调节射精脊髓回路的下行通路:慢性脊髓损伤的影响
Descending pathways modulating the spinal circuitry for ejaculation: effects of chronic spinal cord injury.
作者信息
Johnson Richard D
机构信息
Department of Physiological Sciences, College of Veterinary Medicine and the McKnight Brain Institute, University of Florida, Gainesville, FL 32610-0144, USA.
出版信息
Prog Brain Res. 2006;152:415-26. doi: 10.1016/S0079-6123(05)52028-4.
Sexual dysfunction is a common complication in men with chronic spinal cord injury. In particular, ejaculation is severely compromised or absent and the resulting infertility issues are important to this group of predominantly young men. To investigate the neural circuits and descending spinal pathways involved in ejaculation, animal models have been developed in normal and spinal cord-injured preparations. Primarily through studies in rats, spinal ejaculatory circuits have been described including (i) autonomic circuits at the thoracolumbar and lumbosacral levels mediating the emission phase of ejaculation, (ii) somatic circuits at the lumbosacral level controlling the expulsion phase of ejaculation through sequential and rhythmic contraction of perineal striated muscles (e.g. bulbospongiosus), and (iii) a proposed ejaculatory pattern generator in the lumbar cord. Midthoracic incomplete chronic spinal cord injury has revealed the dependency of spinal ejaculatory circuits on bilateral spinal pathways from the brainstem via modulation of pudendal motor neuron reflexes and pudendal nerve autonomic fibers. Accordingly, sensory input from the dorsal nerve of the penis, required to trigger the ejaculatory response in animals and humans, is no longer inhibited from the lateral paragigantocellularis nucleus in the ventrolateral medulla. This inhibitory effect, likely presynaptic through a serotonergic pathway, is thought to be necessary to provide the rhythmic, bursting, and sequential contractions of the perineal muscles during ejaculation. Chronic lateral hemisection injury, which severs half of the descending lateral funiculus-located pathways, results in new functional connections of the pudendal reflex inhibitory and pudendal sympathetic activation pathways across the midline, above and below the lesion, respectively. Clinical correlations in spinal cord-injured men have demonstrated the validity of the rodent animal for the study of ejaculatory dysfunction after chronic injury.
性功能障碍是慢性脊髓损伤男性的常见并发症。特别是射精功能严重受损或缺失,由此导致的不育问题对于这群以年轻人为主的男性来说至关重要。为了研究参与射精的神经回路和脊髓下行通路,已经在正常和脊髓损伤的实验准备中建立了动物模型。主要通过对大鼠的研究,已经描述了脊髓射精回路,包括:(i)胸腰段和腰骶段的自主神经回路,介导射精的排出阶段;(ii)腰骶段的躯体神经回路,通过会阴横纹肌(如球海绵体肌)的顺序性和节律性收缩来控制射精的排出阶段;(iii)在腰髓中提出的射精模式发生器。胸段中部不完全性慢性脊髓损伤揭示了脊髓射精回路对来自脑干的双侧脊髓通路的依赖性,这是通过对阴部运动神经元反射和阴部神经自主纤维的调节实现的。因此,在动物和人类中触发射精反应所需的来自阴茎背神经的感觉输入,不再受到延髓腹外侧旁巨细胞外侧核的抑制。这种抑制作用可能通过血清素能通路在突触前发挥作用,被认为是在射精过程中为会阴肌肉提供节律性、爆发性和顺序性收缩所必需的。慢性侧半横断损伤切断了位于外侧索的下行通路的一半,导致阴部反射抑制和阴部交感神经激活通路分别在损伤部位上方和下方跨越中线形成新的功能连接。脊髓损伤男性的临床相关性研究已经证明了啮齿动物模型对于研究慢性损伤后射精功能障碍的有效性。