Article(id=1190669166370762988, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190669163988398295, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1671.2024.0704, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1702828800000, receivedDateStr=2023-12-18, revisedDate=null, revisedDateStr=null, acceptedDate=1706112000000, acceptedDateStr=2024-01-25, onlineDate=1761807250825, onlineDateStr=2025-10-30, pubDate=1745769600000, pubDateStr=2025-04-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1761807250825, onlineIssueDateStr=2025-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1761807250825, creator=13701087609, updateTime=1761807250825, updator=13701087609, issue=Issue{id=1190669163988398295, tenantId=1146029695717560320, journalId=1189873630562394117, year='2025', volume='50', issue='4', pageStart='367', pageEnd='503', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1761807250258, creator=13701087609, updateTime=1761807667423, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1190670913772339410, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190669163988398295, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1190670913772339411, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190669163988398295, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=490, endPage=494, ext={EN=ArticleExt(id=1190669166614032622, articleId=1190669166370762988, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress on the role of neurovascular unit dysfunction in elderly patients with epileptic seizures, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

The neurovascular unit (NVU) is the smallest structural unit that maintains the integrity of the blood-brain barrier (BBB), regulates cerebral physiological activities, and maintains the homeostasis of the brain's internal environment. It has become a hot topic in the study of brain physiology and pathological changes. NVU plays a crucial role in age-dependent central nervous system diseases such as cerebral white matter lesions, cognitive impairment, and cerebrovascular disease. Its dysfunction can lead to destruction of BBB integrity, with subsequent protein leakage, immune-inflammatory responses, and alterations in cerebral hemodynamics, all of which can trigger seizures or progression of neurodegenerative disorders. Conversely, seizures can also accelerate NVU dysfunction and promote brain aging. The review summarizes the role of dysfunctional constituent cells of the NVU in the pathogenesis of age-dependent epilepsy and the research progress in related molecular pathways, aiming to provide new perspectives for epilepsy treatment research.

, correspAuthors=Rong Yin, authorNote=null, correspAuthorsNote=
E-mail:
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神经血管单元(NVU)是维持血脑屏障(BBB)完整性、调节大脑生理活动、维持大脑内环境稳态的最小结构单元,已成为大脑生理活动及病理变化研究的热点领域。NVU在脑白质病变、认知障碍、脑血管疾病等年龄依赖性中枢神经系统疾病中具有重要作用,其功能障碍会导致BBB完整性破坏,随之而来的蛋白质渗漏、免疫炎症反应、脑血流动力学改变均可导致癫痫发作或神经退行性疾病进展;反之,癫痫发作亦可加速NVU功能障碍而促进脑衰老。本文综述NVU的组成细胞功能障碍在年龄依赖性癫痫发病过程中的作用机制及相关分子通路的研究进展,旨在为癫痫治疗研究提供新的思路。

, correspAuthors=尹榕, authorNote=null, correspAuthorsNote=
尹榕,E-mail:
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刘璇,硕士研究生,主要从事癫痫、脑血管病的相关研究

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刘璇,硕士研究生,主要从事癫痫、脑血管病的相关研究

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老年癫痫发作中神经血管单元功能障碍的作用机制研究进展
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刘璇 , 尹榕 *
解放军医学杂志 | 综述 2025,50(4): 490-494
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解放军医学杂志 | 综述 2025, 50(4): 490-494
老年癫痫发作中神经血管单元功能障碍的作用机制研究进展
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刘璇, 尹榕*
作者信息
  • 甘肃省妇幼保健院/甘肃省中心医院神经内科,甘肃兰州 730070
  • 刘璇,硕士研究生,主要从事癫痫、脑血管病的相关研究

通讯作者:

尹榕,E-mail:
Research progress on the role of neurovascular unit dysfunction in elderly patients with epileptic seizures
Xuan Liu, Rong Yin*
Affiliations
  • Department of Neurology, Gansu Provincial Maternal and Child Health Hospital/Gansu Provincial Central Hospital, Lanzhou, Gansu 730070, China
出版时间: 2025-04-28 doi: 10.11855/j.issn.0577-7402.1671.2024.0704
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神经血管单元(NVU)是维持血脑屏障(BBB)完整性、调节大脑生理活动、维持大脑内环境稳态的最小结构单元,已成为大脑生理活动及病理变化研究的热点领域。NVU在脑白质病变、认知障碍、脑血管疾病等年龄依赖性中枢神经系统疾病中具有重要作用,其功能障碍会导致BBB完整性破坏,随之而来的蛋白质渗漏、免疫炎症反应、脑血流动力学改变均可导致癫痫发作或神经退行性疾病进展;反之,癫痫发作亦可加速NVU功能障碍而促进脑衰老。本文综述NVU的组成细胞功能障碍在年龄依赖性癫痫发病过程中的作用机制及相关分子通路的研究进展,旨在为癫痫治疗研究提供新的思路。

老年癫痫  /  神经血管单元  /  血脑屏障  /  作用机制

The neurovascular unit (NVU) is the smallest structural unit that maintains the integrity of the blood-brain barrier (BBB), regulates cerebral physiological activities, and maintains the homeostasis of the brain's internal environment. It has become a hot topic in the study of brain physiology and pathological changes. NVU plays a crucial role in age-dependent central nervous system diseases such as cerebral white matter lesions, cognitive impairment, and cerebrovascular disease. Its dysfunction can lead to destruction of BBB integrity, with subsequent protein leakage, immune-inflammatory responses, and alterations in cerebral hemodynamics, all of which can trigger seizures or progression of neurodegenerative disorders. Conversely, seizures can also accelerate NVU dysfunction and promote brain aging. The review summarizes the role of dysfunctional constituent cells of the NVU in the pathogenesis of age-dependent epilepsy and the research progress in related molecular pathways, aiming to provide new perspectives for epilepsy treatment research.

epilepsy in the elderly  /  neurovascular unit  /  blood-brain barrier  /  mechanism of action
刘璇, 尹榕. 老年癫痫发作中神经血管单元功能障碍的作用机制研究进展. 解放军医学杂志, 2025 , 50 (4) : 490 -494 . DOI: 10.11855/j.issn.0577-7402.1671.2024.0704
Xuan Liu, Rong Yin. Research progress on the role of neurovascular unit dysfunction in elderly patients with epileptic seizures[J]. Medical Journal of Chinese People’s Liberation Army, 2025 , 50 (4) : 490 -494 . DOI: 10.11855/j.issn.0577-7402.1671.2024.0704
据世界卫生组织统计,全球至少有5000万癫痫患者[1]。癫痫在老年(年龄>65岁)神经系统疾病中居第3位,仅次于脑卒中和痴呆[2]。目前尚无晚发性癫痫的标准定义。研究显示,癫痫在幼年和老年人群中发病率较高,50岁以后发病率逐步上升,在>75岁人群中发病率最高[3]。幼年癫痫多为原发性,或与遗传因素相关[4],而老年癫痫多为继发性。与年轻人群相比,老年癫痫是一个相对未被重视及研究不足的领域[2]。了解老年癫痫的病理生理机制是探寻其治疗方案的关键。越来越多的证据显示,老年癫痫的发病机制与神经炎症和脑血管功能障碍有关[5-7]。癫痫发生的一个重要病理机制是血脑屏障(blood-brain barrier,BBB)功能失调,导致白蛋白和免疫细胞通过破坏的BBB进入到脑实质[7-8]。针对这一机制进行深入探索,可能为老年癫痫的诊治提供新思路。
BBB是维持外周循环与中枢神经系统(central nervous system,CNS)之间物质交换和生物信息传递的主要组成部分,由微血管内皮细胞、周细胞和星形细胞端足组成,在大脑毛细血管周围形成保护鞘[9-10];其中,组成BBB的微血管基底膜、内皮细胞、周细胞通过星形胶质细胞与神经元耦联,被称为NVU。NVU作为一个有机整体,反映了特殊的脑内皮、胶质细胞和周细胞与神经元之间的结构和功能联系,它们共同调节脑血流、协调物质代谢活动及免疫反应,以维持稳定的CNS微环境[11]
NVU是维持BBB稳定的重要结构,通常由微血管内皮细胞、基底膜、周细胞、星形胶质细胞和神经元组成;星形胶质细胞通过尾足将微血管与神经元联系在一起,形成一个完整的NVU。随着年龄增长,大脑会发生退行性病变,而老年癫痫患者也存在类似的病理变化,在NVU结构中表现为微血管渗漏、周细胞脱离、周围小胶质细胞增生、星形胶质细胞尾足脱离,以及随之而来的神经血管解耦联、BBB损伤,同时NVU周围的炎症反应加剧(图1)。
随着年龄增长,血管内皮细胞和周细胞的密度及覆盖率逐渐降低,严重时可导致BBB功能障碍[11],特别是在容易发生年龄相关退行性病变的大脑区域(如海马)[12]。在衰老过程中,BBB功能障碍可触发星形胶质细胞中转化生长因子-β(transforming growth factor-β,TGF-β)信号的过度激活,导致啮齿动物神经功能障碍及与年龄相关的病理改变。
研究显示,BBB功能障碍及神经血管解耦联可导致癫痫和癫痫持续状态(status epilepticus,SE)[13-14];其中的病理生理变化包括BBB通透性增加、基底膜增厚、周细胞脱离、星形细胞增多、小胶质细胞增生、血管周围炎症、淀粉样蛋白和tau蛋白积累以及神经元死亡。上述病理改变可能促进神经元异常放电,导致癫痫发作或认知功能减退[11,15]。此外,NVU产生的多种化学介质介导的外周细胞招募并渗入大脑的一系列反应也可诱导癫痫发作。这些化学介质包括相关细胞的受体、配体及炎性因子[1]。已有研究观察到C-C基序配体2(C-C motif ligand 2,CCL2)和白细胞介素(interleukin,IL)-1β对上述反应的重要作用[16-17],前者影响单核细胞的迁移,后者具有神经毒性和促惊厥的特性,这两种细胞因子均可隐性地参与癫痫的发病机制[18]。NVU结构的特殊性决定了其生理功能及病理机制的复杂性,而其组成细胞在癫痫发作中的作用也有待进一步探索。
在局灶性BBB损伤动物模型中,已观察到BBB中断的程度与癫痫发作的严重程度密切相关[19-20]。大脑微血管系统破坏是各类癫痫发作的共同特征,BBB完整性破坏似乎是病理改变的关键驱动因素。BBB的核心结构是大脑微血管内的内皮细胞,其主要组成部分是封闭细胞旁空间的内皮间紧密连接蛋白[19]。虽然已有大量研究描述了癫痫动物模型中的BBB功能障碍,但目前对BBB破坏的潜在分子驱动因素仍知之甚少,这意味着靶向调控BBB的功能是一个尚未探索的癫痫治疗途径。
迄今为止,对癫痫中微血管功能的研究较少,也缺乏与微血管病理学相关的实验性癫痫模型。Liu等[21]发现,敲除小鼠内皮细胞特异性细胞周期素依赖蛋白激酶5(cyclin-dependent kinase 5,Cdk5)基因可诱发海马区域癫痫样放电,且呈年龄依赖性,提示内皮细胞Cdk5缺失可通过内皮细胞谷氨酸转运蛋白1(glutamate transporter 1,GLT-1)介导的电流诱导反应性星形胶质细胞进行性增生,进而诱导癫痫发作。
Kucheryavykh等[22]采用脂多糖(lipopolysaccharide,LPS)诱导的全身炎症小鼠模型进行研究发现,肿瘤坏死因子(tumor necrosis factor,TNF)-α介导的坏死可诱导脑内皮损伤、神经炎症和星形胶质细胞离子通道Kir4.1失调,并与随后的神经元过度兴奋和癫痫发作有关。在神经元兴奋过程中,星形胶质细胞的Kir4.1通道在钾离子(K+)外流的过程中发挥主要作用,以维持神经元微环境[13,22]的稳态。TNF-α在与TNF-α1受体结合后,可触发一系列信号通路,调节多种细胞和组织的生物活性。因此,TNF-α介导的信号通路的激活可能会影响脑内皮细胞和BBB的成分[23],导致神经元过度兴奋及异常放电。前期研究表明,给予作用于TNF-α受体和受体相互作用蛋白激酶3(RIP3)的靶向抑制药物,可减轻全身炎症小鼠的脑内皮细胞损伤,提高癫痫发作阈值[13]。上述研究提示了一种很有前途的治疗方法,可通过开发分子通路靶向抑制剂,减轻脑内皮损伤及星形胶质细胞离子通道功能障碍,进而降低神经元兴奋性。
星形胶质细胞在维持BBB稳态中起着关键作用。星形胶质细胞端足包含多种通道蛋白,如向内整流钾(Kir)通道亚基Kir4.1,后者为正交粒子阵列的组成部分之一,是维持BBB特性所必需的[24]。当BBB破坏、对K+的通透性增加时,星形胶质细胞对K+水平的控制能力下降,同时ATP水平降低导致的代谢障碍可限制能量依赖泵对钾的清除,细胞外的血液和CNS中K+含量增加,均会导致水分子向细胞外流,并导致离子性水肿,可进一步损害大脑微环境的稳态[25]。星形胶质细胞通过Kir4.1等通道可直接影响神经兴奋性,并与癫痫发作的发病机制有关[26]
Kyriatzis等[27]发现,IL-1β或LPS介导的炎症反应可诱导星形胶质细胞神经紧张素受体2(neurotensin receptors 2,NTSR2)的表达;在两种颞叶癫痫(temporal lobe epilepsy,TLE)模型中,NTSR2在啮齿动物海马星形胶质细胞中均有表达,且在SE发作后的早期阶段与星形胶质细胞的反应性同步增高。在神经炎症过程中,海马星形胶质细胞参与了神经紧张素能系统的调节,靶向NTSR2受体可调节神经炎症,这可能为星形胶质细胞相关神经炎症的调节开辟了新的途径。星形胶质细胞反应过程中NTSR2的上调可能存在于不同类型的脑损伤及不同物种中,且与癫痫发作密切相关[27]
越来越多的临床和实验证据显示,大脑的神经炎症是癫痫病理改变的关键机制[28]。小胶质细胞为先天免疫细胞,是参与SE后神经炎症及神经元丧失的关键成分[17,29]。Hong等[30]发现,Toll样受体2信号通路在癫痫发作诱导的小胶质细胞增殖中起重要作用,并且小胶质细胞的激活和增殖在癫痫患者中普遍存在,免疫调节治疗可显著降低癫痫发作活跃程度。小胶质细胞增多是SE后常见的病理特征,其数量增多与神经元死亡和癫痫发作的严重程度呈正相关[28]。上述研究提示,小胶质细胞增殖可能深刻影响了癫痫患者的预后,但癫痫诱发小胶质细胞增殖的机制尚不清楚。
生物物理和药理特征观察显示,SE后活化的小胶质细胞中含有Kv1.3亚基的K+通道[31];虽然小胶质细胞和单核细胞表达大量K+通道,但Kv1.3通道在活化的小胶质细胞中高度表达[32],并涉及小胶质细胞的增殖、激活、迁移及细胞因子的释放,但K+通道在癫痫发作诱导的小胶质细胞增殖和单核细胞浸润中的作用有待进一步研究。
有研究显示,集落刺激因子-1受体(colony stimulating factor-1 receptor,CSF-1R)信号通路可影响癫痫发作诱导的小胶质细胞的形态改变和增殖、单核细胞浸润以及由此导致的神经元死亡[33];虽然阻断CSF-1R可防止神经元死亡,保留海马结构,但其对神经元活动和海马功能的直接影响还有待进一步研究。因此,靶向小胶质细胞的增殖特别是CSF-1R信号通路,有望成为癫痫治疗的新策略,同时上述研究进一步加深了对小胶质细胞和单核细胞独特性的理解,有望用于开发新的癫痫治疗方案。
研究显示,周细胞在维持BBB完整性、生成炎症分泌物和招募白细胞方面发挥关键作用,表明其在癫痫发病机制中可能具有潜在的作用[5]
临床和动物模型研究显示,BBB破坏可直接诱发癫痫活动,增加癫痫的严重程度;癫痫与BBB破坏之间是双向关系[34-35]。周细胞是脑微血管系统的重要组成部分,参与了NVU的形成,为BBB提供了物理支持,且在维持CNS稳态和BBB完整性中发挥了不可或缺的作用。
周细胞形态改变可导致微血管血流动力学变化,并进一步导致毛细血管完整性的破坏[36]。周细胞变性和(或)功能障碍可触发NVU功能的改变(包括神经胶质细胞的激活),并可能在TNF-α介导的炎症反应中诱导BBB功能障碍,上述病理改变可能是癫痫的诱发因素[37]。BBB改变除了可导致血清蛋白渗漏而诱导癫痫发作,还可导致各种炎性介质的分泌[34]。癫痫发作可引起血管周围的周细胞重新排列并发生形态学改变,该过程是由炎性介质介导的[38]
近期研究显示,周细胞可能作为CNS炎症反应的传感器响应循环细胞因子等炎症信号,并通过趋化因子和细胞因子的分泌将这些信息传递给周围的细胞[5,39]。与NVU中的其他细胞相比,周细胞对促炎细胞因子更为敏感[40]。NVU及周围细胞分泌的IL-1β、TNF-α和IL-6等促炎细胞因子可导致周细胞的形态学发生改变,其中IL-1β的作用最为明显,而IL-6与周细胞凋亡显著相关[41]
Vezzani等[42]报道,IL-1β可促进周细胞修饰及周细胞-小胶质细胞聚集。海马体中增殖的周细胞与病理条件下增多的周细胞表型一致[41]。此外,有证据显示,IL-1/IL-1R1轴在癫痫患者的炎症反应中发挥了重要作用[18,42]。癫痫发作后及发作期间的周细胞增殖和重排在癫痫发病机制中发挥着重要作用[43-44]。Prager等[36]认为,周细胞损伤是癫痫患者血管功能障碍的诱导因素。
由此可见,周细胞的病理改变既可加剧BBB功能障碍诱发癫痫,也可能作为CNS炎症过程的传感器诱导癫痫发作。进一步探索周细胞的增殖、重排及病理生理变化机制,可能促进癫痫新疗法的发展。
目前越来越多的研究证据显示,老年患者癫痫的发病机制与神经炎症和脑血管功能障碍有关;衰老和癫痫发作的NVU细胞变化机制存在一定的重叠[11]。随着相关研究的深入,已在癫痫模型动物的病理组织中发现了微血管功能障碍的证据;同时BBB损伤在癫痫性疾病中的作用也备受关注,BBB开放时间延长与神经元网络的延迟及结构和功能紊乱有关,但BBB功能障碍在癫痫发作中的具体机制仍不清楚[34]
NVU作为大脑微结构的核心组成部分,在维持BBB完整性及脑功能方面发挥着关键作用。在BBB和NVU的组成部分中,周细胞可能具有特殊的关联,在维持BBB完整性中发挥至关重要的作用[34]。周细胞损伤可导致神经血管解耦联,并可造成微循环功能障碍[34]。研究显示,周细胞在红藻酸诱导的SE和慢性癫痫组织中的分布发生了改变[39]。此外,血管内皮细胞、星形胶质细胞、小胶质细胞在癫痫发作期及发作后的神经炎症反应中的作用也得到了广泛研究。
NVU的部分关键组成细胞与年龄相关性癫痫发作及神经退行性疾病关系密切。因此,对NVU功能障碍在癫痫发病机制中的作用进行深入研究,可能为老年癫痫的治疗提供新的方向。
  • 甘肃省科技重大专项(23ZDFA012)
  • 甘肃省自然科学基金(22JR5RA720)
  • 甘肃省青年科技基金(23JRRA1395)
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doi: 10.11855/j.issn.0577-7402.1671.2024.0704
  • 接收时间:2023-12-18
  • 首发时间:2025-10-30
  • 出版时间:2025-04-28
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  • 收稿日期:2023-12-18
  • 录用日期:2024-01-25
基金
Gansu Provincial Science and Technology Major Program(23ZDFA012)
甘肃省科技重大专项(23ZDFA012)
Natural Science Foundation of Gansu Province(22JR5RA720)
甘肃省自然科学基金(22JR5RA720)
Gansu Youth Science and Technology Fund(23JRRA1395)
甘肃省青年科技基金(23JRRA1395)
作者信息
    甘肃省妇幼保健院/甘肃省中心医院神经内科,甘肃兰州 730070

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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