中西医康复治疗对脑卒中后骨骼肌损伤的修复作用及机制研究进展

脑卒中是指由于脑部血管突然破裂或因血管阻塞引起脑组织损伤的一组疾病。脑卒中是全球人口第二大死亡原因，也是导致残疾的主要原因，每年导致约550万人死亡，脑卒中后大约有60%的患者处于残疾状态，给家庭及社会带来极大负担。目前脑卒中的治疗主要侧重于恢复大脑血供和治疗中风引起的神经损伤，对于脑卒中后导致的外周系统障碍的治疗研究相对较少。骨骼肌是脑卒中后主要影响的外周功能器官，在脑卒中后神经系统的损害会导致肌肉失神经支配，从而导致偏瘫或肌肉力量下降，缺乏神经支配使肌肉无法产生运动所需的肌力，从而无法完成日常任务。在整个过程中骨骼肌出现各种继发改变，包括骨骼肌无力、骨骼肌痉挛、骨骼肌萎缩等，导致肢体功能障碍。而对骨骼肌变化的机制研究则证实脑卒中后骨骼肌的结构和代谢发生明显变化，其中神经肌肉接头功能异常，骨骼肌中炎症标志物的升高，骨骼肌蛋白的降解，肌纤维的表型转变都与脑卒中后骨骼肌功能障碍密切相关。因此脑卒中后骨骼肌的修复及功能的恢复非常重要，现有的康复治疗对脑卒中后骨骼肌的恢复具有良好的修复作用，能降低炎性因子的表达，恢复神经肌肉接头的联系，增强外周与中枢的联系，促进骨骼肌肌纤维的生长，从而达到肢体功能的恢复。本文对脑卒中后骨骼肌的康复治疗进行综述，阐明相关机制，以期为脑卒中后患侧骨骼肌的康复治疗研究提供参考。 

Research progress of rehabilitation effect and mechanism of traditional Chinese and Western medicine on skeletal muscle injury after stroke

Stroke is a disease in which a blood vessel in the brain bursts or a blockage causes damage to brain tissue. Stroke is the second leading cause of death in the world and the main cause of disability, resulting in about 5.5 million deaths every year. About 60% of patients are disabled after stroke, bringing a great burden to their families and society. At present, the treatment of stroke focuses on restoring cerebral blood supply and treating nerve damage caused by stroke, but studies on the treatment of peripheral system disorders caused by stroke are relatively few. As the peripheral functional organ is affected by stroke, the damage of the nervous system after stroke will lead to muscle denervation, resulting in hemiplegia or decreased muscle strength. Lack of nerve innervation makes the muscle unable to produce the muscle strength required for movement, so daily tasks may not be completed. Various secondary changes occur in skeletal muscle during the whole process, including skeletal muscle weakness, skeletal muscle spasm and skeletal muscle atrophy, leading to limb dysfunction. Studies on the mechanism of skeletal muscle changes confirmed that skeletal muscle structure and metabolism change significantly after stroke, amongst which abnormal neuromuscular junction function, increased inflammatory markers in skeletal muscle, degradation of skeletal muscle protein and phenotypic transformation of muscle fibres are closely related to skeletal muscle dysfunction after stroke. Therefore, skeletal muscle repair and functional recovery after stroke are critical. Existing rehabilitation therapy showed that skeletal muscle recovery after stroke has a good repair effects, such as reducing the expression of inflammatory cytokines, recovery of neuromuscular connection link, strengthening the peripheral and central link and promoting the growth of muscle fibre, to achieve the recovery of limb function. In this paper, the rehabilitation of skeletal muscle after stroke was reviewed, and the relevant mechanisms were elucidated to provide a reference for the rehabilitation of skeletal muscle on the affected side after stroke.