Bugajski Andrzej, Gil Krzysztof
Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland.
Folia Med Cracov. 2012;52(3-4):67-77.
Obesity and its complications constitute an important health problem in growing number of people. Behavioral and pharmacological treatment is not much effective and surgical treatment carries too many threats. Promising method to be used is pharmacological or electric manipulation of vagus nerves. Regulation of food intake and energy utilization is a complex process regulated by centers in hypothalamus and brainstem which are receiving information from the peripheral via afferent neural pathways and sending peripherally adequate instructions by efferent neural pathways. In these signals conduction an important role plays vagus nerve. Additionally central nervous system stays under influence of endocrine, paracrine and neuroendocrine signals taking part in these regulations, functioning directly onto the centre or on the afferent neural endings. 80-90% fibers of vagus nerve are afferent fibers, so their action is mainly afferent, but possible contribution of the efferent fibers cannot be excluded. Efferent stimulation induces motility and secretion in the intestinal tract. Afferent unmyelinated C-type fibres of the vagus nerve are more sensitive and easily electrically stimulated. Information from vagus nerve is transmitted to nucleus tractus solitarius, which has projections to nucleus arcuate of the medio-basal hypothalamus, involved in the control of feeding behavior. It is suggested, that interaction onto the vagus nerve (stimulation or blocking) can be an alternative for other ways of obesity treatment. Through the manipulation of the vagus nerve activity the goal is achieved by influence on central nervous system regulating the energy homeostasis.
肥胖及其并发症在越来越多的人当中构成了一个重要的健康问题。行为治疗和药物治疗效果不佳,而手术治疗又存在太多风险。一种有前景的治疗方法是对迷走神经进行药物或电刺激调控。食物摄入和能量利用的调节是一个复杂的过程,由下丘脑和脑干中的中枢进行调控,这些中枢通过传入神经通路接收来自外周的信息,并通过传出神经通路向外周发送适当的指令。在这些信号传导过程中,迷走神经起着重要作用。此外,中枢神经系统还受到参与这些调节的内分泌、旁分泌和神经内分泌信号的影响,这些信号直接作用于中枢或传入神经末梢。迷走神经80%-90%的纤维是传入纤维,因此其作用主要是传入性的,但不能排除传出纤维可能的作用。传出刺激可诱导肠道的蠕动和分泌。迷走神经的传入无髓C型纤维更敏感,更容易受到电刺激。来自迷走神经的信息被传递到孤束核,孤束核投射到中基底下丘脑的弓状核,参与进食行为的控制。有人提出,对迷走神经进行干预(刺激或阻断)可能是肥胖治疗的其他方法的替代方案。通过调控迷走神经活动,可通过影响调节能量平衡的中枢神经系统来实现治疗目标。