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PNAS重磅揭秘控制胃功能的大脑区域，将有利于开发胃肠疾病治疗新途径

2020-12-22 向日葵医学社 MedSci原创

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导语：这可能在未来改变临床胃肠病诊疗实践。

导语：这可能在未来改变临床胃肠病诊疗实践。

 

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Nature
　　随着社会节奏加快，人们生活、工作等各方面压力随之增加，这导致胃溃疡发病、死亡人数也在增加。近日，宾夕法尼亚州匹兹堡大学的研究人员确定了控制胃功能的大脑区域，这一发现可以解释压力如何导致溃疡和其他胃肠疾病，并为开发新的胃肠疾病治疗途径提供依据。

 
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PNAS.Multiple areas of the cerebral cortex influence the stomach.https://doi.org/10.1073/pnas.2002737117

　　中枢神经系统既影响着胃肠系统，也受到胃肠系统的影响。迄今为止，探索肠道与大脑相互作用的研究主要集中在肠道及其微生物群对大脑的影响上，但这并不是单向的——大脑也会影响胃功能。

　　研究人员使用狂犬病毒（RV）的逆行经神经元传输来确定最直接影响大鼠胃的副交感和交感控制的皮质区域。结果显示，影响胃的副交感输出的皮质神经元来源于喙岛和内侧前额叶皮层的部分区域，这些区域与互感和情绪控制有关。相对应地，影响交感神经输出到胃部的皮质神经元绝大部分来源于初级运动皮层、初级体感皮层和次级运动皮层，这些区域与骨骼运动控制和动作有关。

 
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影响大鼠胃副交感或交感控制的皮质网络。
（A）副交感神经网络三阶神经元扁平化皮层图。
（B）交感神经网络四阶神经元扁平化皮层图。
（C）各皮质区三阶神经元的分布情况。
（D）各皮质区域的四阶神经元的分布情况。

　　研究提示我们，胃部的两个自主神经驱动力的激活平衡可以调整胃部微环境。一般来说，副交感神经向胃部的信号输出往往会增加胃分泌物的产生，并增强平滑肌收缩。相反，交感神经对胃的输出倾向于减少分泌物并抑制平滑肌收缩。这两组输出都会改变胃的微环境，从而通过控制酸、蛋白分解酶、粘蛋白和免疫因子改变胃的微生物群组，影响胃功能。


　　胃溃疡的形成提供了一个中枢信号和胃的微生物组之间相互作用的具体例子。胃溃疡形成的最常见原因往往是幽门螺杆菌感染。然而，这种细菌的生长条件可以受到迷走神经传达的副交感神经指令信号的影响，选择性胃迷走神经切除术是一种常见的成功干预措施。

　　同时对胃的副交感神经输出，也阐明了胃肠道疾病的发生有重大心理作用机制。此前已有研究证实，对于那些常规治疗无法解决的功能性胃肠道疾病，如消化不良或肠易激综合征等，采用心理、认知行为治疗等非药物疗法可有积极和持久的治疗效果。

　　2018年，发表在Gastroenterology上的一篇题为“Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome”的文章显示，难治性肠易激综合征患者采用认知行为疗法后胃肠道症状有所改善。

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Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome.doi: 10.1053/j.gastro.2018.03.063. Epub 2018 Apr 25.

　　而另一项2019年发布的基于384篇功能性胃肠道疾病行催眠治疗的Meta研究显示，大量证据和临床经验都表明，催眠疗法可以通过调节某些关键的病理生理过程来改善肠道疾病症状，包括肠易激综合征、功能性消化不良、腹痛等。

 
　　例如，在功能性消化不良中，催眠治疗相对于支持治疗和药物治疗可以更好地提高疾病缓解率，长期改善患者胃肠功能。

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　　在功能性消化不良中，催眠疗法、药物疗法和支持疗法功效对比

Gut‐focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence‐base, practical aspects, and the Manchester Protocol. https://doi.org/10.1111/nmo.13573

　　而匹兹堡大学的研究结果在机制上证实了心理、行为干预对胃肠疾病的积极影响，同时也为基于大脑的功能性胃肠道疾病治疗提供了皮质靶点。提示使用无创经颅刺激单独或联合认知、行为和运动疗法，改变胃功能和/或微生物组的可能性。了解大脑对肠道施加的物理控制，为医生们提供了一种处理肠道问题的新方法，这可能在未来改变临床胃肠病诊疗实践。

 
 
来源：梅斯医学

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    2021-10-30 qindq

    #疾病治疗#

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    2021-08-03 d830372

    #治疗新途径#

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    2021-02-17 12498b3em08(暂无昵称)

    #大脑区域#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1982799, encodeId=460c1982e9999, content=<a href='/topic/show?id=89c4e06902e' target=_blank style='color:#2F92EE;'>#疾病治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70690, encryptionId=89c4e06902e, topicName=疾病治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Sat Oct 30 09:50:19 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1949427, encodeId=05c1194942e21, content=<a href='/topic/show?id=7ac6646456f' target=_blank style='color:#2F92EE;'>#治疗新途径#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64645, encryptionId=7ac6646456f, topicName=治疗新途径)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Tue Aug 03 10:50:19 CST 2021, time=2021-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2038002, encodeId=7bbb20380020c, content=<a href='/topic/show?id=e27b438e92b' target=_blank style='color:#2F92EE;'>#大脑区域#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43879, encryptionId=e27b438e92b, topicName=大脑区域)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Wed Feb 17 11:50:19 CST 2021, time=2021-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1953399, encodeId=5bc2195339976, content=<a href='/topic/show?id=edbb58e115a' target=_blank style='color:#2F92EE;'>#新途径#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58711, encryptionId=edbb58e115a, topicName=新途径)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e30378, createdName=caobinglei8079, createdTime=Sat Oct 16 02:50:19 CST 2021, time=2021-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1856438, encodeId=26981856438d1, content=<a href='/topic/show?id=f32014428fc' target=_blank style='color:#2F92EE;'>#PNAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14428, encryptionId=f32014428fc, topicName=PNAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Sun Jul 11 00:50:19 CST 2021, time=2021-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370264, encodeId=5aa713e0264d7, content=<a href='/topic/show?id=0402832926d' target=_blank style='color:#2F92EE;'>#胃肠疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83292, encryptionId=0402832926d, topicName=胃肠疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=65c7309, createdName=fengxx, createdTime=Thu Dec 24 04:50:19 CST 2020, time=2020-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549646, encodeId=5e1f1549646a1, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Thu Dec 24 04:50:19 CST 2020, time=2020-12-24, status=1, ipAttribution=)]
    2021-10-16 caobinglei8079

    #新途径#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1982799, encodeId=460c1982e9999, content=<a href='/topic/show?id=89c4e06902e' target=_blank style='color:#2F92EE;'>#疾病治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70690, encryptionId=89c4e06902e, topicName=疾病治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Sat Oct 30 09:50:19 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1949427, encodeId=05c1194942e21, content=<a href='/topic/show?id=7ac6646456f' target=_blank style='color:#2F92EE;'>#治疗新途径#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64645, encryptionId=7ac6646456f, topicName=治疗新途径)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Tue Aug 03 10:50:19 CST 2021, time=2021-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2038002, encodeId=7bbb20380020c, content=<a href='/topic/show?id=e27b438e92b' target=_blank style='color:#2F92EE;'>#大脑区域#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43879, encryptionId=e27b438e92b, topicName=大脑区域)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Wed Feb 17 11:50:19 CST 2021, time=2021-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1953399, encodeId=5bc2195339976, content=<a href='/topic/show?id=edbb58e115a' target=_blank style='color:#2F92EE;'>#新途径#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58711, encryptionId=edbb58e115a, topicName=新途径)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e30378, createdName=caobinglei8079, createdTime=Sat Oct 16 02:50:19 CST 2021, time=2021-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1856438, encodeId=26981856438d1, content=<a href='/topic/show?id=f32014428fc' target=_blank style='color:#2F92EE;'>#PNAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14428, encryptionId=f32014428fc, topicName=PNAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Sun Jul 11 00:50:19 CST 2021, time=2021-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370264, encodeId=5aa713e0264d7, content=<a href='/topic/show?id=0402832926d' target=_blank style='color:#2F92EE;'>#胃肠疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83292, encryptionId=0402832926d, topicName=胃肠疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=65c7309, createdName=fengxx, createdTime=Thu Dec 24 04:50:19 CST 2020, time=2020-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549646, encodeId=5e1f1549646a1, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Thu Dec 24 04:50:19 CST 2020, time=2020-12-24, status=1, ipAttribution=)]
    2021-07-11 drwjr

    #PNAS#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1982799, encodeId=460c1982e9999, content=<a href='/topic/show?id=89c4e06902e' target=_blank style='color:#2F92EE;'>#疾病治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70690, encryptionId=89c4e06902e, topicName=疾病治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Sat Oct 30 09:50:19 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1949427, encodeId=05c1194942e21, content=<a href='/topic/show?id=7ac6646456f' target=_blank style='color:#2F92EE;'>#治疗新途径#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64645, encryptionId=7ac6646456f, topicName=治疗新途径)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Tue Aug 03 10:50:19 CST 2021, time=2021-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2038002, encodeId=7bbb20380020c, content=<a href='/topic/show?id=e27b438e92b' target=_blank style='color:#2F92EE;'>#大脑区域#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43879, encryptionId=e27b438e92b, topicName=大脑区域)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Wed Feb 17 11:50:19 CST 2021, time=2021-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1953399, encodeId=5bc2195339976, content=<a href='/topic/show?id=edbb58e115a' target=_blank style='color:#2F92EE;'>#新途径#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58711, encryptionId=edbb58e115a, topicName=新途径)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e30378, createdName=caobinglei8079, createdTime=Sat Oct 16 02:50:19 CST 2021, time=2021-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1856438, encodeId=26981856438d1, content=<a href='/topic/show?id=f32014428fc' target=_blank style='color:#2F92EE;'>#PNAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14428, encryptionId=f32014428fc, topicName=PNAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Sun Jul 11 00:50:19 CST 2021, time=2021-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370264, encodeId=5aa713e0264d7, content=<a href='/topic/show?id=0402832926d' target=_blank style='color:#2F92EE;'>#胃肠疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83292, encryptionId=0402832926d, topicName=胃肠疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=65c7309, createdName=fengxx, createdTime=Thu Dec 24 04:50:19 CST 2020, time=2020-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549646, encodeId=5e1f1549646a1, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Thu Dec 24 04:50:19 CST 2020, time=2020-12-24, status=1, ipAttribution=)]
    2020-12-24 fengxx

    #胃肠疾病#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1982799, encodeId=460c1982e9999, content=<a href='/topic/show?id=89c4e06902e' target=_blank style='color:#2F92EE;'>#疾病治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70690, encryptionId=89c4e06902e, topicName=疾病治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Sat Oct 30 09:50:19 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1949427, encodeId=05c1194942e21, content=<a href='/topic/show?id=7ac6646456f' target=_blank style='color:#2F92EE;'>#治疗新途径#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64645, encryptionId=7ac6646456f, topicName=治疗新途径)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Tue Aug 03 10:50:19 CST 2021, time=2021-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2038002, encodeId=7bbb20380020c, content=<a href='/topic/show?id=e27b438e92b' target=_blank style='color:#2F92EE;'>#大脑区域#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43879, encryptionId=e27b438e92b, topicName=大脑区域)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Wed Feb 17 11:50:19 CST 2021, time=2021-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1953399, encodeId=5bc2195339976, content=<a href='/topic/show?id=edbb58e115a' target=_blank style='color:#2F92EE;'>#新途径#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58711, encryptionId=edbb58e115a, topicName=新途径)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e30378, createdName=caobinglei8079, createdTime=Sat Oct 16 02:50:19 CST 2021, time=2021-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1856438, encodeId=26981856438d1, content=<a href='/topic/show?id=f32014428fc' target=_blank style='color:#2F92EE;'>#PNAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14428, encryptionId=f32014428fc, topicName=PNAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Sun Jul 11 00:50:19 CST 2021, time=2021-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370264, encodeId=5aa713e0264d7, content=<a href='/topic/show?id=0402832926d' target=_blank style='color:#2F92EE;'>#胃肠疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83292, encryptionId=0402832926d, topicName=胃肠疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=65c7309, createdName=fengxx, createdTime=Thu Dec 24 04:50:19 CST 2020, time=2020-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549646, encodeId=5e1f1549646a1, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Thu Dec 24 04:50:19 CST 2020, time=2020-12-24, status=1, ipAttribution=)]
    2020-12-24 xxxx1054

    #重磅#

    0

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