中医药保护脑缺血再灌注损伤后神经血管单元的作用

脑缺血再灌注损伤(CIRI)是多环节、多因素、多途径的酶促级联反应,其发生发展与炎症、氧化应激、血管功能紊乱、细胞凋亡等机制密切相关。目前针对CIRI后特定神经元或血脑屏障等单一结构功能改变的研究较多,而对脑组织整体变化的研究较少。神经血管单元是由血管、神经元、血脑屏障及神经胶质细胞相互作用构成的整体。当CIRI损伤后,出现神经元变性、坏死,血脑屏障通透性改变,小胶质细胞增生等一系列复杂的病理变化,最终引起继发性脑损伤。因此在治疗策略中,通过加强神经细胞-细胞间和非神经细胞之间的信号联系,双向调节神经-胶质细胞-血管内皮细胞,促进神经元存活,提高突触重塑及神经再生等修复过程,是保证神经血管单元间正常功能和血流的物质基础,可作为新的治疗靶点,故神经血管单元概念的提出为缺血性脑损伤的基础研究及临床治疗提供了新的研究方向。中医药具有多组分、多靶点及整体调节的优势特点,能够对CIRI后神经血管单元起到整体保护作用。笔者拟对CIRI后神经血管单元结构的改变及中医药对其调节作用机制进行综述。

Effect of Neurovascular Unit After Cerebral Ischemia Reperfusion Injury Treated by Traditional Chinese Medicine

Cerebral ischemia reperfusion injury (CIRI) is a multiple-link, multiple-factor and multiple-pathway enzyme cascade reaction. Its occurrence and development are closely related to inflammation, oxidative stress, vascular dysfunction, apoptosis and other mechanisms. At present, there are many studies on the changes of single structure and function of specific neurons or blood brain barrier after CIRI, but a few studies on the overall structure and function of brain tissue. The neurovascular unit contains interactions of blood vessels, neurons, blood brain barriers and glial cells. After CIRI, there are a series of complex pathological changes in neuron degeneration and necrosis, blood brain barrier permeability and microglia proliferation, which eventually causes secondary brain injury. Therefore, in the treatment strategy, the signal connection between neuron-cells and non-neuronal cells was strengthened to regulate the neuro-glial cell-vascular endothelial cells in a two-way manner, promote neuronal survival and improve the repair process of synaptic remodeling and nerve regeneration. This is the material basis to guarantee the normal function and blood flow between neurovascular units, and can be used as a new therapeutic target. The concept of neurovascular unit provides a new direction for the basic research and treatment of ischemic brain injury. Traditional Chinese medicine (TCM) has advantages of multiple components, multiple targets and overall regulation, which generally play a protective role to neurovascular units after injury protection. This article reviews the changes of neurovascular unit structure after CIRI and the mechanism of TCM regulation on it.