针刺通过修复皮质脊髓束改善脑卒中后运动功能障碍的研究进展

Progress of researches on involvement of corticospinal tract in the effect of acupuncture on improvement of post-stroke motor dysfunction

脑卒中后引发神经功能缺损,遗留运动功能障碍,严重影响患者的生活质量。针刺治疗脑卒中尤其在改善患者运动功能障碍中疗效显著。脑卒中后皮质脊髓束的损伤及修复情况与患者运动功能密切相关。针刺可以延缓皮质脊髓束的继发性损伤,也可以促进患侧皮质脊髓束的修复,加强健侧皮质脊髓束芽生再次跨越中线支配患侧,重构传导通路加强双侧大脑的联系。针刺促进皮质脊髓束修复的潜在机制与改善神经纤维束周围的神经营养因子,干预神经修复的抑制因子,以及调控RhoA、Notch信号通路等方面密切相关。

The corticospinal tract(CST), descending from the frontoparietal cortex and traveling down to terminate at the anterior horn of the spinal cord to mediate voluntary movements, is frequently injured from the infarcted or hemorrhagic cerebrovascular insults due to stroke. Under the circumstances, motor dysfunction seriously affects the patient’s quality of life. Acupuncture therapy has a sequelae, especially in improving motor deficits. In the present paper, we reviewed the current development of researches on acupuncture treatment of poststroke motor dysfunction and its biological mechanisms from 1) delaying patients’ development of neuronal degeneration and white matter fibrosis(Wallerian degeneration), 2) improving patients’ upper limb motor function and daily life ability by promoting the repair of white matter tracts and CST on the affected side, 3) promoting the compensation of CST on the healthy side, 4) reconstructing the motor conduction pathway to strengthen the bilateral brain connection in ex-perimental animals, and 5) strengthening the sprouting of the contralateral CST to dominate the affected side again across the midline. In addition, acupuncture stimulation induced improvement of axonal rewiring for corticospinal innervation is also possibly related to its functions in accelerating the synthesis and release of neurotrophic factors, down-regulating Nogo-A/RhoA signaling and activating vascular epithelial growth factor/Dll4/Notch signaling pathways.