基于谷氨酸能系统障碍探讨针刺治疗卒中后抑郁的可能机制

Probe into the Possible Mechanism of Acupuncture in the Treatment of Post-stroke Depression Based on Glutamatergic System Disorder

针刺治疗卒中后抑郁的作用机制是多靶点的,针刺对抑郁患者的神经内分泌系统、神经递质、神经免疫系统、各种信号传导通路、神经营养因子以及神经元重塑、神经传导通路等均有所调节和改善,体现了中医针灸疗法中的整体观念。但仍存在以下问题:①慢性应激致动物抑郁模造模法被广泛认可和应用,但对卒中后抑郁造模尚未制定统一标准,期间应激方法的选择、顺序的安排及造模时辰等无统一规范,临床可重复性差;②针刺选穴主要集中于百会、印堂等脑部腧穴,与卒中后抑郁的临床证型没有很好地契合,降低了疗效的可信度;③有关针刺治疗卒中后抑郁中针刺作用机理的实验研究较少,尚无运用针刺通过谷氨酸代谢的变化治疗卒中后抑郁的相关实验研究。故在今后的实验研究中可考虑排除干扰因素,统一造模标准,完善实验设计,研究针刺对卒中后抑郁患者谷氨酸能代谢的影响,以期为临床提供确切证据。

The mechanism of acupuncture in the treatment of post-stroke depression is multi-target. Acupuncture can regulate and improve the neuroendocrine system, neurotransmitters, neuroimmune system, various signal transduction pathways, neurotrophic factors ,neuron remodeling and nerve transduction pathways of patients with depression, which embodies the overall concept of acupuncture and moxibustion therapy in Chinese medicine. However, the following problems still exist :①chronic stress-induced animal depression model has been widely accepted and applied, but there is no unified standard for post-stroke depression model. There is no unified criterion for the selection of stress methods, the sequence of stress methods and the duration of modeling, and the clinical repeatability is poor;②acupuncture mainly focused on Baihui, Yintang and other brain acupoints, which did not fit well with the clinical syndromes of post-stroke depression and reduced the reliability of curative effect;③there are few experimental studies on the mechanism of acupuncture in the treatment of post-stroke depression, and there is no relevant experimental study on the treatment of post-stroke depression by acupuncture through glutamate metabolic changes. Therefore, in the future related experimental studies, we can consider excluding the relevant interference factors, unifying the standard of modeling, improving the experimental design, and studying the effect of acupuncture on glutamate metabolism in patients with post-stroke depression in order to provide accurate evidence for clinical practice.