针刺对中枢神经系统缺血性疾病作用机制的研究概况
|
摘要
针刺疗法广泛应用于中枢缺血性疾病的不同临床治疗时期并取得良好疗效。近年来,大量研究致力于探讨针刺促使脑功能改善的病理生理机制,发现针刺能通过调节中枢血流量、流速,降低血液黏稠度等改善脑血流微循环,其机制可能与调节基底前脑胆碱能血管舒张系统及血管舒缩物质的水平、抑制炎性反应、调控相关基因和蛋白的表达从而改善中枢缺血性损伤有关。本文对以上研究内容作一综述。
Acupuncture is widely used in the treatment of ischemic diseases of the central nervous system in different clinical stages and has achieved a good clinical effect.The current research showed that acupuncture can improve cerebral blood flow perfusion via increasing blood flow volume,blood flow velocity,the levels of vasomotor substances and reduction of blood viscosity and erythrocyte aggregation index.In recent years,many studies focused on the pathophysiological mechanism of acupuncture in improving cerebral ischemia via triggering the cholinergic vasodilatation,up-regulation of expression of vascular-related proteins and genes,attenuation of inflammatory reaction,etc.Currently,the methods for evaluating the effect of acupuncture are mostly noninvasive functional magnetic resonance imaging in healthy subjects.Future studies should include united selection of acupoints and acupuncture needle manipulations,more reasonable combination of different acupoints,united outcome evaluative standards,better repeatability,employment of big data,etc.
Acupuncture is widely used in the treatment of ischemic diseases of the central nervous system in different clinical stages and has achieved a good clinical effect.The current research showed that acupuncture can improve cerebral blood flow perfusion via increasing blood flow volume,blood flow velocity,the levels of vasomotor substances and reduction of blood viscosity and erythrocyte aggregation index.In recent years,many studies focused on the pathophysiological mechanism of acupuncture in improving cerebral ischemia via triggering the cholinergic vasodilatation,up-regulation of expression of vascular-related proteins and genes,attenuation of inflammatory reaction,etc.Currently,the methods for evaluating the effect of acupuncture are mostly noninvasive functional magnetic resonance imaging in healthy subjects.Future studies should include united selection of acupoints and acupuncture needle manipulations,more reasonable combination of different acupoints,united outcome evaluative standards,better repeatability,employment of big data,etc.
引文
[1]张毅敏,陈爱连,唐纯志,等.电针对重型颅脑损伤昏迷患者促醒作用的临床观察[J].针刺研究,2013,38(2):158-162.
[2]刘德芳,赵波,吕云利,等.针刺配合高压氧治疗一氧化碳中毒迟发型脑病32例疗效观察[J].针刺研究,2013,38(5):407-410.
[3]陈超,刘炜宏,王宏才,等.国外临床实践指南相关针灸内容的调查与分析[J].中国针灸,2018,38(4):425-429.
[4]汪瑛,章显宝,肖伟,等.项丛刺针法对缺血性脑卒中大鼠脑微循环障碍的影响[J].针刺研究,2013,38(3):220-223.
[5]张生玉,刘哨兵,谢洪武,等.醒脑开窍针刺法结合高压氧对缺血缺氧性脑病患者血液流变学的影响[J].针刺研究,2017,42(6):518-521.
[6] BYEON H S,MOON S K,PARK S U,et al.Effects of GV20acupuncture on cerebral blood flow velocity of middle cerebral artery and anterior cerebral artery territories,and CO2reactivity during hypocapnia in normal subjects[J].J Altern Complement Med,2011,17(3):219-224.
[7] AN Y S,MOON S K,MIN I K,et al.Changes in regional cerebral blood flow and glucose metabolism following electroacupuncture at LI 4and LI 11in normal volunteers[J].J Altern Complement Med,2009,15(10):1075-1081.
[8] ZHANG Y,GLIELMI C B,JIANG Y,et al.Simultaneous CBF and BOLD mapping of high frequency acupuncture induced brain activity[J].Neurosci Lett,2012,530(1):12-17.
[9] HALL C N,REYNELL C,GESSLEIN B,et al.Capillary pericytes regulate cerebral blood flow in health and disease[J].Nature,2014,508(7494):55-60.
[10] ZHANG S Q,WANG Y J,ZHANG J P,et al.Brain activation and inhibition after acupuncture at Taichong and Taixi:resting-state functional magnetic resonance imaging[J].Neural Regen Res,2015,10(2):292-297.
[11] RATMANSKY M,LEVY A,MESSINGER A,et al.The effects of acupuncture on cerebral blood flow in post-stroke patients:a randomized controlled trial[J].J Altern Complement Med,2016,22(1):33-37.
[12]周鸿飞,王健,曹铁军,等.应用SPECT观察眼针对脑梗死患者脑血流的影响[J].中国针灸,2011,31(5):391-394.
[13] ZHANG X Z,WU B Q,NIE K,et al.Effects of acupuncture on declined cerebral blood flow,impaired mitochondrial respiratory function and oxidative stress in multi-infarct dementia rats[J].Neurochem Int,2014,65:23-29.
[14] ZHOU F,GUO J C,CHENG J S,et al.Electroacupuncture increased cerebral blood flow and reduced ischemic brain injury:dependence on stimulation intensity and frequency[J].J Appl Physiol,2011,111(6):1877-1887.
[15] UCHIDA S,KAGITANI F.Effect of acupuncture-like stimulation on cortical cerebral blood flow in aged rats[J].J Physiol Sci,2015,65(1):67-75.
[16] KIM J H,CHOI K H,JANG Y J,et al.Electroacupuncture acutely improves cerebral blood flow and attenuates moderate ischemic injury via an endothelial mechanism in mice[J].PLoS One,2013,8(2):e56736.
[17]王建枝,殷莲华.病理生理学[M].8版,北京:人民卫生出版社,2013.
[18]冯吉杰,王珂,陈彤宇,等.针刺调控炎性反应在抗缺血再灌注损伤中的研究进展[J].针刺研究,2017,42(6):552-556.
[19]李玉林.病理学[M].8版,北京:人民卫生出版社,2013.
[20]陈素辉,孙华,徐虹,等.针刺对脑缺血再灌注损伤大鼠双侧脑组织白细胞介素-1β、肿瘤坏死因子-α表达的影响[J].针刺研究,2012,37(6):470-475.
[21]陈素辉,孙华,徐虹,等.针刺百会和足三里穴对脑缺血再灌注损伤大鼠双侧脑组织白细胞介素-6表达的影响[J].针灸临床杂志,2014,30(1):42-45.
[22]娄元俊,刘阳,单海军,等.针灸对脑性瘫痪幼鼠模型行为学的影响及其机制[J].中国组织工程研究,2016,20(49):7314-7319.
[23]卢岩,赵海军,王媛,等.电针对局灶性脑缺血大鼠神经功能、脑血流及脑组织细胞色素P450表氧化酶基因表达的影响[J].针刺研究,2014,39(5):345-350.
[24]杨丽红,杜元灏,李晶,等.电针对脑梗死大鼠脑血管内皮细胞Apelin-APJ系统的影响[J].针刺研究,2017,42(1):9-13.
[25]张莹,秦文熠,罗勇.电针对局灶脑缺血/再灌注大鼠大脑缺血皮层区白介素-4/信号传导及转录激活因子6与核因子-κB的影响[J].针刺研究,2017,42(3):217-222.
[26]王金海,赵敏,鲍英存,等.头穴透刺对急性脑梗死患者血清超敏C反应蛋白及炎性反应因子水平的影响[J].针刺研究,2016,41(1):80-84.
[27] HUANG J,YOU X F,LIU W L,et al.Electroacupuncture ameliorating post-stroke cognitive impairments via inhibition of peri-infarct astroglial and microglial/macrophage P2 purinoceptors-mediated neuroinflammation and hyperplasia[J].BMC Complement Altern Med,2017,17(1):480.
[28] LIU W L,WANG X,YANG S L,et al.Electroacupuncture improves motor impairment via inhibition of microglia-mediated neuroinflammation in the sensorimotor cortex after ischemic stroke[J].Life Sci,2016,151:313-322.
[29]沈梅红,项晓仁,李缨,等.电针对脑缺血大鼠大脑皮层γ-谷氨酰半胱氨酸合成酶蛋白及基因表达的影响[J].针刺研究,2012,37(1):25-30.
[30] XU T,XU N G,YANG Z H,et al.Neuroprotective effects of electroacupuncture on hypoxic-ischemic encephalopathy in newborn rats are associated with increased expression of GDNF-RET and protein kinase B[J].Chin J Integr Med,2016,22(6):457-466.
[31] LIN R H,WU Y N,TAO J,et al.Electroacupuncture improves cognitive function through Rho GTPases and enhances dendritic spine plasticity in rats with cerebral ischemia-reperfusion[J].Mol Med Rep,2016,13(3):2655-2660.
[32]张业贵,龚鑫,侯良芹,等.电针预处理对脑缺血再灌注大鼠大脑皮质一氧化氮合酶及胶质纤维酸性蛋白表达的影响[J].针刺研究,2015,40(2):113-118.
[33]林咸明,陈丽萍,姚旭,等.不同时程电针预处理对脑缺血再灌注大鼠血脑屏障基质金属蛋白酶-9、血管内皮生长因子的影响[J].针刺研究,2015,40(1):40-44.
[34]罗磊,孙国杰,杜艳军.针灸对AD模型大鼠海马神经元线粒体能量代谢相关蛋白的影响[J].中国针灸,2013,33(10):913-918.
[35]韩永升,徐银,韩咏竹,等.电针对局灶性脑缺血再灌注大鼠神经血管单元的保护作用[J].针刺研究,2013,38(3):173-180.
[2]刘德芳,赵波,吕云利,等.针刺配合高压氧治疗一氧化碳中毒迟发型脑病32例疗效观察[J].针刺研究,2013,38(5):407-410.
[3]陈超,刘炜宏,王宏才,等.国外临床实践指南相关针灸内容的调查与分析[J].中国针灸,2018,38(4):425-429.
[4]汪瑛,章显宝,肖伟,等.项丛刺针法对缺血性脑卒中大鼠脑微循环障碍的影响[J].针刺研究,2013,38(3):220-223.
[5]张生玉,刘哨兵,谢洪武,等.醒脑开窍针刺法结合高压氧对缺血缺氧性脑病患者血液流变学的影响[J].针刺研究,2017,42(6):518-521.
[6] BYEON H S,MOON S K,PARK S U,et al.Effects of GV20acupuncture on cerebral blood flow velocity of middle cerebral artery and anterior cerebral artery territories,and CO2reactivity during hypocapnia in normal subjects[J].J Altern Complement Med,2011,17(3):219-224.
[7] AN Y S,MOON S K,MIN I K,et al.Changes in regional cerebral blood flow and glucose metabolism following electroacupuncture at LI 4and LI 11in normal volunteers[J].J Altern Complement Med,2009,15(10):1075-1081.
[8] ZHANG Y,GLIELMI C B,JIANG Y,et al.Simultaneous CBF and BOLD mapping of high frequency acupuncture induced brain activity[J].Neurosci Lett,2012,530(1):12-17.
[9] HALL C N,REYNELL C,GESSLEIN B,et al.Capillary pericytes regulate cerebral blood flow in health and disease[J].Nature,2014,508(7494):55-60.
[10] ZHANG S Q,WANG Y J,ZHANG J P,et al.Brain activation and inhibition after acupuncture at Taichong and Taixi:resting-state functional magnetic resonance imaging[J].Neural Regen Res,2015,10(2):292-297.
[11] RATMANSKY M,LEVY A,MESSINGER A,et al.The effects of acupuncture on cerebral blood flow in post-stroke patients:a randomized controlled trial[J].J Altern Complement Med,2016,22(1):33-37.
[12]周鸿飞,王健,曹铁军,等.应用SPECT观察眼针对脑梗死患者脑血流的影响[J].中国针灸,2011,31(5):391-394.
[13] ZHANG X Z,WU B Q,NIE K,et al.Effects of acupuncture on declined cerebral blood flow,impaired mitochondrial respiratory function and oxidative stress in multi-infarct dementia rats[J].Neurochem Int,2014,65:23-29.
[14] ZHOU F,GUO J C,CHENG J S,et al.Electroacupuncture increased cerebral blood flow and reduced ischemic brain injury:dependence on stimulation intensity and frequency[J].J Appl Physiol,2011,111(6):1877-1887.
[15] UCHIDA S,KAGITANI F.Effect of acupuncture-like stimulation on cortical cerebral blood flow in aged rats[J].J Physiol Sci,2015,65(1):67-75.
[16] KIM J H,CHOI K H,JANG Y J,et al.Electroacupuncture acutely improves cerebral blood flow and attenuates moderate ischemic injury via an endothelial mechanism in mice[J].PLoS One,2013,8(2):e56736.
[17]王建枝,殷莲华.病理生理学[M].8版,北京:人民卫生出版社,2013.
[18]冯吉杰,王珂,陈彤宇,等.针刺调控炎性反应在抗缺血再灌注损伤中的研究进展[J].针刺研究,2017,42(6):552-556.
[19]李玉林.病理学[M].8版,北京:人民卫生出版社,2013.
[20]陈素辉,孙华,徐虹,等.针刺对脑缺血再灌注损伤大鼠双侧脑组织白细胞介素-1β、肿瘤坏死因子-α表达的影响[J].针刺研究,2012,37(6):470-475.
[21]陈素辉,孙华,徐虹,等.针刺百会和足三里穴对脑缺血再灌注损伤大鼠双侧脑组织白细胞介素-6表达的影响[J].针灸临床杂志,2014,30(1):42-45.
[22]娄元俊,刘阳,单海军,等.针灸对脑性瘫痪幼鼠模型行为学的影响及其机制[J].中国组织工程研究,2016,20(49):7314-7319.
[23]卢岩,赵海军,王媛,等.电针对局灶性脑缺血大鼠神经功能、脑血流及脑组织细胞色素P450表氧化酶基因表达的影响[J].针刺研究,2014,39(5):345-350.
[24]杨丽红,杜元灏,李晶,等.电针对脑梗死大鼠脑血管内皮细胞Apelin-APJ系统的影响[J].针刺研究,2017,42(1):9-13.
[25]张莹,秦文熠,罗勇.电针对局灶脑缺血/再灌注大鼠大脑缺血皮层区白介素-4/信号传导及转录激活因子6与核因子-κB的影响[J].针刺研究,2017,42(3):217-222.
[26]王金海,赵敏,鲍英存,等.头穴透刺对急性脑梗死患者血清超敏C反应蛋白及炎性反应因子水平的影响[J].针刺研究,2016,41(1):80-84.
[27] HUANG J,YOU X F,LIU W L,et al.Electroacupuncture ameliorating post-stroke cognitive impairments via inhibition of peri-infarct astroglial and microglial/macrophage P2 purinoceptors-mediated neuroinflammation and hyperplasia[J].BMC Complement Altern Med,2017,17(1):480.
[28] LIU W L,WANG X,YANG S L,et al.Electroacupuncture improves motor impairment via inhibition of microglia-mediated neuroinflammation in the sensorimotor cortex after ischemic stroke[J].Life Sci,2016,151:313-322.
[29]沈梅红,项晓仁,李缨,等.电针对脑缺血大鼠大脑皮层γ-谷氨酰半胱氨酸合成酶蛋白及基因表达的影响[J].针刺研究,2012,37(1):25-30.
[30] XU T,XU N G,YANG Z H,et al.Neuroprotective effects of electroacupuncture on hypoxic-ischemic encephalopathy in newborn rats are associated with increased expression of GDNF-RET and protein kinase B[J].Chin J Integr Med,2016,22(6):457-466.
[31] LIN R H,WU Y N,TAO J,et al.Electroacupuncture improves cognitive function through Rho GTPases and enhances dendritic spine plasticity in rats with cerebral ischemia-reperfusion[J].Mol Med Rep,2016,13(3):2655-2660.
[32]张业贵,龚鑫,侯良芹,等.电针预处理对脑缺血再灌注大鼠大脑皮质一氧化氮合酶及胶质纤维酸性蛋白表达的影响[J].针刺研究,2015,40(2):113-118.
[33]林咸明,陈丽萍,姚旭,等.不同时程电针预处理对脑缺血再灌注大鼠血脑屏障基质金属蛋白酶-9、血管内皮生长因子的影响[J].针刺研究,2015,40(1):40-44.
[34]罗磊,孙国杰,杜艳军.针灸对AD模型大鼠海马神经元线粒体能量代谢相关蛋白的影响[J].中国针灸,2013,33(10):913-918.
[35]韩永升,徐银,韩咏竹,等.电针对局灶性脑缺血再灌注大鼠神经血管单元的保护作用[J].针刺研究,2013,38(3):173-180.