자율신경계 중 척수의 엉치부분을 교감신경으로 분류해야 한다는 주장을 둘러싼 논쟁에 대해
A Critical Review on the Argument that the Sacral Division of the Autonomic Nervous System should be Classified as the Sympathetic Nervous System
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초록
100년 전의 Gaskell과 Langley의 발견과 주장에 기반해 자율신경계통이 정의되고 구분되었다. 당시에는 사용할 수 없었던 분자생물학적 기법이 최근에 발전했고, 이에 따라 자율신경계통에 대한 분류도 새로 정의해야 한다는 주장을 담은 논문도 2016년에 출판되었다. 해당 논문은 부교감신경계로 분류되던 엉치부분도 다른 척수부분과 같이 교감신경계로 분류해야 한다고 주장했고, 이후 많은 논쟁을 유발했다. 본 종설 논문에서는 엉치부분의 구분과 명명과 관련한 논쟁과 주장의 근거들을 살펴보고, 자율신경계통 자체의 개념에 대해 고찰하였다. 교감과 부교감신경을 분류하는 해부학적, 생리학적, 약리학적 기준 등 다양한 관점에 비추어 엉치부분을 검토하였다. 또한 엉치부분의 표적장기들이 있는 골반 부분의 자율신경계통 기능과 해부학에 대해 검토하였다. 그 결과 엉치부분을 교감으로 분류하는 것은 다소 무리가 있는 주장이며, 그렇게 분류할 경우 오히려 임상현장에 혼란을 초래할 것이라는 결론을 얻었다. 그럼에도 불구하고 분자생물학적 기술의 발전과 지식의 축적에 따라 자율신경계통을 포함한 해부조직학적 기존 지식에 대한 재검토가 필요해 보인다.
Abstract
The autonomic nervous system was differentiated on the basis of the observations and claims of Gaskell and Langley more than a century ago. In 2016, a study was published arguing that the classification of the autonomic nervous system should also be redefined in light of the recent development of molecular biology tools that were unavailable at the time. The paper argued that the sacral division, which had been classified as the parasympathetic nervous system, should be classified as the sympathetic nervous system, like other spinal cord divisions, which sparked considerable debate. In this review, the classification of the sacral division, as well as the idea of the autonomic nervous system, are investigated, along with the arguments that support them. Various perspectives, including anatomical, physiological, and pharmacological criteria for identifying the sympathetic and parasympathetic nervous systems, were applied to a review of the sacral division. The function and anatomy of the autonomic nervous system in the pelvic region, where the target organs of the sacral division are located, were also reviewed. As a result, it was determined that classifying the sacral division as sympathetic is more or less inappropriate and would rather cause confusion in the clinical field. In spite of this, it appears important to reevaluate the current understanding of anatomy, including the autonomic nervous system, in light of the advancement of molecular biology technology and the accumulation of knowledge.
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