充分调动内源性神经保护——试论针刺对卒中后的脑保护作用机制

Mobilizing endogenous neuroprotection sufficiently:Discussion on the mechanism of brain protection activated and regulated by acupuncture after cerebral ischemic stroke

缺血性脑卒中具有高发病率、高致残率、高病死率的特点,严重危害人类健康。但证实有效的早期溶栓治疗受严苛的时间窗限制。缺血损伤诱导细胞级联反应过程复杂、进展快,针对单一病理因素的治疗不足以明显改善神经功能,患者恢复程度有限,因此增强机体内源性自我保护能力是必需的。针刺可以通过激发人体自身正气,达到防病治病的目的,且经临床验证治疗脑卒中有效。诸多实验研究表明针刺可以增强脑内源性保护通路,即通过增强星形胶质细胞调控途径,以减少氧化应激、抑制兴奋性毒性、炎症及凋亡以保护神经元;促进小胶质细胞抗炎作用,以减少自身免疫反应;调节血管或血脑屏障以恢复血流量,发挥神经保护作用,但其机制尚不清楚。因此,本文通过回顾针刺防治缺血性卒中的实验证据,以期揭示针刺可能的内源性神经保护增效机制,为针刺治疗卒中提供一定的理论依据。

Cerebral ischemic stroke(CIS)is characterized by its high morbidity,disability,and mortality,which seriously endangers human health.However,early thrombolytic therapy which proven effective has been im⁃posed strictly by a rigorous time window.The complicated process of cell cascade reaction induced by ischemic in⁃jury is progressing rapidly.The treatment for any single pathological factor is less than enough to improve nerve function significantly.Therefore,it is essentially necessary to enhance the endogenous self-protection ability of the body due to patients’finite degree of recovery.Acupuncture can somehow achieve the objectives of disease pre⁃vention and treatment by stimulating the self-integrity and righteousness in human body,which has been clinically proved to be effective in the treatment of CIS.Many studies have shown that acupuncture can regulate the func⁃tion of astrocytes,reduce oxidative stress,protecting neurons via inhibiting excitatory toxicity,inflammation and apoptosis through the process of activating endogenous protection pathways in brain.Acupuncture regulates the transformation of microglia to reduce inflammation and autoimmune response,as well as regulates vascular or blood-brain barrier to restore blood flow.However,the mechanism of the entire process is unknown beyond clear.Therefore,this article aims to reveal the potential endogenous neuroprotective mechanism activated by acupunc⁃ture via reviewing the experimental evidences in acupunctural prevention and treatment for Cerebral ischemic stroke,and provide theoretical basis for acupuncture in the treatment of stroke.