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醒脑开窍类中药治疗脑卒中后认知障碍的作用机制与临床应用
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| 篇名： | 醒脑开窍类中药治疗脑卒中后认知障碍的作用机制与临床应用 |
| TITLE： | Mechanisms of action and clinical application of Xingnao kaiqiao-type traditional Chinese medicines for post-stroke cognitive impairment |
| 摘要： | 脑卒中后认知障碍（PSCI）是脑卒中后高发的严重并发症，中医认为其核心病机属本虚标实，风、痰、瘀胶结蒙蔽清窍、神机失用，醒脑开窍是针对性核心治法。本文综述了石菖蒲、郁金、远志、冰片、麝香等代表性醒脑开窍类中药的作用机制，及其复方、中成药治疗PSCI的临床应用进展。结果显示，这类中药可通过靶向调控血脑屏障通透性，抑制Toll样受体4/核因子κB、缺血脑组织高迁移率族蛋白B1等介导的神经炎症，激活脑源性神经营养因子/酪氨酸激酶受体B、环磷酸腺苷（cAMP）/蛋白激酶A/cAMP应答元件结合蛋白等通路增强突触可塑性，多途径改善认知功能。临床应用方面，石菖蒲、远志相关方药的证据链较完整，是改善认知障碍与日常生活能力的核心用药；郁金在合并血管危险因素的前驱阶段具有保护潜力；冰片通过改善血脑屏障功能增强复方疗效；麝香主要用于急性重症期。目前多数机制证据来自动物实验，直接针对PSCI人群的大样本高质量临床研究仍较匮乏，后续有待开展大样本多中心研究，并结合多组学、多模态影像技术进一步阐明其深层作用机制。 |
| ABSTRACT： | Post-stroke cognitive impairment （PSCI） is a highly prevalent severe complication after stroke. In traditional Chinese medicines （TCM）， its core pathogenesis is characterized by deficiency in origin and excess in superficiality： wind， phlegm and blood stasis accumulate， cloud the clear orifices and lead to loss of mental activity， and Xingnao kaiqiao is the targeted principal treatment. This review summarizes the research progress on the pharmacological mechanisms of representative Xingnao kaiqiao-type TCM including Acorus tatarinowii ， Curcumae Radix ， Polygala tenuifolia ， borneol and musk， as well as clinical applications of their related compound formulas and Chinese patent medicines in the treatment of PSCI. The results show that these TCM can improve cognitive function through multiple pathways： targeted regulation of blood-brain barrier permeability， inhibition of neuroinflammation mediated by Toll like receptor 4/nuclear factor-κB， high mobility group protein B1 in ischemic brain tissue and other pathways， and activation of brain-derived neurotrophic factor/tyrosine kinase receptor B， cyclic adenosine monophosphate （cAMP）/protein kinase A/cAMP response element-binding protein and other pathways to promote synaptic plasticity. In terms of clinical application， the evidence chains of formulas based on Acorus tatarinowii and Polygala tenuifolia are relatively complete， which are the core medications to improve cognitive function and activities of daily living； Curcumae Radix has protective potential in the prodromal stage with vascular risk factors； borneol enhances the curative effect of compound prescriptions by improving blood-brain barrier function； musk is mainly used in the acute severe stage. At present， most of the mechanism evidence comes from animal experiments， high-quality large-sample clinical studies directly targeting PSCI populations are still scarce. Subsequent large-sample multicenter studies are needed in the future， combined with multi-omics and multimodal imaging techniques to further clarify its deep-seated mechanism of action. |
| 期刊： | 2026年第37卷第20期 |
| 作者： | 任琼迪；张铭；苏凯奇；崔入元；潘蕊；王春晓；冯雅琛；李琪；张栩 |
| AUTHORS： | REN Qiongdi， ZHANG Ming，SU Kaiqi，CUI Ruyuan，PAN Rui，WANG Chunxiao，FENG Yachen，LI Qi，ZHANG Xu |
| 关键字： | 醒脑开窍类中药;脑卒中后认知障碍;脑卒中;作用机制;临床应用 |
| KEYWORDS： | Xingnao kaiqiao-type traditional Chinese medicines;post‑stroke cognitive impairment;stroke;Mechanism of action;Clinical application |
| 阅读数： | 15 次 |
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