基于神经-血管单元空间构筑探讨针刺治疗缺血性脑卒中的研究进展CSCD

目的:基于脑缺血后神经-血管单元(NVU)空间构筑变化探讨针刺治疗缺血性脑卒中(IS)作用机制的研究进展。方法:通过查阅国内外文献资料,总结归纳神经科学领域中对NVU的研究成果,以及针刺治疗IS的研究现状,主要从NVU的结构功能和在IS中的空间构筑变化,以神经元为单维靶点,以神经元、脑微血管内皮细胞(BMEC)为二维靶点,以及以神经元、BMEC、胶质细胞为多维靶点的针刺研究等方面进行阐述。结果:以往关于针刺治疗IS的研究,大多仅停留在对神经元或血管新生调控的单一层面,较少涉及对NVU的整体及各组分间相互作用的研究,同时无论是基础研究还是临床研究,均缺乏以NVU空间构筑为切入点的系统治疗方案。针刺治疗IS具备多组分、多靶点、多环节作用的优势和特点,此与中医辨证论治、整体观念相吻合,一直是中医学和神经科学等领域的研究热点。针刺可抑制神经元凋亡,调节突触可塑性,重组、补偿大脑功能网络;针刺可诱导新生血管形成,调控脑部血流量,协同神经和血管间的耦合;针刺能调控星形胶质细胞能量代谢,抑制兴奋性毒性和炎症反应,基于双向调节效应,统筹、协调神经元、BMEC、胶质细胞间的相互作用。在诸多靶点中选择针对性干预措施,可为阐明针刺减轻脑缺血损伤的可能物质基础与有效作用靶点提供方向。结论:针刺治疗脑缺血作用机制与NVU关系密切,可通过双向调控NVU空间构筑变化,发挥协同神经保护作用,是促进脑缺血后功能恢复的关键。

Research Progress on the Mechanism of Acupuncture Treatment of Ischemic Stroke Based on the Space Construction of Nerve-vascular Unit

Objective:To explore the research progress on the mechanism of acupuncture treatment of ischemic stroke(IS),based on the changes in the space construction of nerve-vascular unit(NVU)after cerebral ischemia.Methods:The research result of NVU in the field of neuroscience and research status of acupuncture treatment of IS was summarized by referring to domestic and foreign literature.It was mainly discussed on acupuncture research from the structural function of NVU to the spatial structure changes in IS,with neurons as the one-dimensional target,neurons,brain microvascular endothelial cell(BMEC)as the two-dimensional target,and with neurons,BMEC and glial cells as the multi-dimensional target.Results:Most of the previous studies on acupuncture treatment of IS only stayed at a single level of neuron or angiogenesis regulation,and rarely involved the research on the overall NVU and the interaction among its components.Meanwhile there was a lack of systematic treatment plans with NVU space construction as the entry point both for basic and clinical studies.Acupuncture treatment of IS had the advantages and characteristics of multi-component,multi-target and multi-link effect,which was consistent with traditional Chinese medicine(TCM)syndrome differentiation and treatment,and had always been a popular research topic in the fields of TCM and neuroscience.Acupuncture could inhibit neuronal apoptosis,regulate synaptic plasticity,and reorganize and compensate brain functional network and induce neovascularization,regulate cerebral blood flow,and coordinate the coupling between nerves and blood vessels.It could also regulate the energy metabolism of astrocytes,inhibit excitatory toxicity and inflammatory response,and coordinate the interaction among neurons,BMEC and glial cells based on the bidirectional regulation effect.The selection of targeted interventions among many targets could provide a direction to elucidate the possible material basis and effective target of acupuncture to reduce cerebral ischemic injury.Conclusion:The mechanism of acupuncture treatment of ischemic stroke is closely related to NVU,which plays a synergistic neuroprotective role by bidirectional regulation of NVU spatial architecture,and it is the key to promote functional recovery after cerebral ischemia.