摘要
认知障碍(cognitive impairment,CI)高发于蛛网膜下腔出血(subarachnoid hemorrhage,SAH)这一重型脑血管疾病。随着外科治疗发展,SAH病死率已获得有效控制,SAH CI越发引起关注。针刺疗法可改善出血性脑卒中患者日常生活能力,对CI亦有确切效果。相关研究表明细胞凋亡异常是SAH CI发生发展的重要原因。本文系统分析SAH CI过程中凋亡相关通路,并详细论述针刺干预细胞凋亡的机制。由细胞凋亡的线粒体途径看来,针刺能调节B淋巴细胞瘤-2(B cell lymphoma-2,Bcl-2)、Bcl-2相关X蛋白(BCL2-associated X,Bax)、半胱氨酸天冬氨酸蛋白酶-9(cysteinyl aspartate specific proteinase-9,Caspase-9)等表达,控制Caspase级联反应以及非Caspase依赖凋亡过程。于内质网途径来说,针刺疗法可调控蛋白激酶R样内质网激酶、葡萄糖调节蛋白78、Caspase-12等的活性,制约过度内质网应激。就死亡受体途径而言,针刺能够抑制肿瘤坏死因子-α与其受体结合引起的细胞凋亡与炎症反应。可知对于细胞凋亡多种途径,针刺均可发挥调控作用,对过度凋亡信号传递具有削弱效应,且与协调Janus激酶/信号转导和转录激活蛋白、磷脂酰肌醇-3-激酶/蛋白激酶B、丝裂原活化蛋白激酶等信号通路有关,其间也可见针刺的整体、双向、良性调整作用特点。文章尝试从细胞凋亡角度探讨针刺干预SAH CI可能机理,旨在为相关研究和临床防治提供参考与思路。
Cognitive impairment(CI)occurs frequently after subarachnoid hemorrhage(SAH).With the development of surgical treatment,the death rate of SAH has been effectively controlled,and SAH CI has become a growing concern.Acupuncture therapy can improve the ability of daily living in patients with hemorrhagic stroke,and also has good effects on cognitive impairment.Related studies have shown that abnormal apoptosis is an important cause of the development of SAH CI.The article systematically analyzes the apoptosis-related pathways during SAH CI and discusses the mechanism of acupuncture intervention in apoptosis.From the mitochondrial pathway of apoptosis,it is appeared that acupuncture can regulate the expression of Bcell lymphoma-2(BCL-2),BCL2-Associated X(Bax)and Caspase-9.Acupuncture controls the Caspase cascade reaction as well as non-Caspase-dependent apoptotic processes.For the endoplasmic reticulum pathway,acupuncture therapy modulates the activity of PKR-like ER kinase,glucose-regulated protein 78,and caspase-12 to limit excessive endoplasmic reticulum stress.In terms of the death receptor pathway,acupuncture can modulate the apoptotic and inflammatory responses caused by the binding of tumor necrosis factor-α(TNF-α)to its receptor.It can be seen that acupuncture can play a regulatory role in various apoptosis pathways,and has a weakening effect on excessive apoptosis signal transmission.And it is related to the coordination of JAK/STAT,PI3K/Akt,MAPK and other signaling pathways.The characteristics of acupuncture's overall,bidirectional and benign adjustment can also be seen.This article attempts to explore the possible mechanism of acupuncture intervention in SAH CI from the perspective of apoptosis,in order to provide references and ideas for related research and clinical prevention and treatment.
作者
熊康
张美玲
王祯芝
方永军
胡珍渊
周锋
XIONG Kang;ZHANG Meiling;WANG Zhenzhi;FANG Yongjun;HU Zhenyuan;ZHOU Feng(Shaanxi University of Chinese Medicine,Xianyang 712000,China)
出处
《环球中医药》
CAS
2023年第5期1044-1050,共7页
Global Traditional Chinese Medicine
基金
国家自然科学基金面上项目(81873387)
国家中医药创新骨干人才项目(国中医药人教涵[2019]128号)
咸阳市中青年科技领军人才培育项目(重大科技创新专项)(2019k01-52)
陕西中医药大学培养计划项目(2017SZKY-018)。
