Experimental Study on the Safety of Hypertime Window Thrombolysis for Cerebral Infarction by Inhibiting the Activation of Astrocytes with Acupuncture
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摘要: 目的 观察针刺对提高急性脑梗死大鼠超时间窗溶栓安全性的效应, 并从星形胶质细胞的途径探讨其作用机制。方法 采用改良的大鼠自体血栓栓塞法制备脑梗死模型, 选用“醒脑开窍”针刺法作为介入手段, 尾静脉注射阿替普酶(rt-PA)作为溶栓方法。将66只SD大鼠随机分为假手术组、模型组、4.5 h溶栓组、6 h溶栓组、针刺+4.5 h溶栓组、针刺+6 h溶栓组, 每组11只。Bederson法对各组大鼠在造模后2 h和24 h分别进行神经行为学评分, TTC染色法比较各组大鼠脑梗死体积百分比, EB渗透法比较各组大鼠血脑屏障(BBB)通透性, 干湿质量法测定各组大鼠脑含水量。另取48只SD大鼠随机分为假手术组、模型组、6 h溶栓组、针刺+6 h溶栓组, 每组12只。qPCR和Western blot法分别检测各组大鼠大脑皮层中星形胶质细胞相关指标胶质纤维酸性蛋白(GFAP)、水通道蛋白-4(AQP-4)的mRNA和蛋白表达。结果 与假手术组相比, 模型组神经行为学评分、脑梗死体积百分比、脑含水量均明显升高(P < 0.01);4.5 h溶栓组、针刺+4.5 h溶栓组神经行为学评分、脑梗死体积百分比、脑含水量均低于模型组(P < 0.01);与模型组和6 h溶栓组相比, 针刺+6 h溶栓组神经行为学评分、脑梗死体积百分比、脑含水量均明显降低(P < 0.05,P < 0.01)。模型组GFAP、AQP-4 mRNA和蛋白表达水平均明显高于假手术组(P < 0.05,P < 0.01);针刺+6 h溶栓组GFAP、AQP-4 mRNA和蛋白表达水平均显著低于模型组和6 h溶栓组(P < 0.05,P < 0.01)。结论 针刺可以通过下调GFAP、AQP-4的表达来抑制星形胶质细胞活化, 从而提高脑梗死超时间窗溶栓安全性。Abstract: OBJECTIVE To observe the effect of acupuncture on the safety of hypertime window thrombolysis in rats with acute cerebral infarction, and to explore its mechanism from the way of astrocytes.METHODS Cerebral infarction model was prepared by improved autoembolism method in rats. "Xingnao Kaiqiao" acupuncture was used as interventional method, and rt-PA was injected through caudal vein as thrombolysis method. 66 SD rats were randomly divided into sham operation group, model group, 4.5 h thrombolysis group, 6 h thrombolysis group, acupuncture+4.5 h thrombolysis group and acupuncture+6 h thrombolysis group, with 11 rats in each group. Bederson method was used to evaluate the neurobehavioral scores of rats at the 2nd and 24th hour after modeling. TTC staining method was used to compare the cerebral infarct volume percentage of rats in each group, EB osmotic method was used to compare the blood-brain barrier (BBB) permeability of rats in each group, and dry-wet weight method was used to measure the brain water content of rats in each group. 48 SD rats were randomly divided into sham operation group, model group, 6 h thrombolysis group and acupuncture+6 h thrombolysis group, with 12 rats in each group. The qPCR and Western blot were used to detect the mRNA and protein expressions of astrocyte-related indexes glial fibrillary acidic protein (GFAP) and aquaporin-4 (AQP-4) in the cerebral cortex of rats in each group.RESULTS Compared with the sham operation group, the neurobehavioral score, percentage of cerebral infarct volume and brain water content in the model group significantly increased (P < 0.01). The neurobehavioral scores, percentage of cerebral infarct volume and brain water content in the 4.5 h thrombolysis group and the acupuncture+4.5 h thrombolysis group were lower than those in the model group (P < 0.01). Compared with the model group and the 6 h thrombolytic group, the neurobehavioral score, the percentage of cerebral infarct volume and brain water content in the acupuncture+6 h thrombolytic group significantly decreased (P < 0.05, P < 0.01). The mRNA and protein expression levels of GFAP and AQP-4 in model group were significantly higher than those in sham group (P < 0.05, P < 0.01). The mRNA and protein expression levels of GFAP and AQP-4 in acupuncture+6 h thrombolysis group were significantly lower than those in model group and 6 h thrombolysis group (P < 0.05, P < 0.01).CONCLUSION Acupuncture can inhibit the activation of astrocytes by down-regulating the expression of GFAP and AQP-4, thus improve the safety of hypertime window thrombolysis in cerebral infarction.
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Key words:
- acupuncture /
- cerebral infarction /
- safety of thrombolysis /
- astrocytes /
- GFAP /
- AQP-4
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表 1 引物序列
基因 引物(5′→3′) GFAP 上游: ATGACTATCGCCGCCAACTG 下游: CTGGTAACTCGCCGACTCCC AQP-4 上游: CGCCAAGTCCGTCTTCTACA 下游: GCCAGCAGTGAGGTTTCCAT GAPDH 上游: TGGAATTGTGAGGGAGATG 下游: GCCCAGCAAGGATACTGA -
[1] TSIVGOULIS G, KARGIOTIS O, ALEXANDROV AV. Intravenous thrombolysis for acute ischemic stroke: A bridge between two centuries[J]. Exp Rev Neurother, 2017, 17(8): 819-837. doi: 10.1080/14737175.2017.1347039 [2] JAUCH EC, SAVER JL, ADAMS HP, et al. Guidelines for the early management of patients with acute ischemic stroke[J]. Stroke, 2013, 44(3): 870-947. doi: 10.1161/STR.0b013e318284056a [3] 蔡颖源, 马玉苹, 王真真, 等. rt-PA静脉溶栓对脑缺血大鼠血脑屏障通透性及MMP-2、MMP-9活性和表达的影响[J]. 国际脑血管病杂志, 2012(12): 918-923. doi: 10.3760/cma.j.issn.1673-4165.2012.12.005 [4] 顾亚会, 张新昌, 徐文韬, 等. 基于神经细胞凋亡信号通路探讨针刺延长脑梗死的溶栓时间窗效应[J]. 针刺研究, 2020, 45(3): 209-214. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ202003007.htm [5] 刘丽芳. rt-PA静脉溶栓联合依达拉奉超早期治疗对急性脑梗死患者的影响[J]. 吉林医学, 2021, 42(2): 283-287. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYX202102008.htm [6] 宁文华, 李礼, 郭扬, 等. 星形胶质细胞与缺血性脑卒中的关系及针刺干预研究进展[J]. 针刺研究, 2019, 44(10): 777-780. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ201910015.htm [7] 王艳艳, 李常新, 牛小媛. 电针对脑梗死大鼠神经功能及胶质纤维酸性蛋白表达的影响[J]. 中西医结合心脑血管病杂志, 2012, 10(10): 1222-1224. doi: 10.3969/j.issn.1672-1349.2012.10.038 [8] ZHANG XC, GU YH, XU WT, et al. Early electroacupuncture extends the rtPA time window to 6 h in a male rat model of embolic stroke via the ERK1/2-MMP9 pathway[J]. Neur Plast, 2020(7): e158848. http://www.researchgate.net/publication/346851124_Early_Electroacupuncture_Extends_the_rtPA_Time_Window_to_6_h_in_a_Male_Rat_Model_of_Embolic_Stroke_via_the_ERK12-MMP9_Pathway [9] BEDERSON JB, PITTS LH, TSUJI M, et al. Rat middle cerebral artery occlusion: Evaluation of the model and development of a neurologic examination[J]. Stroke, 1986, 17(3): 472-476. doi: 10.1161/01.STR.17.3.472 [10] BIEBER M, GRONEWOLD J, SCHARF A, et al. Validity and reliability of neurological scores in mice exposed to middle cerebral artery occlusion[J]. Stroke, 2019, 50(10): 2875-2882. doi: 10.1161/STROKEAHA.119.026652 [11] POWERS WJ, RABINSTEIN AA, ACKERSON T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50(12): e344-e418. http://www.researchgate.net/publication/336901575_Guidelines_for_the_Early_Management_of_Patients_With_Acute_Ischemic_Stroke_2019_Update_to_the_2018_Guidelines_for_the_Early_Management_of_Acute_Ischemic_Stroke [12] 何淼红, 徐吉芬, 姚兵明. 急性脑梗死静脉内溶栓治疗时间窗的影响因素分析[J]. 中国当代医药, 2019, 26(16): 83-85. doi: 10.3969/j.issn.1674-4721.2019.16.026 [13] GUO Z, YU S, XIAO L, et al. Dynamic change of neutrophil to lymphocyte ratio and hemorrhagic transformation after thrombolysis in stroke[J]. J Neuroinflamm, 2016, 13(1): 199. doi: 10.1186/s12974-016-0680-x [14] WALCOTT BP, WALCOTT BP, KAHLE KT, et al. Novel treatment targets for cerebral edema[J]. Neurotherapeutics, 2012, 9(1): 65-72. doi: 10.1007/s13311-011-0087-4 [15] 刘李静, 傅勤慧, 裴建. 基质金属蛋白酶-9在脑梗死溶栓治疗中作用的研究进展[J]. 国际神经病学神经外科学杂志, 2018, 45(5): 546-550. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSK201805027.htm [16] YEON KS, YEONG CS, JUNG KE, et al. Isoflurane postconditioning inhibits tPA-induced matrix metalloproteinases activation after hypoxic injury via low-density lipoprotein receptor-related protein and extracellular signal-regulated kinase pathway[J]. Neurochem Res, 2017, 42(5): 1533-1542. doi: 10.1007/s11064-017-2211-2 [17] VERKHRATSKY A, PARPURA V. Recent advances in(patho)physiology of astroglia[J]. Acta Pharmacol Sin, 2010, 31(9): 1044-1054. doi: 10.1038/aps.2010.108 [18] 魏珍珍, 方晓艳, 白明, 等. 基于星形胶质细胞的脑缺血损伤治疗研究进展[J]. 神经药理学报, 2019, 9(1): 36-43. doi: 10.3969/j.issn.2095-1396.2019.01.007 [19] 余琼. 七氟醚预处理对成年大鼠局灶性脑缺血再灌注损伤后血脑屏障保护作用及其机制研究[D]. 上海: 复旦大学, 2010. [20] 宋铁山, 周明凤. 针刺对脑缺血再灌注损伤后星形胶质细胞增生的影响[J]. 中华物理医学与康复杂志, 2008, 30(4): 244-247. doi: 10.3321/j.issn:0254-1424.2008.04.007 [21] PIRICI I, BALSANU T, BOGDAN C, et al. Inhibition of Aquaporin-4 improves the outcome of ischaemic stroke and modulates brain paravascular drainage pathways[J]. Int J Mol Sci, 2018, 19(1): 46. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5795996/pdf/ijms-19-00046.pdf [22] 卞炜, 秦文熠. 电针通过抑制AQP4表达减轻局灶脑缺血/再灌注大鼠脑水肿损伤及星形胶质细胞激活[J]. 现代医药卫生, 2018, 34(5): 665-668. doi: 10.3969/j.issn.1009-5519.2018.05.007