基于"心主神明"理论的针刺不同配穴对心肌缺血脑损伤保护作用及机制研究

The compatibility of points is one of the key factors of acupuncture clinical curative effect which need to be solved urgently.The study on effects and mechanism of compatibility of points is the key link to reveal acupuncture mechanism.The previous researches indicated that the cardiac insufficiency could impact the brain function. The protective effects and mechanism of brain damage induce by myocardial ischemia with acupuncture is lack of related research.This study focus on combination of source point and connecting point(HT7+SI7), source point and shu point(HT7+BL15), heart meridian point and governor meridian ponts(HT7+GV16). To observe the protective effects and differences of brain damage induce by myocardial ischemia with acupuncture at different adjunct points. The discharge of neurons and neurotransmitter in related brain areas also were detected. To investigate the protective effects and mechanism of brain damage induce by myocardial ischemia with acupuncture at different adjunct points.And to observe the changes of protective effects of brain damage induce by myocardial ischemia with acupuncture after the related brain areas were blocked.To discuss the central regulatory mechanism of protective effects of brain damage induce by myocardial ischemia with acupuncture. And we want to reveal the relationship between acupoints- meridians- brain and interpretation the theory of "heart governing mind", which provide support of research on relationship between the effects of adjunct points and central neural pathways.

组方配穴是针灸临床疗效得以发挥的关键因素之一，深入研究穴位配伍的针刺效应及机制，是进一步揭示针刺作用机理的关键环节，值得特别关注。临床与实验研究均证实，心功能不全可影响脑功能。有关针刺对心肌缺血引起的神经功能损伤的保护作用及机制尚缺乏深入研究。本项目拟选取原络配穴（神门+支正）、原俞配穴（神门+心俞）、心督配穴（神门+风府），重点观察不同配穴对心肌缺血脑损伤的保护作用以及不同配穴针刺效应的差异性；观察针刺不同配穴对心肌缺血大鼠相关脑区神经元电活动及微透析采样分析相应部位的神经递质变化，探讨针刺对心肌缺血脑损伤的保护作用机制及腧穴配伍的效应机制；并观察药物阻断相应脑区后针刺不同配穴对心肌缺血大鼠脑损伤保护作用的变化，初步探讨针刺对心肌缺血脑损伤保护作用的中枢调控机制，为进一步研究腧穴-经络-脑之间的关系以及"心主神明"的现代阐释，探讨腧穴配伍效应与中枢神经通路的相互关系等研究提供支撑。

本项目通过观察心肌缺血大鼠脑组织变化，以及电针不同经穴和电针不同配穴（原络配穴、俞原配穴等）对心肌缺血模型大鼠大脑皮质、海马、下丘脑的影响，以及对心肌缺血模型家兔脑电事件相关电位变化的影响，初步发现大鼠心肌缺血可导致脑损伤，引起大鼠皮质区、海马区形态的改变，和细胞凋亡因子、Bax、Bcl-2关系密切；下丘脑内多巴胺含量显著降低；而急性心肌缺血状态下的家兔大脑感觉门控能力（P50）、信息自动加工（MMN）能力存在异常变化。动物实验表明，心肌缺血能够引起下丘脑、海马等边缘系统损伤，影响脑功能活动。电针可对心肌缺血大鼠脑损伤大脑皮质及海马神经元起到保护作用，其机制可能与调节相关脑区的凋亡因子Bax、Bcl-2，BDNF、TrkB，以及大脑皮质区的神经生长因子（NGF）及其受体酪氨酸激酶A（TrkA）表达相关。电针不同经穴具有保护心肌缺血致脑损伤的作用，心经经脉的原穴“神门”效果优于小肠经络穴“支正”、肺经原穴“太渊”，表明经穴效应具有相对特异性；俞原配穴（神门+心俞）、原络配穴（神门+支正）的效果优于单穴，表明腧穴效应具有协同作用。为保护大脑神经元，针刺治疗心肌缺血致脑损伤应在心肌缺血出现的早期。本研究初步阐释了心肌缺血可以引起脑损伤的作用机制，进一步明确了腧穴配伍效应的优越性，为临床配穴使用提供实验支持。