基于钙调节的腺苷受体介导针刺预治疗改善缺血性心肌损害的思路探讨

A Potential Role of Adenosine A 2 b Receptor in Mediating Acupuncture Pretreatment Induced Cardioprotection via Influencing Intracellular Calcium Regulator

缺血预处理能够改善缺血性心肌损害,但因其操作不便,很少付诸临床。以往的实验和临床研究表明针刺预治疗可以模仿缺血预处理减轻缺血性心肌损害。腺苷受体A 2b激活被证明参与和介导了缺血预处理对心肌的保护作用,针刺镇痛的研究证明腺苷受体可以被针刺激活,有关研究还证明,针刺预治疗可以影响细胞腺苷受体A 2b。因此,腺苷受体A 2b极有可能参与了介导针刺预治疗对缺血心肌的保护作用。本文通过系统梳理和讨论缺血预处理的作用及其局限性、针刺预治疗与缺血预处理对心肌相似的保护作用、针刺预治疗保护缺血性心肌的临床应用、心肌缺血性损伤与细胞内钙调节的相关机制、腺苷受体与细胞内钙关系以及针刺与腺苷受体的关系等,提出腺苷受体A 2b极有可能参与介导针刺预治疗减轻缺血性心肌损害的新研究思路。未来的研究可以围绕心肌细胞腺苷受体A 2b及心肌细胞内钙信号转导相关因子对针刺预治疗保护缺血性心肌的科学机制进行深入系统的探讨。

It has been shown that ischemia preconditioning （IPC） can attenuate the myocardial injury induced by ischemic and reperfusion. But it was rarely used in clinic due to its inoperability. Previous studies indicate that electroacupuncture （EA） pretreatment can mimic myocardial ischemia preconditioning （MIPC） to produce cardioprotective effect. The activated adenosine A 2 b receptor has been proven to be involved in mediating the cardioprotection of IPO. In the studies on acupuncture analgesia, it was reported that adenosine receptor was activated by acupuncture stimulation, and acupuncture pretreatment can affect the acti- vities of intracellular A 2 b receptor. Based on those mentioned above, it is highly likely that the A 2 b receptor may also partici- pate in the cardioprotection produced by acupuncture pretreatment. In this paper, we comprehensively reviewed relevant studies regarding 1） the cardioprotective effect of IPC and its limitations, 2） the similar cardioprotection produced by both acupuncture pre-treatment and IPO, 3） the mechanism underlying myocardial ischemic injury and intracellular calcium regulation, 4） the acti- vation of adenosine receptors and effects of acupuncture, 5） the relationship between adenosine receptors and intracellular calcium ion, and 6） the effect of acupuncture on adenosine receptors, so as to provide a novel assumption that A 2 b receptor may be a key factor in mediating the cardioprotection of acupuncture pretreatment. Our future research will systematically explore the me- chanism of acupuncture pretreatment in protecting ischemic myocardium from myocardial cell adenosine A 2 b receptor and intracellu- lar calcium signal transduction related factors.