炎性痛是由外周组织损伤或炎症时引起的疼痛.近10年来,关于针刺缓解炎症性疼痛机制的研究有了显著性进展.本研究从神经免疫交互的角度,在炎症局部和外周背根神经节(DRG)水平,总结针刺通过调节机体神经-免疫相互作用改善炎性痛的镇痛机制.在炎症局部,针刺可通过调节组织的单核巨噬细胞、T淋巴细胞等多种免疫细胞及信号转导通路抑制炎症介质的释放并促进阿片肽、大麻素与腺苷类等镇痛物质及其受体的活性,控制炎症级联反应及疼痛的神经传入,减轻炎性痛.在DRG水平,针刺能够通过抑制外周DRG神经元的过度兴奋、TRPV1信号通路的转导及其释放的P物质(SP)、P2X4受体、P2X7受体和酪氨酸羟化酶TH等,改善慢性炎症性疼痛.综上,本研究围绕针刺调节炎症局部与DRG神经-免疫互作改善炎性痛的镇痛机制角度展开论述,为改善针刺镇痛的临床应用策略、提高临床疗效提供思路,也为基础研究指明方向.
Inflammatory pain is caused by peripheral tissue injury and inflammation.Over the past decade,the researches on the mechanism of acupuncture relieving inflammatory pain have made remarkable progresses.This study concluded the analgesic mechanism of acupuncture in alleviating inflammatory pain through regulating nerve-immune interaction within body,from the levels of local inflammation and peripheral dorsal root ganglion(DRG).In the area of inflammation,acupuncture can inhibit the release of inflammatory mediators by regulating signal transduction pathways and various immune cells in tissues,including monocytes,macrophages and T lymphocytes.At the same time,it promotes the activity of opioid peptides,cannabinoids,adenosine and other analgesic substances and their receptors,controls the inflammatory cascade reaction and the neural transmission to alleviate inflammatory pain.At the DRG level,acupuncture can improve chronic inflammatory pain by inhibiting the over-excitation of peripheral DRG neurons,transduction of TRPV1 signaling pathway and its release of substance P(SP),P2X4 and P2X7 receptors,tyrosine hydroxylase TH,etc.In summary,this review focuses on the analgesic mechanisms of acupuncture in regulating local inflammation and DRG in improving inflammatory pain,provides ideas for improving clinical application strategies of acupuncture analgesia and enhancing clinical efficacy,and it also points out certain directions for basic researches.