中医药对缺血性卒中后神经血管单元的保护作用

摘要神经血管单元（Neurovascular Unit，NVU）的提出改变了单纯恢复脑组织血供是治疗卒中后神经元损伤的关键这一观点，使人们认识到缺血性卒中诱导的脑损伤是一个复杂的病理过程，涉及到NVU中的各组成成分，而神经保护的目标应从之前传统观点中对单一的神经元保护扩展为对多组成成分的全面保护，药物保护的靶点也应该针对各种有害因子。真正认识到全面保护会使缺血性卒中的治疗达到更理想的效果。中药具有多组分、多靶点、多环节、多途径的全面保护及整体调节的优势和特点，与神经血管单元治疗策略的要求相吻合。现主要基于神经血管单元，对中医药治疗不同病机的中风研究进展进行综述，以期为后续中医药治疗缺血性卒中的临床研究及方案选取提供一定参考。

关键词缺血性卒中；神经血管单元；中医药；保护作用

Progress of Study on Traditional Chinese Medicine in Protecting Neuro Vascular Unit after Ischemic Stroke

Xu Zhenmin1，Liu Xuemei2，Zeng Zixiu2，Zhang Xinyang2，Liu Xiaohan2，Zhang Yunling3

（1 Second Department of Encephalopathy，Dongfang Hospital，Beijing University of Chinese Medicine，Beijing 100078，China； 2 Experiment Center，Dongfang Hospital，Beijing University of Chinese Medicine，Beijing 100078，China； 3 Xiyuan Hospital，China Academy of Chinese Medical Sciences，Beijing 100091，China）

AbstractThe proposal of neurovascular unit（NVU）has changed the idea that pure rehabilitation of brain blood supply is the key to the treatment of neuron damage after a stroke which makes people realize that the brain injury induced by ischemic stroke is a complex pathological process.It involves the various components of NVU，and nerve protection goals should expand into a comprehensive protection of multiple components from a single neuron protection.Drug protection should target at all kinds of harmful factors in pathological process.The identification of comprehensive protection would allow the treatment of ischemic stroke to achieve ideal effects.The traditional Chinese medicine has the advantages and characteristics of multicomponent，multitarget，multilink and multichannel protection and overall regulation，which is in line with the requirements of the treatment strategy of neurovascular unit.Based on neural vascular unit，this paper reviewed the research progress of traditional Chinese medicine treatment of ischemic stroke in order to provide certain reference for followup treatment of traditional Chinese medicine clinical research and treatment of ischemic stroke.

Key WordsIschemic stroke； Neuro vascular unit； Traditional Chinese medicine； Protection effect

中圖分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.08.062

脑卒中与心血管疾病、肿瘤是当前威胁人类健康的三大主要疾病，卒中因其高发病率、高复发率、高致残率、高死亡率“四高”的疾病特点，严重危害人类健康，给社会、家庭带来沉重负担。其中缺血性卒中占脑卒中发病率的60%～80%。缺血性卒中系脑组织缺血导致功能障碍的疾病，及时恢复血供应对脑组织损伤的修复及其功能恢复具有重要意义。但局限于溶栓后症状性颅内出血的危险增高和用药时间窗的狭窄，仅有3%～5%的急性缺血性卒中患者从静脉溶栓中获益[1]。然而静脉溶栓虽恢复了脑组织血供，但神经元的损伤仍在发生，这说明脑缺血后神经元坏死和凋亡不仅与脑组织的血供有关，还受其他因素影响。21世纪初期提出的神经血管单元（NVU）这一概念，为缺血性卒中的发病机制及药物治疗靶点及诊治策略的探讨带来了新思路[23]。