皮肤具有独自的HPA轴系统.docVIP

作者单位：1, 广东医学院附属医院皮肤性病研究所 湛江524001 2， 第三军医大学西南医院皮肤科 重庆 400800 作者简介：郭红卫 女 36岁 副主任医师 现于第三大学就读皮肤性病学博士 皮肤HPA轴的研究进展 郭红卫 郝飞 摘要 皮肤是一神经内分泌器官，皮肤及其附属器与神经内分泌系统有着多方位联系。HPA轴中的神经肽激素及它们相应的受体分布于皮肤表皮和真皮的特定部位，以自分泌或旁分泌方式相互作用，对精神抑郁和环境抑郁因素如UV、外伤、理化物质刺激作出反应。皮肤的HPA轴不仅自身相互作用，也通过体液和神经冲动传递与系统神经内分泌系统交互呼应，诱导表皮分化、色素沉着、血管反应、免疫反应以缓解抑郁刺激引起的皮肤反应，从而保持皮肤结构功能的完整性以及与系统的动态平衡。 [关键词] 皮肤，HPA轴，抑郁 An independent HPA system in skin Guo Hong-wei1, Hao-Fei2* 1, Institute of Dermatology of Guangdong Medical college, Zhanjiang 524001 2, *Department of Dermatology of The Third Military Medical University, Chongqing 400800 Abstract Skin has an independent neuroendocrine circuitry by which it as well as its appendages compose a complicated net with neural and endocrine system. The elements controlling the activity of the hypothalamus-pituitary-adrenal(HPA) axis include CRH, urocortin, and POMC with its products ACTH, α-MSH, and β-endorphin. The interaction of all these elements and their corresponding receptors is carried out by para- or autocrine mechanisms. These elements respond to environmental stressors such as UV light and have a role for response to psychological stress in a field-restricted manner in the skin. The skin HPA axis communicates with itself and with the central neural system through humoral and neural pathways to induce vascular, immune, or pigmentary changes to neutralize the elicited local reactions. So the skin neuroendocrine system acts as maintaining the skin structural and functional integrity and systemic homeostasis. [key words] skin, HPA axis, stress 皮肤与中枢神经系统（CNS）具有相同的神经外胚层来源，皮肤密布复杂的神经并表达多种激素及其受体，暗示着皮肤与神经及内分泌系统的可能联系。目前认为皮肤是外周的神经内分泌器官，皮肤具有和中枢相似的下丘脑-垂体-肾上腺(HPA)系统1。皮肤的神经内分泌功能由皮肤的神经内分泌单位完成，神经内分泌单位包括表皮细胞如角质形成细胞、神经脊源细胞如黑素细胞、间叶细胞如成纤维细胞和骨髓来源的细胞如免疫细胞，这些细胞通过自分泌及旁分泌方式相互作用，形成一完整有序的神经内分泌网络2。 皮肤和中枢HPA轴的关系 精神抑郁刺激下，CNS通过HPA轴分泌的神经激素调控内分泌系统，具体途径如下：接受到抑郁信号的下丘脑释放促皮质激素释放激素(corticotropin-releasing hormone (CRH))，CRH与垂体的CRH受体结合（主要为CRHR1）引发信号转导促进垂体前叶的黑素皮质激素原(POMC)肽的合成和分泌，在前激素转化酶(PC1或PC2)作用下POMC