针刺改善睡眠障碍中NREMS异常的中枢睡眠相关机制探讨
|
摘要
睡眠障碍中非快速眼动睡眠(NREMS)异常与多种涉及睡眠模式异常的病理状态间具有显著的双向相关性,目前尚没有针对睡眠障碍中NREMS异常的特效治疗手段,但针刺治疗本病已显示出一定的疗效。该文从中枢神经系统NREMS相关靶基点出发,认为针刺可能通过调节机体褪黑素水平及睡眠-觉醒昼夜节律、选择性拮抗脑干中缝5-HT能神经元5-HT_(2A)受体、减少下丘脑室旁核CRH及CRH-R_1受体表达及降低大脑微血管壁Ab沉积,调节NREMS,进而改善睡眠障碍中NREMS异常。
Abnormal non-rapid-eye-movement sleep(NREMS) has a significant bidirectional correlation with manifold pathological states involving abnormal sleep modes. At present there is no specific treatment for abnormal NREMS in sleep disorders, but it has been showed that acupuncture has a certain therapeutic effect on this disease. This article considers, from NREMS-related target points in the central nervous system, that acupuncture improves abnormal NREMS in dyssomnia through regulating bodily melatonin levels and the circadian sleep-wake rhythm, selectively antagonizing 5-HT_(2A) receptors on 5-HT neurons in the brainstem raphe, decreasing the expressions of CRH and CRH-R_1 receptors in the hypothalamic paraventricular nucleus, reducing A? deposition in cerebral microvascular walls and adjusting NREMS.
Abnormal non-rapid-eye-movement sleep(NREMS) has a significant bidirectional correlation with manifold pathological states involving abnormal sleep modes. At present there is no specific treatment for abnormal NREMS in sleep disorders, but it has been showed that acupuncture has a certain therapeutic effect on this disease. This article considers, from NREMS-related target points in the central nervous system, that acupuncture improves abnormal NREMS in dyssomnia through regulating bodily melatonin levels and the circadian sleep-wake rhythm, selectively antagonizing 5-HT_(2A) receptors on 5-HT neurons in the brainstem raphe, decreasing the expressions of CRH and CRH-R_1 receptors in the hypothalamic paraventricular nucleus, reducing A? deposition in cerebral microvascular walls and adjusting NREMS.
引文
[1]Ringli M,Huber R.Developmental aspects of sleep slow waves:linking sleep,brain maturation and behavior[J].Prog Brain Res,2011,193:63-82.
[2]Hobson JA,Pace-Schott EF.The cognitive neuroscience of sleep:neuronal systems,consciousness and learning[J].Nat Rev Neurosci,2002,3(9):679-693.
[3]Doucette MR,Kurth S,Chevalier N,et al.Topography of slow sigma power during sleep is associated with processing speed in preschool children[J].Brain Sci,2015,5(4):494-508.
[4]Krueger JM,Majde JA,Obál F.Sleep in host defense[J].Brain Behav Immun,2003,17(Suppl 1):S41-47.
[5]Walker MP,Stickgold R.Sleep,memory,and plasticity[J].Annu Rev Psychol,2006,57:139-166.
[6]Jiang X,Shamie I,K Doyle W,et al.Replay of largescale spatio-temporal patterns from waking during subsequent NREM sleep in human cortex[J].Sci Rep,2017,7(1):17380.
[7]Ju YE,Lucey BP,Holtzman DM.Sleep and Alzheimer disease pathology--a bidirectional relationship[J].Nat Rev Neurol,2014,10(2):115-119.
[8]Phillips KG,Bartsch U,McCarthy AP,et al.Decoupling of sleep-dependent cortical and hippocampal interactions in a neurodevelopmental model of schizophrenia[J].Neuron,2012,76(3):526-533.
[9]Manoach DS,Pan JQ,Purcell SM,et al.Reduced sleep spindles in schizophrenia:A treatable endophenotype that links risk genes to impaired cognition?[J].Biol Psychiatry,2015,80(8):599-608.
[10]Limogesé,Mottron L,Bolduc C,et al.Atypical sleep architecture and the autism phenotype[J].Brain,2005,128(Pt 5):1049-1061.
[11]阮经文,郑沛仪.针灸疗法对合并睡眠障碍的早期脑卒中患者运动功能的影响[J].中国康复理论与实践,2000,6(2):72-75.
[12]胡桢,倪光夏.针灸治疗中风后睡眠障碍的概况[J].中医药学报,2016,44(3):78-81.
[13]冉茜,吴曦,洪肖娟,等.针灸治疗昼夜节律失调性睡眠障碍研究进展[J].辽宁中医杂志,2011,(3):570-572.
[14]李宁,吴滨,王成伟,等.针灸治疗失眠症随机对照试验的系统评价[J].中国针灸,2005,25(1):7-10.
[15]陈鹏典,杨卓欣,黎杰运,等.针灸治疗失眠症的机制研究进展[J].中国医药导报,2015,12(9):43-46.
[16]杨来福,刘建武,和青松,等.“调阴阳五脏配穴针刺法”治疗顽固性失眠症[J].中国针灸,2013,33(7):591-594.
[17]杨军雄,张建平,于建春,等.针灸治疗失眠症的临床疗效研究[J].中国全科医学,2013,16(4):466-468.
[18]周艳丽,高希言,王培育,等.针刺不同腧穴对失眠大鼠下丘脑?-氨基丁酸和?-氨基丁酸A受体的影响[J].针刺研究,2012,37(4):302-307.
[19]罗文政,张清仲,赖新生.解郁调神针刺法治疗失眠伴抑郁障碍疗效观察[J].中国针灸,2010,30(11):899-903.
[20]刘臻,赵娜,谢晨,等.电针对失眠大鼠睡眠-觉醒昼夜节律及褪黑素节律的影响[J].中华中医药杂志,2016,31(9):3695-3699.
[21]张熙.现代睡眠医学(精)[M].北京:人民军医出版社,2007:59-68.
[22]赵超英,吴绪敏,姚小曼,等.MLT改善睡眠试验研究[J].中国食品卫生杂志,1998,(5):11-12.
[23]张连龙,张庆柱,张均田,等.褪黑素防治老年相关性疾病的临床研究进展[J].中国老年学杂志,2001,(5):397-399.
[24]高允东,耿金荣.褪黑素临床研究进展[J].中国医院药学杂志,2001,(3):173-174.
[25]Lewy AJ,Ahmed S,Jackson JM,et al.Melatonin shifts human circadian rhythms according to a phase-response curve[J].Chronobiol Int,1992,9(5):380-392.
[26]Ochoa-Sanchez R,Comai S,Lacoste B,et al.Promotion of non-rapid eye movement sleep and activation of reticular thalamic neurons by a novel MT2 melatonin receptor ligand[J].J Neurosci,2011,31(50):18439-18452.
[27]姚海江,宋洪涛,莫雨平,等.电针对慢性应激诱导的抑郁模型大鼠体温及褪黑素昼夜节律的影响[J].中国针灸,2014,34(7):685-689.
[28]Spence DW,Kayumov L,Chen A,et al.Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety:a preliminary report[J].JNeuropsychiatry Clin Neurosci,2004,16(1):19-28.
[29]Popa D,Léna C,Fabre V,et al.Contribution of 5-HT2receptor subtypes to sleep-wakefulness and respiratory control,and functional adaptations in knock-out mice lacking 5-HT2A receptors[J].J Neurosci,2005,25(49):11231-11238.
[30]Roth BL,Berry SA,Kroeze WK,et al.Serotonin 5-HT2Areceptors:molecular biology and mechanisms of regulation[J].Crit Rev Neurobiol,1998,12(4):319-338.
[31]Declerck AC,Wauquier A,Van Der Ham-Veltman PHM,et al.Increase in slow-wave sleep in humans with the serotonin-S2 antagonist ritanserin.The first exploratory polysomnographic sleep study[J].Curr Ther Res,1987,41:427-432.
[32]Landolt HP,Meier V,Burgess HJ,et al.Serotonin-2receptors and human sleep:Effect of a selective antagonist on EEG power spectra[J].Neuropsychopharmacology,1999,21(3):455-466.
[33]Rosenberg R,Seiden DJ,Hull SG,et al.APD125,a selective serotonin 5-HT(2A)receptor inverse agonist,significantly improves sleep maintenance in primary insomnia[J].Sleep,2008,31(12):1663-1671.
[34]Ancoli-Israel S,Vanover KE,Weiner DM,et al.Pimavanserin tartrate,a 5-HT2A receptor inverse agonist,increases slow wave sleep as measured by polysomnography in healthy adult volunteers[J].Sleep Med,2011,12(2):134-141.
[35]Cole P.ITI-007.5-HT2A receptor antagonist,dopamine D2 receptor modulator,treatment of schizophrenia,treatment of insomnia[J].Drugs of the Future,2015,40(10):643.
[36]罗本华,王燕,张亚飞,等.三种针法对对氯苯丙氨酸诱导失眠大鼠海马5-HT1A、5-HT2A基因表达影响研究[J].中华中医药学刊,2017,35(10):2630-2633.
[37]Friess E,Tagaya H,Grethe C,et al.Acute cortisol administration promotes sleep intensity in man[J].Neuropsychopharmacology,2004,29(3):598-604.
[38]Neylan TC,Lenoci M,Maglione ML,et al.Delta sleep response to metyrapone in post-traumatic stress disorder[J].Neuropsychopharmacology,2003,28(9):1666-1676.
[39]吴雪芬,郑雪娜,郭鑫,等.针灸干预HPA轴相关激素改善睡眠的研究进展[J].针灸临床杂志,2017,33(8):69-71.
[40]梁佳,卢峻,王俊仁,等.不同针刺方法对慢性应激抑郁大鼠下丘脑CRH基因表达及血清ACTH、CORT的影响[J].北京中医药大学学报,2012,35(4):265-268.
[41]史榕荇,丁海涛,李辉,等.不同穴组针刺对抑郁大鼠下丘脑-垂体-肾上腺轴相关因子及血清脑源性神经营养因子的影响[J].针刺研究,2015,40(6):444-448.
[42]徐虹,孙忠人,李丽萍,等.针刺治疗抑郁症及其对患者下丘脑-垂体-肾上腺轴的影响[J].中国针灸,2004,24(2):78-80.
[43]周奇志,彭晓华,吴巧凤,等.电针对焦虑大鼠室旁核促肾上腺皮质素释放激素及其Ⅰ型受体mRNA表达的影响[J].针刺研究,2008,33(6):372-376.
[44]Selkoe DJ.Cell biology of protein misfolding:The examples of Alzheimer’s and Parkinson’s diseases[J].Nat Cell Biol,2004,6(11):1054-1061.
[45]高曲文,陈俊抛.β淀粉样蛋白诱导脑内神经元调亡及褪黑素的保护作用[J].中华神经科杂志,2000,33(1):7-9.
[46]涂荣波,董军.β-淀粉样蛋白在老年痴呆症发生发展中的作用及其机制[J].第四军医大学学报,2007,28(1):91-93.
[47]高曲文,陈俊抛.β淀粉样蛋白诱导脑内神经元凋亡的研究[J].中风与神经疾病杂志,2000,17(2):79-81.
[48]Varga AW,Wohlleber ME,Giménez S,et al.Reduced slow-wave sleep is associated with high cerebrospinal fluid A?42 levels in cognitively normal elderly[J].Sleep,2016,39(11):2041-2048.
[49]Kang JE,Lim MM,Bateman RJ,et al.Amyloid-beta dynamics are regulated by orexin and the sleep-wake cycle[J].Science,2009,326(5955):1005-1007.
[50]Vyazovskiy VV,Olcese U,Hanlon EC,et al.Local sleep in awake rats[J].Nature,2011,472(7344):443-447.
[51]Irwin MR.Why sleep is important for health:a psychoneuroimmunology perspective[J].Annu Rev Psychol,2015,66:143-172.
[52]S?mann PG,Wehrle R,Hoehn D,et al.Development of the brain’s default mode network from wakefulness to slow wave sleep[J].Cerebral Cortex,2011,21(9):2082-2093.
[53]Boespflug EL,Iliff JJ.The emerging relationship between interstitial fluid-cerebrospinal fluid exchange,amyloid-?,and sleep[J].Biol Psychiatry,2018,83(4):328-336.
[54]Simoncini M,Gatti A,Quirico PE,et al.Acupressure in insomnia and other sleep disorders in elderly institutionalized patients suffering from Alzheimer’s disease[J].Aging Clin Exp Res,2015,27(1):37-42.
[55]李芙,李丽娜,王鑫,等.电针“百会”“涌泉”对APP/PS1双转基因小鼠海马?淀粉样蛋白及低密度脂蛋白受体相关蛋白-1水平的影响[J].针刺研究,2015,40(1):30-34.
[56]罗玳红,赖新生,唐纯志.电针治疗对老年性痴呆大鼠血清?淀粉样蛋白及生长因子水平的影响[J].中国中医药信息杂志,2003,10(10):22-23.
[57]蔡涛,肖冬玲.针刺对老年性痴呆患者Hcy、A?干预作用的临床观察[J].上海针灸杂志,2008,27(12):3-5.
[58]姜美驰,梁静,张玉杰,等.针刺“四关”穴对阿尔茨海默病大鼠学习记忆及海马区?淀粉样蛋白42、白介素-1?和白介素-2的影响[J].针刺研究,2016,41(2):113-118.
[2]Hobson JA,Pace-Schott EF.The cognitive neuroscience of sleep:neuronal systems,consciousness and learning[J].Nat Rev Neurosci,2002,3(9):679-693.
[3]Doucette MR,Kurth S,Chevalier N,et al.Topography of slow sigma power during sleep is associated with processing speed in preschool children[J].Brain Sci,2015,5(4):494-508.
[4]Krueger JM,Majde JA,Obál F.Sleep in host defense[J].Brain Behav Immun,2003,17(Suppl 1):S41-47.
[5]Walker MP,Stickgold R.Sleep,memory,and plasticity[J].Annu Rev Psychol,2006,57:139-166.
[6]Jiang X,Shamie I,K Doyle W,et al.Replay of largescale spatio-temporal patterns from waking during subsequent NREM sleep in human cortex[J].Sci Rep,2017,7(1):17380.
[7]Ju YE,Lucey BP,Holtzman DM.Sleep and Alzheimer disease pathology--a bidirectional relationship[J].Nat Rev Neurol,2014,10(2):115-119.
[8]Phillips KG,Bartsch U,McCarthy AP,et al.Decoupling of sleep-dependent cortical and hippocampal interactions in a neurodevelopmental model of schizophrenia[J].Neuron,2012,76(3):526-533.
[9]Manoach DS,Pan JQ,Purcell SM,et al.Reduced sleep spindles in schizophrenia:A treatable endophenotype that links risk genes to impaired cognition?[J].Biol Psychiatry,2015,80(8):599-608.
[10]Limogesé,Mottron L,Bolduc C,et al.Atypical sleep architecture and the autism phenotype[J].Brain,2005,128(Pt 5):1049-1061.
[11]阮经文,郑沛仪.针灸疗法对合并睡眠障碍的早期脑卒中患者运动功能的影响[J].中国康复理论与实践,2000,6(2):72-75.
[12]胡桢,倪光夏.针灸治疗中风后睡眠障碍的概况[J].中医药学报,2016,44(3):78-81.
[13]冉茜,吴曦,洪肖娟,等.针灸治疗昼夜节律失调性睡眠障碍研究进展[J].辽宁中医杂志,2011,(3):570-572.
[14]李宁,吴滨,王成伟,等.针灸治疗失眠症随机对照试验的系统评价[J].中国针灸,2005,25(1):7-10.
[15]陈鹏典,杨卓欣,黎杰运,等.针灸治疗失眠症的机制研究进展[J].中国医药导报,2015,12(9):43-46.
[16]杨来福,刘建武,和青松,等.“调阴阳五脏配穴针刺法”治疗顽固性失眠症[J].中国针灸,2013,33(7):591-594.
[17]杨军雄,张建平,于建春,等.针灸治疗失眠症的临床疗效研究[J].中国全科医学,2013,16(4):466-468.
[18]周艳丽,高希言,王培育,等.针刺不同腧穴对失眠大鼠下丘脑?-氨基丁酸和?-氨基丁酸A受体的影响[J].针刺研究,2012,37(4):302-307.
[19]罗文政,张清仲,赖新生.解郁调神针刺法治疗失眠伴抑郁障碍疗效观察[J].中国针灸,2010,30(11):899-903.
[20]刘臻,赵娜,谢晨,等.电针对失眠大鼠睡眠-觉醒昼夜节律及褪黑素节律的影响[J].中华中医药杂志,2016,31(9):3695-3699.
[21]张熙.现代睡眠医学(精)[M].北京:人民军医出版社,2007:59-68.
[22]赵超英,吴绪敏,姚小曼,等.MLT改善睡眠试验研究[J].中国食品卫生杂志,1998,(5):11-12.
[23]张连龙,张庆柱,张均田,等.褪黑素防治老年相关性疾病的临床研究进展[J].中国老年学杂志,2001,(5):397-399.
[24]高允东,耿金荣.褪黑素临床研究进展[J].中国医院药学杂志,2001,(3):173-174.
[25]Lewy AJ,Ahmed S,Jackson JM,et al.Melatonin shifts human circadian rhythms according to a phase-response curve[J].Chronobiol Int,1992,9(5):380-392.
[26]Ochoa-Sanchez R,Comai S,Lacoste B,et al.Promotion of non-rapid eye movement sleep and activation of reticular thalamic neurons by a novel MT2 melatonin receptor ligand[J].J Neurosci,2011,31(50):18439-18452.
[27]姚海江,宋洪涛,莫雨平,等.电针对慢性应激诱导的抑郁模型大鼠体温及褪黑素昼夜节律的影响[J].中国针灸,2014,34(7):685-689.
[28]Spence DW,Kayumov L,Chen A,et al.Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety:a preliminary report[J].JNeuropsychiatry Clin Neurosci,2004,16(1):19-28.
[29]Popa D,Léna C,Fabre V,et al.Contribution of 5-HT2receptor subtypes to sleep-wakefulness and respiratory control,and functional adaptations in knock-out mice lacking 5-HT2A receptors[J].J Neurosci,2005,25(49):11231-11238.
[30]Roth BL,Berry SA,Kroeze WK,et al.Serotonin 5-HT2Areceptors:molecular biology and mechanisms of regulation[J].Crit Rev Neurobiol,1998,12(4):319-338.
[31]Declerck AC,Wauquier A,Van Der Ham-Veltman PHM,et al.Increase in slow-wave sleep in humans with the serotonin-S2 antagonist ritanserin.The first exploratory polysomnographic sleep study[J].Curr Ther Res,1987,41:427-432.
[32]Landolt HP,Meier V,Burgess HJ,et al.Serotonin-2receptors and human sleep:Effect of a selective antagonist on EEG power spectra[J].Neuropsychopharmacology,1999,21(3):455-466.
[33]Rosenberg R,Seiden DJ,Hull SG,et al.APD125,a selective serotonin 5-HT(2A)receptor inverse agonist,significantly improves sleep maintenance in primary insomnia[J].Sleep,2008,31(12):1663-1671.
[34]Ancoli-Israel S,Vanover KE,Weiner DM,et al.Pimavanserin tartrate,a 5-HT2A receptor inverse agonist,increases slow wave sleep as measured by polysomnography in healthy adult volunteers[J].Sleep Med,2011,12(2):134-141.
[35]Cole P.ITI-007.5-HT2A receptor antagonist,dopamine D2 receptor modulator,treatment of schizophrenia,treatment of insomnia[J].Drugs of the Future,2015,40(10):643.
[36]罗本华,王燕,张亚飞,等.三种针法对对氯苯丙氨酸诱导失眠大鼠海马5-HT1A、5-HT2A基因表达影响研究[J].中华中医药学刊,2017,35(10):2630-2633.
[37]Friess E,Tagaya H,Grethe C,et al.Acute cortisol administration promotes sleep intensity in man[J].Neuropsychopharmacology,2004,29(3):598-604.
[38]Neylan TC,Lenoci M,Maglione ML,et al.Delta sleep response to metyrapone in post-traumatic stress disorder[J].Neuropsychopharmacology,2003,28(9):1666-1676.
[39]吴雪芬,郑雪娜,郭鑫,等.针灸干预HPA轴相关激素改善睡眠的研究进展[J].针灸临床杂志,2017,33(8):69-71.
[40]梁佳,卢峻,王俊仁,等.不同针刺方法对慢性应激抑郁大鼠下丘脑CRH基因表达及血清ACTH、CORT的影响[J].北京中医药大学学报,2012,35(4):265-268.
[41]史榕荇,丁海涛,李辉,等.不同穴组针刺对抑郁大鼠下丘脑-垂体-肾上腺轴相关因子及血清脑源性神经营养因子的影响[J].针刺研究,2015,40(6):444-448.
[42]徐虹,孙忠人,李丽萍,等.针刺治疗抑郁症及其对患者下丘脑-垂体-肾上腺轴的影响[J].中国针灸,2004,24(2):78-80.
[43]周奇志,彭晓华,吴巧凤,等.电针对焦虑大鼠室旁核促肾上腺皮质素释放激素及其Ⅰ型受体mRNA表达的影响[J].针刺研究,2008,33(6):372-376.
[44]Selkoe DJ.Cell biology of protein misfolding:The examples of Alzheimer’s and Parkinson’s diseases[J].Nat Cell Biol,2004,6(11):1054-1061.
[45]高曲文,陈俊抛.β淀粉样蛋白诱导脑内神经元调亡及褪黑素的保护作用[J].中华神经科杂志,2000,33(1):7-9.
[46]涂荣波,董军.β-淀粉样蛋白在老年痴呆症发生发展中的作用及其机制[J].第四军医大学学报,2007,28(1):91-93.
[47]高曲文,陈俊抛.β淀粉样蛋白诱导脑内神经元凋亡的研究[J].中风与神经疾病杂志,2000,17(2):79-81.
[48]Varga AW,Wohlleber ME,Giménez S,et al.Reduced slow-wave sleep is associated with high cerebrospinal fluid A?42 levels in cognitively normal elderly[J].Sleep,2016,39(11):2041-2048.
[49]Kang JE,Lim MM,Bateman RJ,et al.Amyloid-beta dynamics are regulated by orexin and the sleep-wake cycle[J].Science,2009,326(5955):1005-1007.
[50]Vyazovskiy VV,Olcese U,Hanlon EC,et al.Local sleep in awake rats[J].Nature,2011,472(7344):443-447.
[51]Irwin MR.Why sleep is important for health:a psychoneuroimmunology perspective[J].Annu Rev Psychol,2015,66:143-172.
[52]S?mann PG,Wehrle R,Hoehn D,et al.Development of the brain’s default mode network from wakefulness to slow wave sleep[J].Cerebral Cortex,2011,21(9):2082-2093.
[53]Boespflug EL,Iliff JJ.The emerging relationship between interstitial fluid-cerebrospinal fluid exchange,amyloid-?,and sleep[J].Biol Psychiatry,2018,83(4):328-336.
[54]Simoncini M,Gatti A,Quirico PE,et al.Acupressure in insomnia and other sleep disorders in elderly institutionalized patients suffering from Alzheimer’s disease[J].Aging Clin Exp Res,2015,27(1):37-42.
[55]李芙,李丽娜,王鑫,等.电针“百会”“涌泉”对APP/PS1双转基因小鼠海马?淀粉样蛋白及低密度脂蛋白受体相关蛋白-1水平的影响[J].针刺研究,2015,40(1):30-34.
[56]罗玳红,赖新生,唐纯志.电针治疗对老年性痴呆大鼠血清?淀粉样蛋白及生长因子水平的影响[J].中国中医药信息杂志,2003,10(10):22-23.
[57]蔡涛,肖冬玲.针刺对老年性痴呆患者Hcy、A?干预作用的临床观察[J].上海针灸杂志,2008,27(12):3-5.
[58]姜美驰,梁静,张玉杰,等.针刺“四关”穴对阿尔茨海默病大鼠学习记忆及海马区?淀粉样蛋白42、白介素-1?和白介素-2的影响[J].针刺研究,2016,41(2):113-118.