基于脑-肠轴探讨针灸治疗缺血性卒中机制的基础研究进展 Research Progress on the Mechanism of Acupuncture in Treating Ischemic Stroke Based on the Gut-Brain Axis

针灸作为传统医学的重要组成部分，近年来在缺血性卒中治疗中的机制受到广泛关注。本文对针灸通过干预脑-肠轴治疗缺血性卒中的相关基础研究进行汇总分析，发现其可能涉及以下机制：其一，调节肠道菌群组成，抑制致病菌增殖并促进有益菌定植，同时增强肠上皮紧密连接蛋白表达以维持肠道屏障功能，减少肠源性毒素入血；其二，通过神经内分泌调控抑制下丘脑-垂体-肾上腺轴过度激活，降低促炎因子释放，并激活迷走神经介导的抗炎通路；其三，调节短链脂肪酸、氧化三甲胺等肠道菌群代谢产物的动态平衡，改善全身炎症微环境；其四，重塑免疫细胞亚群比例，抑制过度炎症反应并促进神经修复。本文通过梳理近年来的研究成果，探讨针灸通过脑-肠轴调控缺血性卒中的靶点与潜在通路，为后续相关基础研究及针灸的临床应用提供依据。 Abstract: Acupuncture, as an important part of traditional Chinese medicine, has received widespread attention in recent years for its mechanisms in the treatment of ischemic stroke. This paper summarizes and analyzes the basic research on acupuncture treating ischemic stroke through modulation of the gut-brain axis. It is found that it may involve the following mechanisms. Firstly, it modulates the gut microbiota composition by inhibiting the proliferation of pathogenic bacteria and promoting the colonization of beneficial bacteria. It also enhances the expression of intestinal epithelial tight junction protein to maintain gut barrier function and reduce enterotoxin entry into the bloodstream. Secondly, it inhibits the overactivation of the hypothalamic-pituitary-adrenal axis through neuroendocrine regulation, reduces the release of pro-inflammatory cytokine, and activates the anti-inflammatory pathways mediated by the vagus nerve. Thirdly, it regulates the dynamic balance of gut microbiota metabolic products such as short-chain fatty acids and trimethylamine N-oxide, ameliorating the systemic inflammatory microenvironments. Fourthly, it reshapes the proportion of immune cell subpopulations, inhibits excessive inflammation reactions, and facilitates neural repair. By synthesizing recent research advancements, this paper reviews potential therapeutic targets and pathways through which acupuncture modulates ischemic stroke via the gut-brain axis, aiming to provide a basis for subsequent basic research and clinical application of acupuncture.