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不同部位卒中后中枢性疼痛的临床表现及病理机制

陈小莉¹, 雷静^1,2, 尤浩军^1,2,*

¹延安大学感觉与运动疾病转化医学研究中心，延安 716000；²疼痛精准治疗与康复陕西省高等学校重点实验室，延安 716000

摘要

卒中后中枢性疼痛(central post-stroke pain, CPSP)是脑卒中后常见的后遗症之一，属于中枢性神经病理性疼痛。CPSP以自发性疼痛、痛觉过敏及触诱发痛为临床特征，严重阻碍脑卒中患者康复。CPSP的病理机制复杂，涉及多部位神经通路的功能异常，其核心机制包括中枢敏化、中枢去抑制、神经胶质细胞过度激活、神经递质失衡等，均涉及神经炎症和离子通道的改变。本文系统综述了不同部位(脑干、丘脑、皮质)卒中病灶引发CPSP的临床表现及病理机制，重点探讨疼痛传导通路的异常重组、神经胶质细胞介导的神经炎症，以及离子通道的调控作用，旨在为CPSP 的靶向干预提供理论依据，并探讨潜在的治疗策略。

关键词： 感觉传导通路; 卒中后中枢性疼痛; 神经炎症; 丘脑; 离子通道

Clinical manifestations and pathological mechanisms of central post-stroke pain at different lesion sites

CHEN Xiao-Li¹, LEI Jing^1,2, YOU Hao-Jun^1,2,*

¹Center for Translational Medicine Research on Sensory-Motor Diseases, Yan'an University, Yan'an 716000, China；²Key Laboratory of Pain Precision Treatment and Rehabilitation of Shaanxi Province Higher Education Institutions, Yan'an 716000, China

Abstract

Central post-stroke pain (CPSP), a common sequela of stroke, is a type of central neuropathic pain characterized by spontaneous pain, hyperalgesia, and allodynia, which significantly hinders post-stroke rehabilitation. The pathophysiology of CPSP is complex, involving functional abnormalities in multiple neural pathways. Core mechanisms include central sensitization, central disinhibition, neuroglial overactivation, and neurotransmitter imbalances, all of which are associated with neuroinflammation and ion channel dysregulation. This review systematically summarizes the clinical manifestations and molecular mechanisms of CPSP induced by stroke lesions in different brain regions (brainstem, thalamus, and cortex), with a focus on maladaptive reorganization of pain pathways, neuroglia-mediated neuroinflammation, and ion channel modulation. The aim is to provide a theoretical foundation for targeted interventions in CPSP and explore potential therapeutic strategies.

Key words: sensory pathway; central post-stroke pain; neuroinflammation; thalamus; ion channels

收稿日期：　　录用日期：

通讯作者：尤浩军　　E-mail:

DOI: 10.13294/j.aps.2025.0088

引用本文：

陈小莉, 雷静, 尤浩军. 不同部位卒中后中枢性疼痛的临床表现及病理机制[J]. 生理学报 2025; 77 (6): 1023-1034.

CHEN Xiao-Li, LEI Jing, YOU Hao-Jun. Clinical manifestations and pathological mechanisms of central post-stroke pain at different lesion sites. Acta Physiol Sin 2025; 77 (6): 1023-1034 (in Chinese with English abstract).