从“肝-脑相关”探讨中枢敏化对非糜烂性胃食管反流病的影响及机制

Discussion on Mechanism of Central Sensitization in Non-Erosive Reflux Disease Based on Theory of "Liver-Brain Being Related"

中医学认为非糜烂性胃食管反流病(non-erosive reflux disease,NERD)的主要病机为肝郁气滞,胃气上逆而致反酸,因此中医大多从“肝”论治NERD。现代医学研究认为NERD的核心病机是内脏高敏感,而随着神经电生理学、功能性脑显像技术的发展,人们进一步认识到中枢敏化是形成NERD内脏高敏感的关键。这种中枢神经系统的改变与中医“脑”功能关系密切。由此提出,从“肝”论治NERD可能是通过调控“脑”内发生的中枢敏化来改善内脏高敏感,从而发挥对NERD的治疗作用。

Traditional Chinese medicine believes that the main pathogenesis of non-erosive gastroesophageal reflux disease(NERD)is stagnation of liver Qi,and the upside-down of the stomach Qi causes acid reflux.Therefore,most Chinese medicine physicians treat NERD from"liver".Modern medical research believes that the core pathogenesis of NERD is visceral hypersensitivity.With the development of neuroelectrophysiology and functional brain imaging,it is further recognized that the central sensitization mechanism is the key to the development of NERD visceral hypersensitivity.This change in the central nervous system is closely related to the"brain"function of traditional Chinese medicine.It is suggested that the treatment of NERD in terms of"liver"may improve visceral hypersensitivity by regulating the central sensitization in the brain.