针刺调节神经递质治疗卒中后失眠研究现况

Research Status of Acupuncture Regulating Neurotransmitter in the Treatment of Post-stroke Insomnia

神经递质水平失调是脑卒中常见的病理变化,以大脑相关结构的损伤为病理基础,破坏睡眠诱导通路和觉醒诱导通路,造成卒中后失眠,对卒中患者预后造成不利影响。针刺可以通过调节大脑及血浆中相关神经递质的水平从而达到改善睡眠的目的。现代研究发现针刺对于神经递质的调控具有多通路联合作用、多递质广泛调节的特点:(1)抑制兴奋性神经递质如去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)等交感类神经递质和皮质醇、食欲素等,维持深度睡眠,减少觉醒倾向,增加睡眠时长;(2)提高γ-氨基丁酸(GABA)等抑制性神经递质的表达,减少过度觉醒,改善睡眠质量;(3)调节褪黑素、阿片类物质等相关神经递质正常分泌,改善睡眠结构,减轻患者不适感,促使睡眠恢复正常节律。该文对相关神经递质研究进展进行评述,并分析目前研究存在的问题及缺点,为后续展开进一步研究提供思路。

Dysregulation of neurotransmitter levels is a common pathological change in stroke,based on damage to relevant brain structures,which disrupts sleep-inducing pathways and wake-inducing pathways,causing insomnia after stroke and adversely affecting the prognosis of stroke patients.Acupuncture can improve sleep by regulating the levels of relevant neurotransmitters in the brain and plasma.Modern studies have found that acupuncture's modulatory effects on neurotransmitters are characterized by the combined effects of multiple pathways and extensive regulation of multiple transmitters:(1)Inhibiting excitatory neurotransmitters such as norepinephrine(NE),dopamine(DA),5-hydroxytryptamine(5-HT)and other sympathetic neurotransmitters,cortisol and orexin,maintaining deep sleep,reducing the tendency to wake up and increasing the length of sleep;(2)Increasing the level of-aminobutyric acid(GABA)and other inhibitory neurotransmitters to reduce excessive wakefulness and improve sleep quality;(3)Regulate the normal secretion of melatonin,opioids and other related neurotransmitters to improve sleep structure,reduce patients'discomfort,and promote the restoration of normal sleep rhythm.This paper reviews the progress of related neurotransmitter research,and analyzes the problems and shortcomings of current research to provide ideas for further research to be carried out subsequently.