中药治疗出血性脑卒中的研究进展

Research Progress on Amelioration of Hemorrhagic Stroke by Traditional Chinese Medicine

脑出血,也称出血性卒中,是指非外伤性脑实质内出血,是中老年人的常见病、多发病,具有病死率高、致残率高等特点,绝大多数存活者遗留严重的神经功能缺损症状,严重威胁人类健康和生活质量。出血性脑卒中的病理过程比较复杂,主要包括血肿的形成及扩大、颅内压升高、血脑屏障的破坏、脑水肿、神经细胞凋亡以及神经功能障碍。目前西医治疗脑出血的主要方法有抗血小板治疗、降压以及祛除血肿的外科手术等,然而通常伴有手术造成的再出血、感染、神经损伤、有效灌注压不足等风险。中医认为,瘀血阻滞、内生热毒是急性期脑出血的最基本病机。研究证实许多中药可以改善脑出血相关的血脑屏障损伤、脑水肿、神经细胞凋亡以及神经功能障碍,从而减轻脑出血损伤,其调控的主要信号转导通路包括水通道转运蛋白4(AQP4)相关分子通路,磷脂酰肌醇3-激酶/蛋白激酶B(PI3K/Akt)分子通路,核转录因子-κB(NF-κB),肿瘤阻抑蛋白/B-细胞白血病淋巴瘤-2-相关X蛋白/半胱氨酸蛋白酶-3(P53/Bax/Caspase-3)分子通路等。本文从目前中药对脑出血介导脑损伤的改善作用以及干预的分子通路出发,综述近十年来发表在国外期刊的相关研究进展,以期为中医药防治出血性脑卒中的临床应用和进一步新药研发提供线索和参考依据。

Cerebral hemorrhage,also known as hemorrhagic stroke,refers to non-traumatic intracerebral hemorrhage.Cerebral hemorrhage is a common and frequently-occurring disease in middle-aged and elderly people.It has the characteristics of high mortality and high disability rate.Most survivors have serious neurological deficits,which seriously threaten human health and quality of life.The pathological process of cerebral hemorrhage is more complicated,including the formation and expansion of hematoma,elevated intracranial pressure,destruction of blood-brain barrier,brain edema,neuronal apoptosis and neurological dysfunction.At present,the main methods for treating cerebral hemorrhage by western medicine include antiplatelet therapy,blood pressure reduction and hematoma surgery.However,it is usually accompanied by the risk of rebleeding caused by surgery,infection,nerve damage and insufficient effective perfusion pressure.Chinese medicine believes that blood stasis and endogenous fever are the most basic pathogenesis of acute cerebral hemorrhage.The previous studies found that many traditional Chinese medicine(TCM)can improve blood-brain barrier damage,brain edema,neuronal apoptosis and neurological dysfunction related to cerebral hemorrhage to reduce cerebral hemorrhage injury.Main signal transduction pathways regulated by TCM to treat cerebral hemorrhageinclude Aquaporin 4(AQP4)-related,phosphatidylinositol-3-kinase/protein kinase B(PI3 K/Akt),nuclear factor kappa B(NF-κB),suppressor protein 53/Bcl-2-associated X protein/Caspase-3(p53/Bax/Caspase-3)molecular pathways,etc.In this paper,based on the current Chinese medicine to improve the brain damage caused by cerebral hemorrhage and the molecular pathway of intervention,it reviews the research progress published in foreign journals in the past ten years,in order to provide clues and reference for the treatment of hemorrhagic stroke diseases and and the further development of new drugs.