中国神经再生研究(英文版) ›› 2017, Vol. 12 ›› Issue (6): 845-864.doi: 10.4103/1673-5374.208539

• 综述:脊髓损伤修复保护与再生 •    下一篇

膈神经交叉现象:高位颈脊髓损伤后呼吸恢复机制及治疗意义

  

  • 收稿日期:2017-05-15 出版日期:2017-06-15 发布日期:2017-06-15
  • 基金资助:

    此项工作得到了德雷克塞尔大学医学院的部分支持

The crossed phrenic phenomenon

Michael George Zaki Ghali   

  1. Department of Neurobiology & Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA
  • Received:2017-05-15 Online:2017-06-15 Published:2017-06-15
  • Contact: Michael George Zaki Ghali, Ph.D., M.S., mgg26@drexel.edu.
  • Supported by:

    This work was supported in part by Drexel University College of Medicine.

摘要:

颈椎是创伤性脊柱损伤最常见的部位。颈椎损伤最常发生在15-30岁个体当中,并且影响男性患者通常是女性的3-4倍。颈部脊髓损伤十分复杂,通常分为完全(四肢瘫痪,颈椎感觉病变,神经源性休克)或不完全(前位,脊髓中央型损伤综合征和脊髓半侧损害综合征)。呼吸功能不全在发病负担构成中占很大比例,是脊髓损伤患者死亡的最常见原因。为了提高我们在脊髓损伤后治疗特异性呼吸功能障碍的能力,文章研究了“膈神经交叉现象”,其中通过呼吸道上方的同侧颈部脊髓的完全半切瘫痪的膈肌收缩可以由呼吸压力和时间自主恢复。如今已经提出了的机制是加强潜在对侧投射对膈核和新生下游轴突发芽有助于自主恢复。研究已经证实了在C1型半切的未麻醉大鼠大脑中发生的自发交叉膈活动可在数分钟至数小时内恢复。损伤后交叉膈活动的特定神经化学和分子途径需要进一步阐释。彻底了解这些是十分必要的,这有利于开发针对脊髓创伤后呼吸神经康复的靶向治疗。动物研究提供了血清素能和腺苷能途径,神经移植物,嗅鞘细胞的神经药理学操作实用性的初步证据,以及脊髓损伤后背根切割术恢复膈肌活动的可能作用。

ORCID:0000-0001-7660-620X(Michael George Zaki Ghali)

Abstract:

The cervical spine is the most common site of traumatic vertebral column injuries. Respiratory insufficiency constitutes a significant proportion of the morbidity burden and is the most common cause of mortality in these patients. In seeking to enhance our capacity to treat specifically the respiratory dysfunction following spinal cord injury, investigators have studied the “crossed phrenic phenomenon”, wherein contraction of a hemidiaphragm paralyzed by a complete hemisection of the ipsilateral cervical spinal cord above the phrenic nucleus can be induced by respiratory stressors and recovers spontaneously over time. Strengthening of latent contralateral projections to the phrenic nucleus and sprouting of new descending axons have been proposed as mechanisms contributing to the observed recovery. We have recently demonstrated recovery of spontaneous crossed phrenic activity occurring over minutes to hours in C1-hemisected unanesthetized decerebrate rats. The specific neurochemical and molecular pathways underlying crossed phrenic activity following injury require further clarification. A thorough understanding of these is necessary in order to develop targeted therapies for respiratory neurorehabilitation following spinal trauma. Animal studies provide preliminary evidence for the utility of neuropharmacological manipulation of serotonergic and adenosinergic pathways, nerve grafts, olfactory ensheathing cells, intraspinal microstimulation and a possible role for dorsal rhizotomy in recovering phrenic activity following spinal cord injury.

Key words: spinal cord injury, SCI, cervical, C1, C2, hemisection, respiratory, recovery, phrenic, diaphragm, hemidiaphragm, paralysis, neuroplasticity