电针对轴突生长与抑制因子的干预

Interventional effect of electro-acupuncture on axon growth and inhibitive factor

目的:电针抗脑缺血和恢复神经功能的作用勿庸置疑,从国内外电针对脑缺血损伤后神经元轴突干预作用的研究发展现状出发,就电针对轴突生长与抑制因子干预作用等方面的进展作一综述。资料来源:应用计算机检索Medline1995-01/2006-04的与脑卒中早期神经再生相关文献,检索词“electricneedle,axongrowthandinhibitivefactor”,限定文献语种为英文;同时计算机检索CNKI数据库1999-01/2005-04期间的与电针对轴突生长与抑制因子影响的相关文献,检索词“电针,轴突生长与抑制因子”,限定文献语种为中文。资料选择:从资料中选取包括治疗组和对照组的文献,然后选择是随机临床试验的研究。纳入标准:①脑卒中早期康复治疗的随机对照临床试验。②治疗组为早期康复治疗组。③对照组为不进行早期康复治疗组。④患者年龄<80岁。⑤患者均为首次卒中。排除标准:综述类文献、没有对照组的文献。资料提炼:共收集到54篇关于脑卒中早期神经再生和电针对轴突生长与抑制因子影响的文献,29篇为随机临床试验纳入综述。排除的25篇中11篇是重复的同一研究,14篇为Meta分析研究。共32个试验包括3472例患者。资料综合:轴突生长与抑制因子在中枢神经系统神经再生的突出作用是调控轴突导向、引导轴突生长,协助构建精确的神经网络形成,在脑缺血损伤的病理生理过程发挥重要的双重功能。①脑缺血与神经再生:神经再生可以看成是成年脑内神经发育过程的重新启动,是特定条件下神经元突起的再生。轴突生长抑制性蛋白在正常发育过程中主要参与调控轴突导向、引导轴突生长,协助构建精确的神经网络。在神经损伤时表达则阻止成年动物神经再生的活性和轴突再生。轴突生长除受生长抑制蛋白调控外,还受轴突生长因子的作用,神经生长相关蛋白是其中的代表。②电针与轴突生长相关因子:针刺可增加碱性成纤维细胞生长因子、胶质细胞源性神经营养因子的表达,促进短暂性大脑中动脉闭塞大鼠血管内皮生长因子星形胶质细胞的表达和梗塞大脑血管的形成,增强急性脑缺血大鼠梗死灶周围血管内皮生长因子、Flt-1的表达。结论:神经再生是特定条件下神经元突起的再生,与生长抑制蛋白的调控和轴突生长因子的作用密切相关,电针通过调控轴突生长因子而促进中枢神经功能恢复。

OBJECTIVE： There is no doubt that electro-acupuncture can resist cerebral ischenfia and make neurofunctional recovery. This article is aimed to review the progression of the interventional effect of electro-acupuncture on axon growth and inhibitive factor and so on based on the internal and external research status of interventional effect of electro-acupuncture on neuronal axis after cerebral isehernia injury. DATA SOURCES： Related articles of early stroke nerve regeneration were searched for in Medline database published from January 1995 to April 2006 with the key words of “electric needle,axon growth and inhibitive factor” in English. Meanwhile, related literatures of effect of electro-aeupuncture on axon growth and inhibition factor in China National Knowledge Infrastructure （CNKI） database published between January 1999 and April 2005 with the key words of “electro-acupuncture, axon growth, inhibitive factor” in Chinese. STUDY SELECTION： The paper contained treatment group and control group were selected firstly, and then papers included studies of randomized clinical trial. Inclusive criteria： ①Randomized control clinical trial of early rehabilitative intervention of stroke, ②treatment group should be early rehabilitative intervention group, ③control group should be non early rehabilitative intervention group, and ④the patients were less than 80 years old, ⑤the patients were first onset of stroke. Exclusive criteria： reviews, literatures without control group. DATA EXTRACTION： Totally 54 papers of early stroke nerve regeneration as well as effects of electro-acupuncture on axon growth and inhibitive factor were selected, of which 29 articles of randomized clinical trial were collected. Of the excluded 25 papers, 11 papers were repetitive research, 14 papers were Mcta analysis. There were totally 32 trials contained 3 472 patients. DATA SYNTHESIS： The important function of axon growth and inhibitive factor in central nervous system was regulating axon guidance, guiding axon growth and assisting construction of the precise neural network. It played an important double role in pathological and physiological process of the cerebral isehemia damage. ①Cerebral isehemia and nerve regeneration： The nerve regeneration could be considered as the new start of neural development process in adult brain, was a regeneration of neurite under special condition. Repressible protein of axon growth mainly participated in regulating axon guidance, guiding axon growth and assisting construction of the precise neural network, The expression inhibited the activity of nerve regeneration and axon regeheration of adult animals when nerve was damaged. Axon growth was regulated not only by growth inhibitive protein, but also affected by axon growth factors. The nerve growth associ-ated protein was one of the representatives. ②Electro-acupuncture and axon growth correlation factor： Acupuncture could increase the expression of basic fibroblast growth factor （bFGF） and glial cell line-derived neurotrophic factor （GDNF）, enhance expression of astrocytes of vascular endothelial growth factor and the infarction cerebrovascular formation of rats with transient middle cerebral artery occulusion, and facilitate the expression of vascular endothelial growth factor and Flt-1 around infarcted focus of rats with acute cerebral ischemia. CONCLUSION： Nerve regeneration is the regeneration of neurite under special condition, which is closely assooiated with the regulation of growth inhibiting protein and the effect of axon growth factor. Electro-acupuncture promotes the recovery of central nerve function by regulating axon growth factor.