Acupuncture for Pain Management: Molecular Mechanisms of Action
Acupuncture for Pain Management: Molecular Mechanisms of Action
复制标题
针灸治疗疼痛：分子作用机制
DOI：
10.1142/s0192415x20500408
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发表时间：
2020-01-01
影响因子：
5.7
通讯作者：
Wang, Yan-Qing
中科院分区：
文献类型：
--
作者：
Chen, Teng;Zhang, Wen Wen;Wang, Yan-Qing
针灸通过激活患者身体上称为穴位的特定区域来减轻疼痛。当这些穴位完全激活时，临床医生和患者会感到酸痛、麻木、饱胀或沉重的感觉，称为“得气”或“特气”。针灸有两种：手动针灸和电针灸（EA）。与非穴位相比，穴位因其介导针刺信号的血管、肥大细胞和神经纤维的特殊组成而很容易被激活。在脊髓中，EA 可通过下调趋化因子 CX3CL1 和增加抗炎细胞因子 IL-10 来抑制神经胶质细胞活化。这会抑制 P38 丝裂原激活蛋白激酶和细胞外信号调节激酶通路，这些通路与小胶质细胞 C-Jun N 末端激酶信号通路的激活以及随后的星形胶质细胞激活有关。脊髓小胶质细胞和星形胶质细胞的失活分别介导 EA 的即时和长期镇痛作用。神经胶质细胞释放的多种与疼痛相关的物质如促炎细胞因子肿瘤坏死因子α、白细胞介素1β、白细胞介素6以及前列腺素如前列腺素E2也可减少。大脑中的下行疼痛调节系统，包括前扣带皮层、导水管周围灰质和头端腹内侧延髓，在电针镇痛中发挥着重要作用。针刺镇痛涉及多种递质和调节剂，包括内源性阿片类药物、缩胆囊素八肽、5-羟色胺、谷氨酸、去甲肾上腺素、多巴胺、γ-氨基丁酸、乙酰胆碱和食欲素A。最后，介绍了“针刺”策略，帮助临床医生取得更好的镇痛效果，并讨论了新报道的穴位埋线针灸方法，即在穴位注射由可吸收材料制成的缝线，以达到长期效果。
Acupuncture reduces pain by activating specific areas called acupoints on the patient's body. When these acupoints are fully activated, sensations of soreness, numbness, fullness, or heaviness called De qi or Te qi are felt by clinicians and patients. There are two kinds of acupuncture, manual acupuncture and electroacupuncture (EA). Compared with non-acupoints, acupoints are easily activated on the basis of their special composition of blood vessels, mast cells, and nerve fibers that mediate the acupuncture signals. In the spinal cord, EA can inhibit glial cell activation by down-regulating the chemokine CX3CL1 and increasing the anti-inflammatory cytokine interleukin-10. This inhibits P38 mitogenactivated protein kinase and extracellular signal-regulated kinase pathways, which are associated with microglial activation of the C-Jun N-terminal kinase signaling pathway and subsequent astrocyte activation. The inactivation of spinal microglia and astrocytes mediates the immediate and long-term analgesic effects of EA, respectively. A variety of pain-related substances released by glial cells such as the proinflammatory cytokines tumor necrosis factor alpha, interleukin-1 beta, interleukin-6, and prostaglandins such as prostaglandins E2 can also be reduced. The descending pain modulation system in the brain, including the anterior cingulated cortex, the periaqueductal gray, and the rostral ventromedial medulla, plays an important role in EA analgesia. Multiple transmitters and modulators, including endogenous opioids, cholecystokinin octapeptide, 5-hydroxytryptamine, glutamate, noradrenalin, dopamine, gamma-aminobutyric acid, acetylcholine, and orexin A, are involved in acupuncture analgesia. Finally, the "Acupuncture thorn" strategy is introduced to help clinicians achieve better analgesic effects, and a newly reported acupuncture method called acupoint catgut embedding, which injects sutures made of absorbable materials at acupoints to achieve longterm effects, is discussed.