针刺调控脑肠轴改善卒中后便秘的多机制协同作用OA

As a common complication of stroke,post-stroke constipation(PSC)has a high incidence rate of about 45%in the acute stage and 48%in the rehabilitation stage.It not only causes abdominal distension,abdominal pain and other discomforts,which affects patients'quality of life and recovery process,but also may lead to complications such as pneumonia,recurrent stroke,and even increase the risk of brain herniation due to the patient's straining to defecate,which is life-threatening.Currently,drug treatment for PSC has side effects such as dependence and deterioration of intestinal function,while acupuncture,as a green and safe Chinese medicine therapy,shows significant advantages.The brain-gut axis(GBA),as a bidirectional regulatory network between the central nervous system and the gastrointestinal tract,provides a new target for acupuncture therapy.In this paper,we propose the integration hypothesis that acupuncture improves PSC through the"neuro-endocrine-flora"tertiary regulatory network.In terms of nervous system regulation,acupuncture can affect the central nervous system(e.g.,up-regulate BDNF expression to enhance intestinal motility),enteric nervous system(e.g.,increase the number of enteric plexus,remove abnormal aggregation of α-synaptic nucleoprotein),and the autonomic nervous system(e.g.,activate the vagus nerve to promote gastrointestinal conduction);in terms of the regulation of cerebral and intestinal peptides,it can elevate excitatory peptides(e.g.,SP,5-HT),reduce inhibitory peptides(e.g.,SS,VIP),and improve gastrointestinal conduction.and VIP),improving gastrointestinal dynamics;in the regulation of intestinal flora,it can reduce the abundance of Escherichia coli,increase the beneficial bacteria,and maintain the balance of bacterial flora;it can also regulate the hypothalamus-pituitary-adrenal axis(HPA axis),correcting the dysfunction of its function,and alleviating the hypersensitivity reaction of internal organs.These mechanisms are interrelated,forming a cascade of"neural guidance-hormonal synergy-bacterial homeostasis",which reveals for the first time the synergistic effect of acupuncture in improving PSC,and provides a theoretical paradigm and a new way of thinking for the treatment of PSC by combining traditional Chinese and Western medicine.Future studies may focus on the signaling pathway of acupuncture,vagus nerve monitoring and"acupoint-colony"relationship,in order to further elucidate its mechanism of action.