褪黑素在治疗慢性痛-抑郁共病中的机制探讨

Mechanism of melatonin in the treatment of chronic pain-depression co-morbidity

疼痛和抑郁是对许多有害刺激最常见的神经反应,两者互为彼此的危险因素,疼痛与抑郁的共病关系增加了临床治疗难度。寻求一种兼具镇痛、抗抑郁的药物是当前临床管理疼痛与抑郁的迫切目标。松果腺分泌的褪黑素(N-乙酰基-5-甲氧基色胺)具有多种功能,包括抗炎、抗氧化、免疫调节、镇静和镇痛。褪黑素作为一种止痛剂和抗抑郁药的高效性、安全性以及基本无毒副作用已经在各种疼痛动物模型中得到证实,这使得褪黑素在不同的病理条件下以及在手术患者中得到了临床应用。褪黑素介导的镇痛、抗抑郁作用可能涉及炎性因子、星形胶质细胞、蛋白激酶C(PKC)/N-甲基-D-天冬氨酸(NMDA)通路。然而,目前国内关于褪黑素在疼痛综合征与抑郁中的作用机制报道较少,故笔者通过查阅国内外文献,归纳分析了褪黑素镇痛、抗抑郁的作用机理,为推广褪黑素在临床治疗相关疾病提供理论依据。

Pain and depression are the most common neural responses to many harmful materials or stimuli.They are risk factors for each other.The comorbid relationship between pain and depression makes clinical treatment difficult.Seeking a drug with analgesic and antidepressant activities is an urgent goal for the clinical management of pain and depression.Melatonin(N-acetyl-5-methoxytryptamine)secreted by the pineal gland has multiple functions,including anti-inflammatory,antioxidant,immunomodulatory,sedative and analgesic activities.The effectiveness,safety,and non-toxic side effects of melatonin as an analgesic and antidepressant have been demonstrated in various pain animal models,which allows application of melatonin in different pathological conditions and during surgery.Melatonin-mediated analgesic and antidepressant effects may be associated with inflammatory factors,astrocytes,protein kinase C(PKC)/N-methyl-D-aspartate(NMDA)pathway.However,there are few reports about the mechanism of melatonin in pain syndrome and depression in China.Therefore,this article summarizes the analgesic and antidepressant mechanism of melatonin by searching domestic and foreign literature to provide theoretical basis for the clinical treatment of related diseases.