脑缺血再灌注后神经细胞凋亡及针灸干预机制的研究进展

Research Progress of Neurocyte Apoptosis after Cerebral Ischemia-Reperfusion Injury and Mechanism of Acupuncture and Moxibustion Intervention

脑缺血再灌注损伤(CIRI)是指在梗死区缺血脑组织的血管重新恢复血流灌注后所产生的一系列级联反应而造成的损害,其症状可较前期加重,表现为脑神经细胞凋亡、坏死或者组织形态学改变等。神经细胞凋亡在CIRI病理过程中发挥关键作用。现通过国内外文献总结了脑缺血再灌注后神经细胞凋亡的相关因素,主要包括兴奋性氨基酸/氧自由基、钙超载、线粒体损伤、凋亡基因、内质网应激、炎症反应。溶栓治疗是目前缺血性脑血管病(IVCD)最有效、最常用的治疗方式,但存在过程复杂化、操作不便利等缺点,而针灸疗法对于IVCD治疗具有操作方便、不良反应少等优点,能很好地弥补溶栓疗法操作复杂、易受时间地点等客观因素限制的不足,有较佳的辅助治疗效果。目前经大量基础研究发现,针灸疗法可介导包括兴奋性氨基酸毒性、钙超载、炎症反应、凋亡基因等方面对神经细胞凋亡进行治疗,但目前在内质网应激、线粒体损伤的针灸疗法研究较少,故加强对于这2个方向的研究可为针灸治疗IVCD取得新的突破。

Cerebral ischemia-reperfusion injury(CIRI) refers to the damage caused by a series of cascade reactions after the blood vessels of ischemic brain tissue in the infarct area restore blood perfusion,and its symptoms can be aggravated compared with the previous stage.It is manifested as apoptosis,necrosis,or morphological changes of brain neurocytes.Neurocyte apoptosis plays an extremely important role in the pathological process of CIRI.As indicated by literature review in China and abroad,there are many factors that cause neurocyte apoptosis after CIRI,including excitatory amino acid/oxygen free radical,Ca~(2+) overload,mitochondrial damage,apoptosis-associated gene,endoplasmic reticulum stress,and inflammatory response.Currently,thrombolysis serves as the most effective and commonly used treatment for ischemic cerebrovascular disease(ICVD),but it is disadvantageous in the complicated process and inconvenient operation.Acupuncture and moxibustion therapy has the advantages of convenient operation and few side effects for the treatment of ICVD.It can make up for the deficiency of thrombolysis with the complex operation which is limited by objective factors such as time and place and has a good adjuvant effect on the disease.As reported by a large number of basic studies,acupuncture and moxibustion therapy can treat neurocyte apoptosis by mediating excitatory amino acid toxicity,Ca~(2+) overload,inflammatory response,apoptosis-associated gene,etc.At present,however,research on acupuncture and moxibustion therapy in endoplasmic reticulum stress and mitochondrial damage is rarely reported.Strengthening the research on these two aspects may make a breakthrough in the acupuncture and moxibustion treatment of CIRI.