基于小胶质细胞极化探讨中医药治疗缺血性卒中的研究进展

A review on treating ischemic stroke in TCM based on microglial cell polarization

由脑血管血流受阻所致的卒中为缺血性卒中,缺血性率中占所有卒中的85%左右,且有较高的致残率和病死率,严重危害人类身体健康。目前,静脉溶栓和机械取栓是治疗缺血性卒中的唯一有效手段,但是静脉溶栓有时间窗限制,而且静脉溶栓后突然恢复供血会引起脑组织二次损伤,即脑缺血再灌注损伤。脑缺血再灌注损伤会导致一系列炎症和氧化应激损伤,加重脑部神经损伤。研究认为神经炎症反应是缺血性卒中的重要机制。小胶质细胞是神经系统中重要的免疫细胞,在发生缺血性卒中后,小胶质细胞被快速激活并引发神经炎症反应。小胶质细胞的激活在损伤发作后持续数月。目前卒中后神经炎症及小胶质细胞极化的机制研究已经取得一定进展,中医药在通过抑制小胶质细胞极化控制炎症方面有一定的作用。国内外中医专家以小胶质细胞极化为切入点,运用中药单味药、复方药或者外治法治疗缺血性卒中,减少神经炎症损伤,降低神经元凋亡。文章概述了缺血性卒中后M1和M2小胶质细胞的激活、极化的分子机制,旨在描述小胶质细胞极化对缺血性卒中的作用及分子机制,同时还讨论了中医药通过小胶质细胞极化防治缺血性脑损伤,为缺血性卒中的治疗提供参考。

Stroke caused by obstruction of blood flow in cerebral vessels is ischemic stroke,which is the most common type of Sstroke.Ischemic stroke accounts for about 85%of all strokes,with a high rate of disability and mortality,which is seriously harmful to human health.At present,intravenous thrombolysis and mechanical thrombectomy are effective methods for the treatment of ischemic stroke.But intravenous thrombolysis has a time window.The sudden resumption of blood supply after intravenous thrombolysis will cause secondary brain injury,that is,cerebral ischemia-reperfusion injury.Cerebral ischemia-reperfusion injury can lead to a series of inflammatory and oxidative stress injury,and aggravate the brain nerve injury.Studies have shown that neuroinflammatory response is an important mechanism of ischemic stroke.Microglia is important immune cell in the nervous system.After ischemic stroke,microglia is rapidly activated and triggers neuroinflammatory response.The activation of microglia lasted for several months after the onset of injury.Progress has been made in the study of the mechanism of neuroinflammation and microglial polarization after stroke.TCM can inhibit the polarization of microglia and control inflammation.Ischemic stroke is treated by TCM experts with single,compound or external treatment of TCM based on microglial polarization,and neuronal inflammatory injury and neuronal apoptosis were reduced.In this paper,the molecular mechanisms of activation and polarization of M1 and M2 microglia after ischemic stroke are reviewed in order to describe the effect of microglial polarization on ischemic stroke and its molecular mechanism.At the same time,the mechanism of TCM in the prevention and treatment of ischemic brain injury based on microglia polarization is discussed,which is helpful to provide reference for the new treatment strategy of ischemic stroke.