中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2022, Vol. 17 ›› Issue (9): 1991-1997.doi: 10.4103/1673-5374.335162

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

星状神经节阻滞有助于改善糖尿病缺血性脑卒中的神经功能及炎症反应

  

  • 出版日期:2022-09-15 发布日期:2022-03-05

Stellate ganglion block reduces inflammation and improves neurological function in diabetic rats during ischemic stroke

Ting-Ting Li, Qiang Wan, Xin Zhang, Yuan Xiao, Li-Ying Sun, Yu-Rong Zhang, Xiang-Nan Liu, Wan-Chao Yang*   

  1. Department of Anesthesiology, the 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
  • Online:2022-09-15 Published:2022-03-05
  • Contact: Wan-Chao Yang, PhD, dachao_1980@126.com.
  • Supported by:
    The study was approved by Postdoctoral Scientific Research Developmental Fund of Heilongjiang Province, No. LBH-Q18074 (to WCY).

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摘要：

糖尿病是缺血性脑卒中的独立危险因素，且全身炎症反应可能加重脑卒中。有证据表明星状神经节阻滞可有效调节炎症反应，因此作者假设其可能成为一种潜在的治疗糖尿病缺血性脑卒中的方法。实验首先连续4周高脂肪饮食诱导糖尿病大鼠模型，而后以左侧大脑中动脉闭塞建立缺血性脑卒中模型，在再灌注前15min以及再灌注后20和44h经皮后侧入路行左侧星状神经节阻滞。结果显示，星状神经节阻滞虽不能降低糖尿病缺血性脑卒中大鼠的血糖水平，但可以降低大鼠的脑梗死体积以及脑含水量，同时可有效改善大鼠的神经功能以及28d生存率，并可抑制Toll样受体4/核因子κB信号通路以及血浆中的炎症反应。但是在星状神经节阻滞前5min注射Toll样受体4激动剂脂多糖可抑制星状神经节阻滞的作用，而注射Toll样受体4抑制剂TAK242则无此效果。同时实验还发现晚上星状神经节阻滞对糖尿病缺血性脑卒中没有积极的作用。上述结果表明，星状神经节阻滞是一种治疗糖尿病缺血性脑卒中的潜在方法，其可能通过Toll样受体4/核因子κB信号通路其作用，且其效果受到昼夜节律的影响。

https://orcid.org/0000-0001-9964-9528 (Wan-Chao Yan)

关键词: 星状神经节阻滞, 糖尿病, 炎症, 缺血性脑卒中, 神经元, 远期预后, 昼夜节律, 神经功能, 围手术期, Toll样受体4, 核因子κB

Abstract: Diabetes mellitus is an independent risk factor for ischemic stroke. Both diabetes mellitus and stroke are linked to systemic inflammation that aggravates patient outcomes. Stellate ganglion block can effectively regulate the inflammatory response. Therefore, it is hypothesized that stellate ganglion block could be a potential therapy for ischemic stroke in diabetic subjects. In this study, we induced diabetes mellitus in rats by feeding them a high-fat diet for 4 successive weeks. The left middle cerebral artery was occluded to establish models of ischemic stroke in diabetic rats. Subsequently, we performed left stellate ganglion block with 1% lidocaine using the percutaneous posterior approach 15 minutes before reperfusion and again 20 and 44 hours after reperfusion. Our results showed that stellate ganglion block did not decrease the blood glucose level in diabetic rats with diabetes mellitus but did reduce the cerebral infarct volume and the cerebral water content. It also improved the recovery of neurological function, increased 28-day survival rate, inhibited Toll like receptor 4/nuclear factor kappa B signaling pathway and reduced inflammatory response in the plasma of rats. However, injection of Toll like receptor 4 agonist lipopolysaccharide 5 minutes before stellate ganglion block inhibited the effect of stellate ganglion block, whereas injection of Toll like receptor 4 inhibitor TAK242 had no such effect. We also found that stellate ganglion block performed at night had no positive effect on diabetic ischemic stroke. These findings suggest that stellate ganglion block is a potential therapy for diabetic ischemic stroke and that it may be mediated through the Toll like receptor 4/nuclear factor kappa B signaling pathway. We also found that the therapeutic effect of stellate ganglion block is affected by circadian rhythm. 

Key words: circadian rhythms, diabetes mellitus, inflammation, ischemic stroke, long-term prognosis, neurological function, neuron, nuclear factor kappa B, stellate ganglion block, Toll like receptor 4