microbiome-brain-gut axis communication.Adv Exp Med Biol2014;817:115-133[PMID:24997031 DOI:10.1007/978-1-4939-0897-4_5]
15 Julio-Pieper M,O’Connor RM,Dinan TG,Cryan JF.Regulation of the brain-gut axis by group III metabotropic glutamate receptors.Eur J Pharmacol 2013;698:19-30[PMID:23123053 DOI:10.1016/j.ejphar.2012.10.027]
16 Plante DT,Jensen JE,Schoerning L,Winkelman JW.Reducedγ-aminobutyric acid in occipital and anterior cingulate cortices in primary insomnia:a link to major depressive disorder?Neuropsychopharmacology 2012;37:1548-1557[PMID:22318195 DOI:10.1038/npp.2012.4]
17 Schwartz MD,Kilduff TS.The Neurobiology of Sleep and Wakefulness.Psychiatr Clin North Am 2015;38:615-644[PMID:26600100 DOI:10.1016/j.psc.2015.07.002]
18 Dinan TG,Stilling RM,Stanton C,Cryan JF.Collective unconscious:how gut microbes shape human behavior.JPsychiatr Res 2015;63:1-9[PMID:25772005 DOI:10.1016/j.jps ychires.2015.02.021]
19 Boonstra E,de Kleijn R,Colzato LS,Alkemade A,Forstmann BU,Nieuwenhuis S.Neurotransmitters as food supplements:the effects of GABA on brain and behavior.Front Psychol 2015;6:1520[PMID:26500584 DOI:10.3389/fpsyg.2015.01520]
20马佳佳.从脑肠轴角度探讨针刺对应激性溃疡模型大鼠GAS、SS和MT含量的影响.北京中医药大学,2018
21尹伯元.标记免疫学.原子能出版社,1998
22方健,方以群.睡眠剥夺对大鼠下丘脑生长抑素mRNA表达的影响.解放军医学杂志2008;33:1104-1104[DOI:10.3321/j.issn:0577-7402.2008.09.034]
23彭静微,韩旭.褪黑素与睡眠的关系探讨.国际中医中药杂志2014;36:550-551[DOI:10.3760/cma.j.issn.1673-4246.2014.06.021]
24 Zhong LY,Yang ZH,Li XR,Wang H,Li L.Protective effects of melatonin against the damages of neuroendocrine-immune induced by lipopolysaccharide in diabetic rats.Exp Clin Endocrinol Diabetes 2009;117:463-469[PMID:19449282 DOI:10.1055/s-0029-1202790]
25 Joscelyn J,Kasper LH.Digesting the emerging role for the gut microbiome in central nervous system demyelination.Mult Scler 2014;20:1553-1559[PMID:25070675 DOI:10.1177/1352458514541579]
26张永梅,徐青.IL-25的研究进展.细胞与分子免疫学杂志2008;24:1034-1036[DOI:10.3321/j.issn:1007-8738.2008.10.032]
27 Yehuda S,Sredni B,Carasso RL,Kenigsbuch-Sredni D.REM sleep deprivation in rats results in inflammation and interleukin-17 elevation.J Interferon Cytokine Res 2009;29:393-398[PMID:19450150 DOI:10.1089/jir.2008.0080]
28黄凯裕,梁爽,傅淑平,于美玲,卢圣锋.基于脑肠轴理论探讨胃肠调理在针灸治疗脑病中的应用.中医杂志2016;57:1099-1104[DOI:10.13288/j.11-2166/r.2016.13.006]
29 Wang Y,Kasper LH.The role of microbiome in central nervous system disorders.Brain Behav Immun 2014;38:1-12[PMID:24370461 DOI:10.1016/j.bbi.2013.12.015]
30 Bravo JA,Forsythe P,Chew MV,Escaravage E,Savignac HM,Dinan TG,Bienenstock J,Cryan JF.Ingestion of Lactobacillus strain regulates emotional behavior and central GABAreceptor expression in a mouse via the vagus nerve.Proc Natl Acad Sci USA 2011;108:16050-16055[PMID:21876150 DOI:10.1073/pnas.1102999108]
31 Matsumoto M,Kibe R,Ooga T,Aiba Y,Kurihara S,Sawaki E,Koga Y,Benno Y.Impact of intestinal microbiota on intestinal luminal metabolome.Sci Rep 2012;2:233[PMID:22724057DOI:10.1038/srep00233]
32 Powley TL,Wang XY,Fox EA,Phillips RJ,Liu LW,Huizinga JD.Ultrastructural evidence for communication between intramuscular vagal mechanoreceptors and interstitial cells of Cajal in the rat fundus.Neurogastroenterol Motil 2008;20:69-79[PMID:17931338 DOI:10.1111/j.1365-2982.2007.00990.x]
33 Gershon MD,Tack J.The serotonin signaling system:from basic understanding to drug development for functional GIdisorders.Gastroenterology 2007;132:397-414[PMID:17241888DOI:10.1053/j.gastro.2006.11.002]
34 Dinan TG,Cryan JF.The Microbiome-Gut-Brain Axis in Health and Disease.Gastroenterol Clin North Am 2017;46:77-89[PMID:28164854 DOI:10.1016/j.gtc.2016.09.007]
35周艳丽,高希言,王培育,任珊.针刺不同腧穴对失眠大鼠下丘脑γ-氨基丁酸和γ-氨基丁酸A受体的影响.针刺研究2012;37:302-307[DOI:10.13702/j.1000-0607.2012.04.010]
36阮继源.电针对失眠大鼠脑内谷氨酸、γ-氨基丁酸含量及γ-氨基丁酸A型受体表达的影响.中华中医药杂志2013;28:3657-3660
37马佳佳,闫亚南,关翰宇,付晨露,李婧婷,薛婷,王旒靖,邵一轩,熊敏,葛东宇,董瑞娟,马惠芳.针刺对应激性胃溃疡模型大鼠血清和下丘脑中GAS、SS和MT表达的影响.环球中医药2018;11:486-491[DOI:10.3969/j.issn.1674-1749.2018.04.002]
38许冠荪,申国明,方正清,刘自兵,徐颖,张荣军.针灸防治功能性胃肠病进展.基础医学与临床2003;23:36-37[DOI:10.3969/j.issn.1001-6325.2003.z1.024]
39虞意华,金肖青,俞迈红,龚仕金,刘秉宇,李莉.针灸对老年严重脓毒症患者胃肠功能及胃肠激素影响的临床研究.中华中医药学刊2015;33:1953-1956[DOI:10.13193/j.issn.1673-7717.2015.08.048]
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49魏大能.针灸对UC模型小鼠焦虑情绪的改善作用及其与肠道菌群的关系研究.成都中医药大学,2017
2 Soldatos CR,Allaert FA,Ohta T,Dikeos DG.How do individuals sleep around the world?Results from a singleday survey in ten countries.Sleep Med 2005;6:5-13[PMID:15680289 DOI:10.1016/j.sleep.2004.10.006]
3 Rains JL,Jain SK.Oxidative stress,insulin signaling,and diabetes.Free Radic Biol Med 2011;50:567-575[PMID:21163346 DOI:10.1016/j.freeradbiomed.2010.12.006]
4 Janszky I.Insomnia is associated with risk of future cardiovascular events irrespective of comorbidities.Evid Based Med 2016;21:107[PMID:26887423 DOI:10.1136/ebmed-2015-110380]
5罗莹莹.从脾胃调治失眠的理论及临床研究.广州中医药大学,2013
6 Fass R,Fullerton S,Tung S,Mayer EA.Sleep disturbances in clinic patients with functional bowel disorders.Am JGastroenterol 2000;95:1195-2000[PMID:10811327 DOI:10.1111/j.1572-0241.2000.02009.x]
7马桂凤,华建平,张双霞,王邦茂,刘艳迪.功能性胃肠病患者不同消化道症状与睡眠质量、情绪障碍的研究.医学信息2016;29:315[DOI:10.3969/j.issn.1006-1959.2016.08.252]
8杨萍,彭磊,李捷婷,马惠芳.针刺对胃黏膜损伤大鼠睡眠时间的改变及血清和纹状体多巴胺含量的影响.针刺研究2014;39:52-57[DOI:10.13702/j.1000-0607.2014.01.010]
9高飞,刘铁钢,白辰,李卓,李旖旎,于河,谷晓红.脑肠轴与胃肠动力之间相关性的研究进展.天津中医药大学学报2018;37:520-524[DOI:10.11656/j.issn.1673-9043.2018.06.18]
10张璐,刘懿萱,段丽萍.肠道菌群与脑-肠轴功能相互影响的研究进展.胃肠病学2014;19:563-565[DOI:10.3969/j.issn.1008-7125.2014.09.013]
11 Mertz HR.Overview of functional gastrointestinal disorders:dysfunction of the brain-gut axis.Gastroenterol Clin North Am 2003;32:463-476[PMID:12858602 DOI:10.1016/S0889-8553(03)00019-0]
12 Holzer P,Farzi A.Neuropeptides and the microbiota-gutbrain axis.Adv Exp Med Biol 2014;817:195-219[PMID:24997035 DOI:10.1007/978-1-4939-0897-4_9]
13包春辉,窦传字,徐斌,刘慧荣,吴焕淦.炎症性肠病的脑肠互动及针灸干预.世界华人消化杂志2013;21:2300-2307[DOI:10.11569/wcjd.v21.i23.2300]
14 Forsythe P,Bienenstock J,Kunze WA.Vagal pathways for microbiome-brain-gut axis communication.Adv Exp Med Biol2014;817:115-133[PMID:24997031 DOI:10.1007/978-1-4939-0897-4_5]
15 Julio-Pieper M,O’Connor RM,Dinan TG,Cryan JF.Regulation of the brain-gut axis by group III metabotropic glutamate receptors.Eur J Pharmacol 2013;698:19-30[PMID:23123053 DOI:10.1016/j.ejphar.2012.10.027]
16 Plante DT,Jensen JE,Schoerning L,Winkelman JW.Reducedγ-aminobutyric acid in occipital and anterior cingulate cortices in primary insomnia:a link to major depressive disorder?Neuropsychopharmacology 2012;37:1548-1557[PMID:22318195 DOI:10.1038/npp.2012.4]
17 Schwartz MD,Kilduff TS.The Neurobiology of Sleep and Wakefulness.Psychiatr Clin North Am 2015;38:615-644[PMID:26600100 DOI:10.1016/j.psc.2015.07.002]
18 Dinan TG,Stilling RM,Stanton C,Cryan JF.Collective unconscious:how gut microbes shape human behavior.JPsychiatr Res 2015;63:1-9[PMID:25772005 DOI:10.1016/j.jps ychires.2015.02.021]
19 Boonstra E,de Kleijn R,Colzato LS,Alkemade A,Forstmann BU,Nieuwenhuis S.Neurotransmitters as food supplements:the effects of GABA on brain and behavior.Front Psychol 2015;6:1520[PMID:26500584 DOI:10.3389/fpsyg.2015.01520]
20马佳佳.从脑肠轴角度探讨针刺对应激性溃疡模型大鼠GAS、SS和MT含量的影响.北京中医药大学,2018
21尹伯元.标记免疫学.原子能出版社,1998
22方健,方以群.睡眠剥夺对大鼠下丘脑生长抑素mRNA表达的影响.解放军医学杂志2008;33:1104-1104[DOI:10.3321/j.issn:0577-7402.2008.09.034]
23彭静微,韩旭.褪黑素与睡眠的关系探讨.国际中医中药杂志2014;36:550-551[DOI:10.3760/cma.j.issn.1673-4246.2014.06.021]
24 Zhong LY,Yang ZH,Li XR,Wang H,Li L.Protective effects of melatonin against the damages of neuroendocrine-immune induced by lipopolysaccharide in diabetic rats.Exp Clin Endocrinol Diabetes 2009;117:463-469[PMID:19449282 DOI:10.1055/s-0029-1202790]
25 Joscelyn J,Kasper LH.Digesting the emerging role for the gut microbiome in central nervous system demyelination.Mult Scler 2014;20:1553-1559[PMID:25070675 DOI:10.1177/1352458514541579]
26张永梅,徐青.IL-25的研究进展.细胞与分子免疫学杂志2008;24:1034-1036[DOI:10.3321/j.issn:1007-8738.2008.10.032]
27 Yehuda S,Sredni B,Carasso RL,Kenigsbuch-Sredni D.REM sleep deprivation in rats results in inflammation and interleukin-17 elevation.J Interferon Cytokine Res 2009;29:393-398[PMID:19450150 DOI:10.1089/jir.2008.0080]
28黄凯裕,梁爽,傅淑平,于美玲,卢圣锋.基于脑肠轴理论探讨胃肠调理在针灸治疗脑病中的应用.中医杂志2016;57:1099-1104[DOI:10.13288/j.11-2166/r.2016.13.006]
29 Wang Y,Kasper LH.The role of microbiome in central nervous system disorders.Brain Behav Immun 2014;38:1-12[PMID:24370461 DOI:10.1016/j.bbi.2013.12.015]
30 Bravo JA,Forsythe P,Chew MV,Escaravage E,Savignac HM,Dinan TG,Bienenstock J,Cryan JF.Ingestion of Lactobacillus strain regulates emotional behavior and central GABAreceptor expression in a mouse via the vagus nerve.Proc Natl Acad Sci USA 2011;108:16050-16055[PMID:21876150 DOI:10.1073/pnas.1102999108]
31 Matsumoto M,Kibe R,Ooga T,Aiba Y,Kurihara S,Sawaki E,Koga Y,Benno Y.Impact of intestinal microbiota on intestinal luminal metabolome.Sci Rep 2012;2:233[PMID:22724057DOI:10.1038/srep00233]
32 Powley TL,Wang XY,Fox EA,Phillips RJ,Liu LW,Huizinga JD.Ultrastructural evidence for communication between intramuscular vagal mechanoreceptors and interstitial cells of Cajal in the rat fundus.Neurogastroenterol Motil 2008;20:69-79[PMID:17931338 DOI:10.1111/j.1365-2982.2007.00990.x]
33 Gershon MD,Tack J.The serotonin signaling system:from basic understanding to drug development for functional GIdisorders.Gastroenterology 2007;132:397-414[PMID:17241888DOI:10.1053/j.gastro.2006.11.002]
34 Dinan TG,Cryan JF.The Microbiome-Gut-Brain Axis in Health and Disease.Gastroenterol Clin North Am 2017;46:77-89[PMID:28164854 DOI:10.1016/j.gtc.2016.09.007]
35周艳丽,高希言,王培育,任珊.针刺不同腧穴对失眠大鼠下丘脑γ-氨基丁酸和γ-氨基丁酸A受体的影响.针刺研究2012;37:302-307[DOI:10.13702/j.1000-0607.2012.04.010]
36阮继源.电针对失眠大鼠脑内谷氨酸、γ-氨基丁酸含量及γ-氨基丁酸A型受体表达的影响.中华中医药杂志2013;28:3657-3660
37马佳佳,闫亚南,关翰宇,付晨露,李婧婷,薛婷,王旒靖,邵一轩,熊敏,葛东宇,董瑞娟,马惠芳.针刺对应激性胃溃疡模型大鼠血清和下丘脑中GAS、SS和MT表达的影响.环球中医药2018;11:486-491[DOI:10.3969/j.issn.1674-1749.2018.04.002]
38许冠荪,申国明,方正清,刘自兵,徐颖,张荣军.针灸防治功能性胃肠病进展.基础医学与临床2003;23:36-37[DOI:10.3969/j.issn.1001-6325.2003.z1.024]
39虞意华,金肖青,俞迈红,龚仕金,刘秉宇,李莉.针灸对老年严重脓毒症患者胃肠功能及胃肠激素影响的临床研究.中华中医药学刊2015;33:1953-1956[DOI:10.13193/j.issn.1673-7717.2015.08.048]
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