|
|
基于针灸提高血清睾酮的机制探讨心脑血管疾病的治疗思路
|
Abstract:
心脑血管疾病是我国相当严重的疾病，具有高发病率、高死亡率、高复发率、高致残率等特点，且大有年轻化趋势。国内外研究已充分证明，内源性睾酮具有保护心脑血管疾病的生理作用，低睾酮水平与心脑血管疾病高发病率高度相关。而随研究深入，外源性睾酮治疗性腺功能减退症会增加心脑血管风险，因此如何有效提高内源性或血清睾酮成为了一个值得探究的问题。越来越多的实验研究表明，针灸可有效提高人体内源性睾酮，对于预防或治疗心脑血管疾病提供了一种重要手段。本文就针灸提高内源性或血清睾酮的机制，睾酮对心血管的作用机制两大方面探讨治疗心脑血管疾病的治疗思路。以期为研究人员和临床工作人员治疗睾酮缺乏症，性腺功能减退症和心脑血管疾病提供治疗思路。
Cardiovascular and cerebrovascular diseases are quite serious diseases in China, which are characterized by high incidence rate, high mortality, high recurrence rate, high disability rate, and have a great trend of youth. Studies at home and abroad have fully proved that endogenous testosterone has a physiological role in protecting cardiovascular and cerebrovascular diseases. Low testosterone levels are highly correlated with high incidence rate of cardiovascular and cerebrovascular diseases. As research deepens, exogenous testosterone treatment for hypogonadism increases the risk of cardiovascular and cerebrovascular diseases. Therefore, how to effectively increase endogenous or serum testosterone has become a question worth exploring. More and more experimental studies show that acupuncture and moxibustion can effectively improve endogenous testosterone in human body, which provides an important means for preventing or treating cardiovascular and cerebrovascular diseases. This article discusses the treatment of cardiovascular and cerebrovascular diseases from two aspects: the mechanism of acupuncture and moxibustion to increase endogenous or serum testosterone, and the mechanism of testosterone on cardiovascular, to provide treatment ideas for researchers and clinical staff in the treatment of testosterone deficiency, hypogonadism, and cardiovascular and cerebrovascular diseases.
| [1] | 刘素丽, 衣蕾, 李娟娥, 等. 基于“主动健康”理念的心脑血管疾病慢病管理模式[J]. 现代医药卫生, 2024, 40(4): 655-659. |
| [2] | 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2022概要[J]. 中国循环杂志, 2023, 38(6): 583-612. |
| [3] | 李小鹰. 雄激素、雄激素受体与男性老年心脑血管疾病[C]//中国病理生理学会. 国际心脏研究会中国分会第八届学术会议暨中国病理生理学会心血管专业委员会第十一届学术会议论文摘要集. 广州: 暨南大学, 2004: 2. |
| [4] | Yeap, B.B., Hyde, Z., Almeida, O.P., Norman, P.E., Chubb, S.A.P., Jamrozik, K., et al. (2009) Lower Testosterone Levels Predict Incident Stroke and Transient Ischemic Attack in Older Men. The Journal of Clinical Endocrinology & Metabolism, 94, 2353-2359. https://doi.org/10.1210/jc.2008-2416 |
| [5] | 谢龙, 刘捡娣, 谢东明. 睾酮与心血管疾病关系的研究进展[J]. 赣南医学院学报, 2019, 39(4): 426-432. |
| [6] | 王丹, 殷梅. 性激素与缺血性脑卒中关系的研究进展[J]. 医学综述, 2020, 26(23): 4689-4693. |
| [7] | CFDA. CFDA: 关注睾酮药品的心血管事件风险[J]. 上海医药, 2017, 38(5): 79-80. |
| [8] | 赵晖, 颜明明, 张千, 等. 睾酮治疗相关严重不良事件分析[J]. 世界临床药物, 2024, 45(2): 119-127. |
| [9] | Li, P., Peng, J., Ding, Z., Zhou, X. and Liang, R. (2022) Effects of Acupuncture Combined with Moxibustion on Reproductive and Metabolic Outcomes in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2022, Article ID: 3616036. https://doi.org/10.1155/2022/3616036 |
| [10] | Lu, X., Han, H., Zhang, Z., Chen, H., Huang, X. and Zhang, R. (2022) Study on the Efficacy of Electric Acupuncture in the Treatment of Premature Ejaculation Based on Testosterone Level. Journal of Healthcare Engineering, 2022, Article ID: 8331688. https://doi.org/10.1155/2022/8331688 |
| [11] | Zhu, M., Quan, F., Xue, K., Xiao, C. and Cui, J. (2024) Acupuncture for Erectile Dysfunction: A Randomized Controlled Trial. Chinese Acupuncture & Moxibustion, 44, 418-422. |
| [12] | 马红. 针刺治疗多囊卵巢综合征及其改善焦虑状态的研究[D]: [博士学位论文]. 广州: 广州中医药大学, 2014. |
| [13] | 陈玉慧, 李学伟, 马继登. 睾酮及其受体对心血管发育和功能的影响[J]. 中国生物化学与分子生物学报, 2021, 37(11): 1423-1431. |
| [14] | 赵健, 桂士良, 崔腾腾, 等. 睾酮的生理作用及临床应用进展[J]. 中国性科学, 2020, 29(1): 20-24. |
| [15] | 冯朵, 何悦, 蒋勇军, 等. 肉苁蓉抗衰老功能的研究进展[J]. 食品安全质量检测学报, 2021, 12(11): 4429-4437. |
| [16] | 马秉哲, 焦丹丽, 崔梦凡, 等. 麦粒灸足三里穴调控氧化应激对自然衰老小鼠睾酮水平的影响[J/OL]. 辽宁中医药大学学报: 1-8. https://kns.cnki.net/kcms/Detail/Detail.aspx?doi=21.1543.r.20240429.1140.011, 2024-05-22. |
| [17] | Midzak, A.S., Chen, H., Papadopoulos, V. and Zirkin, B.R. (2009) Leydig Cell Aging and the Mechanisms of Reduced Testosterone Synthesis. Molecular and Cellular Endocrinology, 299, 23-31. https://doi.org/10.1016/j.mce.2008.07.016 |
| [18] | 邓志玲, 苗芙蕊, 赵彩娇, 等. 灵龟八法对衰老大鼠睾酮合成与分泌的影响[J]. 时珍国医国药, 2022, 33(7): 1784-1787. |
| [19] | Zeng, T.T., Yao, T.W., Li, X.Z. and Tang, C.L. (2019) [Electroacupuncture Intervention Increases Testosterone Level of Aged Rats by Activating ERK/Nrf2/HO-1 Signaling of Leydig Cells]. Acupuncture Research, 44, 566-570. |
| [20] | Ren, Y., Yang, X., Zhang, Y., Wang, Y. and Li, X. (2016) Effects and Mechanisms of Acupuncture and Moxibustion on Reproductive Endocrine Function in Male Rats with Partial Androgen Deficiency. Acupuncture in Medicine, 34, 136-143. https://doi.org/10.1136/acupmed-2014-010734 |
| [21] | 马琳. 针灸疗法对老年雄性大鼠下丘脑-垂体-睾丸轴KISS-1/GPR54和RFRP-3/GPR147系统的影响[D]: [硕士学位论文]. 重庆: 重庆医科大学, 2019. |
| [22] | 孙文静. 不同配穴电针疗法对少弱精症大鼠下丘脑-垂体-睾丸轴的作用机制研究[D]: [硕士学位论文]. 银川: 宁夏医科大学, 2023. |
| [23] | 宫星, 王友京. 针刺对内分泌激素调节作用的研究概况[J]. 中国针灸, 1997(5): 315-318. |
| [24] | Zheng, X.F. and Li, P. (2007) [Study on Effects of Acupuncture Combined with Medication on Reproductive Endocrines in the Patient of PADAM]. Chinese Acupuncture & Moxibustion, 27, 333-335. |
| [25] | 孙佳音, 应锋, 韩晓冬. 睾丸间质细胞中睾酮合成酶及蛋白表达的调控因子[J]. 生殖与避孕, 2009, 29(1): 42-47. |
| [26] | 曾婷婷. 电针对睾酮低下老年大鼠氧化应激ERK/Nrf2-ARE通路的影响[D]: [硕士学位论文]. 重庆: 重庆医科大学, 2020. |
| [27] | Jones, T. and Kelly, D. (2018) Randomized Controlled Trials—Mechanistic Studies of Testosterone and the Cardiovascular System. Asian Journal of Andrology, 20, 120-130. https://doi.org/10.4103/aja.aja_6_18 |
| [28] | Webb, C.M., McNeill, J.G., Hayward, C.S., de Zeigler, D. and Collins, P. (1999) Effects of Testosterone on Coronary Vasomotor Regulation in Men with Coronary Heart Disease. Circulation, 100, 1690-1696. https://doi.org/10.1161/01.cir.100.16.1690 |
| [29] | Kelly, D.M. and Jones, T.H. (2013) Testosterone: A Metabolic Hormone in Health and Disease. Journal of Endocrinology, 217, R25-R45. https://doi.org/10.1530/joe-12-0455 |
| [30] | Alexandersen, P., Haarbo, J., Byrjalsen, I., Lawaetz, H. and Christiansen, C. (1999) Natural Androgens Inhibit Male Atherosclerosis: A Study in Castrated, Cholesterolfed Rabbits. Circulation Research, 84, 813-819. https://doi.org/10.1161/01.res.84.7.813 |
| [31] | Nettleship, J.E., Jones, T.H., Channer, K.S. and Jones, R.D. (2007) Physiological Testosterone Replacement Therapy Attenuates Fatty Streak Formation and Improves High-Density Lipoprotein Cholesterol in the TFM Mouse: An Effect That Is Independent of the Classic Androgen Receptor. Circulation, 116, 2427-2434. https://doi.org/10.1161/circulationaha.107.708768 |
| [32] | McInnes, K.J., Smith, L.B., Hunger, N.I., Saunders, P.T.K., Andrew, R. and Walker, B.R. (2012) Deletion of the Androgen Receptor in Adipose Tissue in Male Mice Elevates Retinol Binding Protein 4 and Reveals Independent Effects on Visceral Fat Mass and on Glucose Homeostasis. Diabetes, 61, 1072-1081. https://doi.org/10.2337/db11-1136 |
| [33] | Tambo, A., Roshan, M.H.K. and Pace, N.P. (2016) Testosterone and Cardiovascular Disease. The Open Cardiovascular Medicine Journal, 10, 1-10. https://doi.org/10.2174/1874192401610010001 |
| [34] | Hanke, H., Lenz, C., Hess, B., Spindler, K. and Weidemann, W. (2001) Effect of Testosterone on Plaque Development and Androgen Receptor Expression in the Arterial Vessel Wall. Circulation, 103, 1382-1385. https://doi.org/10.1161/01.cir.103.10.1382 |
| [35] | Natoli, A.K., Medley, T.L., Ahimastos, A.A., Drew, B.G., Thearle, D.J., Dilley, R.J., et al. (2005) Sex Steroids Modulate Human Aortic Smooth Muscle Cell Matrix Protein Deposition and Matrix Metalloproteinase Expression. Hypertension, 46, 1129-1134. https://doi.org/10.1161/01.hyp.0000187016.06549.96 |
| [36] | Pugh, P. (2003) Acute Haemodynamic Effects of Testosterone in Men with Chronic Heart Failure. European Heart Journal, 24, 909-915. https://doi.org/10.1016/s0195-668x(03)00083-6 |
| [37] | Volterrani, M., Rosano, G. and Iellamo, F. (2012) Testosterone and Heart Failure. Endocrine, 42, 272-277. https://doi.org/10.1007/s12020-012-9725-9 |
| [38] | 李圆龙, 马婧, 韩瑞钰, 等. 高血压与男性生殖损伤男性生殖功能的研究进展[J]. 中国性科学, 2020, 29(2): 14-17. |
| [39] | Torkler, S., Wallaschofski, H., Baumeister, S.E., Völzke, H., Dörr, M., Felix, S., et al. (2010) Inverse Association between Total Testosterone Concentrations, Incident Hypertension and Blood Pressure. The Aging Male, 14, 176-182. https://doi.org/10.3109/13685538.2010.529194 |
| [40] | 魏丹丹. 血清睾酮与高血压的关联研究[D]: [硕士学位论文]. 郑州: 郑州大学, 2022. |
| [41] | Traish, A.M., Miner, M.M., Morgentaler, A. and Zitzmann, M. (2011) Testosterone Deficiency. The American Journal of Medicine, 124, 578-587. https://doi.org/10.1016/j.amjmed.2010.12.027 |
| [42] | Miller, J.A., Nguyen, T.T., Loeb, C., Khera, M. and Yafi, F.A. (2023) Oral Testosterone Therapy: Past, Present, and Future. Sexual Medicine Reviews, 11, 124-138. https://doi.org/10.1093/sxmrev/qead003 |
| [43] | 康凯. 高血压脑出血的发病机制及手术治疗进展研究[J]. 系统医学, 2018, 3(19): 196-198. |
| [44] | Fanaei, H., Karimian, S.M., Sadeghipour, H.R., Hassanzade, G., Kasaeian, A., Attari, F., et al. (2014) Testosterone Enhances Functional Recovery after Stroke through Promotion of Antioxidant Defenses, BDNF Levels and Neurogenesis in Male Rats. Brain Research, 1558, 74-83. https://doi.org/10.1016/j.brainres.2014.02.028 |
