基于神经炎症机制的卒中后癫痫中医药干预研究进展

Progress of Traditional Chinese Medicine Intervention for Poststroke Epilepsy Based on Neuroinflammatory Mechanisms

摘要: 卒中后癫痫(post-stroke epilepsy, PSE)是脑卒中后常见的神经系统并发症，具有高致残率、高复发率特点，其发病机制复杂，神经炎症在其中发挥关键作用，参与血脑屏障破坏、神经递质失衡、胶质细胞活化及突触重构等多个病理环节。炎症因子过度释放、小胶质细胞促炎极化与NLRP3炎症小体激活可协同降低癫痫阈值，诱发痫性发作。中医药干预通过多靶点调控神经炎症展现出独特优势：中药单体如川芎嗪、天麻素等通过抑制炎症信号通路，调节炎症因子与神经递质平衡；柴胡加龙骨牡蛎汤、通窍活血汤及定痫丸等复方以“镇静安神、豁痰开窍、活血化瘀”为治法，协同调控神经炎症、平衡神经递质、改善脑血流动力学及抑制氧化应激；针灸干预通过针灸干预的脑循环–氧化应激–神经功能调节网络，抑制胶质细胞活化与炎症级联反应。基于神经炎症机制的中医药干预为卒中后癫痫的多靶点联合干预提供了理论依据与转化方向。

Abstract: Post-stroke epilepsy (PSE) is a common neurological complication after stroke, which is characterized by high disability and recurrence rates. Its pathogenesis is complex, and neuroinflammation plays a key role in it, participating in multiple pathological aspects such as blood-brain barrier disruption, neurotransmitter imbalance, glial cell activation and synaptic remodeling. Excessive release of inflammatory factors, pro-inflammatory polarization of microglia and activation of NLRP3 inflammatory vesicles can synergistically lower the epileptic threshold and induce epileptic seizures. Traditional Chinese medicine (TCM) interventions show unique advantages through multi-targeted regulation of neuroinflammation: TCM monomers such as Chuanxiongxizine and Tianmuin regulate the balance of inflammatory factors and neurotransmitters by inhibiting the inflammatory signaling pathway; and compound prescriptions such as Chaihu plus Longbiao and Oyster Tang, Tongkou and Xuebao Tang, and Dinghao Wan synergize to “calm and tranquilize the nerves, expel phlegm and open the orifices, and activate blood circulation and remove blood stasis” to regulate neuroinflammation and balance neurological stasis, regulate neuroinflammation, balance neurotransmitters, improve cerebral hemodynamics and inhibit oxidative stress; acupuncture intervention inhibits glial cell activation and inflammatory cascade response through the cerebral circulation-oxidative stress-neurological function regulation network of acupuncture intervention. The TCM intervention based on neuroinflammatory mechanisms provides a theoretical basis and translational direction for the precise treatment of post-stroke epilepsy.