1.山东中医药大学 山东 250013
2.山东大学齐鲁医院
3.山东第一医科大学第一附属医院
怀宝赓,男,在读博士生
# 刘德山,男,博士,主任医师,教授,博士生导师,主要研究方向:中西医结合防治老年病,E-mail:liudeshan@sdu.edu.cn
纸质出版日期:2023-07-30,
网络出版日期:2023-05-15,
收稿日期:2023-03-04,
移动端阅览
怀宝赓, 李昌玲, 怀宝莎, 等. 基于血浊理论探讨内皮细胞损伤在糖尿病微血管病变中的作用机制[J]. 北京中医药大学学报, 2023,46(7):937-942.
HUAI Baogeng, LI Changling, HUAI Baosha, et al. Explore the mechanism of endothelial cell injury in diabetic microangiopathy based on the theory of "turbid blood"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(7):937-942.
怀宝赓, 李昌玲, 怀宝莎, 等. 基于血浊理论探讨内皮细胞损伤在糖尿病微血管病变中的作用机制[J]. 北京中医药大学学报, 2023,46(7):937-942. DOI: 10.3969/j.issn.1006-2157.2023.07.008.
HUAI Baogeng, LI Changling, HUAI Baosha, et al. Explore the mechanism of endothelial cell injury in diabetic microangiopathy based on the theory of "turbid blood"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(7):937-942. DOI: 10.3969/j.issn.1006-2157.2023.07.008.
血浊理论作为现代中医学理论,是指血液在各种因素作用下,失去清纯状态,转变为混乱、浊化、失序的病理现象。血浊作为病理产物的同时,又可以作为诸多疾病的继发性致病因素。微血管病变是糖尿病常见的并发症之一,主要包括肾脏病变及视网膜病变。内皮细胞是血浆与血管壁之间的一层特殊扁平上皮细胞,具有完成血浆与组织液代谢交换、合成和分泌生物活性物质、维持血管张力等功能。糖尿病诱导的内皮细胞损伤与功能障碍是导致微血管病变的关键病理因素,这与血浊的特性高度契合。血浊既是导致内皮细胞损伤的致病因素,内皮细胞持续损伤亦是血浊继而为病的病理基础。本文首先阐释了血浊理论的源流,强调了血浊的中医学属性特点;然后,介绍了血浊与内皮细胞损伤的密切联系,并认为血浊与内皮细胞损伤是导致糖尿病微血管病变的核心病机。最后,基于血浊理论,结合糖尿病微血管病变的疾病特点,归纳出该病阴虚燥热、血浊内生、络脉瘀痹的病机演变特点,并提出以养阴护脉、清化血浊、通瘀畅络为治法,延缓糖尿病微血管病变的进程,从而改善患者的临床症状。
"Turbid blood" theory as a new theory of traditional Chinese medicine(TCM)
refers to the pathological phenomenon that blood loses its pure state and becomes chaotic
turbid and dysfunctional under the action of various factors. As a pathological product
turbid blood can also be a secondary pathogenic factor of many diseases. Microangiopathy is one of the common complications of diabetes
along with kidney disease and retinopathy. Endothelial cells are a layer of special flat cells between plasma and the blood vessel wall. They have many functions
such as metabolic exchange between plasma and the tissue fluid
synthesis and secretion of bioactive substances
and maintenance of vascular tension. Endothelial cell injury and dysfunction induced by diabetes are the key pathological factors leading to microangiopathy
which is highly consistent with the characteristics of turbid blood. Turbid blood is the cause of endothelial cell damage
and the sustained injury of endothelial cells is the pathological basis of turbid blood followed by disease. In this article
we explain the origin of the theory of turbid blood
emphasize that turbid blood belongs to the theory of TCM
and introduce the close relationship between turbid blood and endothelial cell injury. This article is based on the belief that turbid blood and endothelial cell injury are the core pathogenesis leading to diabetic microangiopathy. Moreover
based on the theory of turbid blood and combined with the disease characteristics of diabetic microangiopathy
the pathogenic evolution characteristics of the disease are summarized as yin deficiency leading to dryness-heat
endogenous turbid blood
and collateral stasis obstruction
and the proposed treatment is based on nourishing yin and protecting vessels
clearing turbid blood
and dredging blood stasis to delay the process of diabetic microangiopathy
thereby improving the clinical symptoms of patients.
血浊内皮细胞糖尿病微血管病变
turbid bloodendothelial cellsdiabetic microangiopathy
SUN H, SAEEDI P, KARURANGA S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J/OL]. Diabetes Res Clin Pract,2022,183:109119[2022-12-05]. https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(21)00478-2/fulltext.
KRUGER-GENGE A, BLOCKI A, FRANKE RP, et al. Vascular Endothelial Cell Biology: An Update[J/OL]. Int J Mol Sci,2019,20(18):4411[2022-12-07]. https://www.mdpi.com/1422-0067/20/18/4411.
王新陆.“浊”与“血浊”[J]. 天津中医药,2019,36(9):833-838.
王新陆,王栋先.血浊的性质特点和辨证论治[J]. 天津中医药,2020,37(2):148-152.
王新陆.血浊理论产生的历史背景和现实意义[J]. 天津中医药,2019,36(10):937-941.
韩萍,周永红,王新陆.血浊致病理论初探[J]. 山东中医药大学学报,2008,32(6):456-457.
孙一奎.赤水玄珠[M].叶川,建一,校注.北京:中国中医药出版社,1996:6.
王媛,王钧左,严溢泉,等.内皮细胞糖代谢在血管发育中的作用[J]. 中国病理生理杂志,2020,36(8):1515-1520.
LI XR, SUN XD, CARMELIET P. Hallmarks of Endothelial Cell Metabolism in Health and Disease[J].Cell Metab,2019,30(3):414-433.
ECKEL RH, GRUNDY SM, ZIMMER PZ. The metabolic syndrome[J].Lancet,2005,365(9468):1415-1428.
LEE WL, KLIP A. Endothelial Transcytosis of Insulin: Does It Contribute to Insulin Resistance?[J].Physiology (Bethesda),2016,31(5):336-345.
ARTUNC F, SCHLEICHER E, WEIGERT C, et al. The impact of insulin resistance on the kidney and vasculature[J].Nat Rev Nephrol,2016,12(12):721-737.
SHI Y, VANHOUTTE PM. Macro- and microvascular endothelial dysfunction in diabetes[J].J Diabetes,2017,9(5):434-449.
REDDY MA, ZHANG E, NATARAJAN R. Epigenetic mechanisms in diabetic complications and metabolic memory[J].Diabetologia,2015,58(3):443-455.
谢春光.伏邪理论指导下糖尿病大血管病变中医药防治体系的构建[J]. 中国中医基础医学杂志,2022,28(8):1205-1209.
宋莹莹,杨进.从络病学说论治糖尿病血管并发症[J]. 南京中医药大学学报,2014,30(5):406-409.
RUDRARAJU M, NARAYANAN SP, SOMANATH PR. Regulation of blood-retinal barrier cell-junctions in diabetic retinopathy[J/OL]. Pharmacol Res,2020,161:105115[2022-12-12]. https://www.sciencedirect.com/science/article/abs/pii/S1043661820314237.
GUI F, YOU ZP, FU SH, et al. Endothelial Dysfunction in Diabetic Retinopathy[J/OL]. Front Endocrinol (Lausanne),2020,11:591[2023-01-04]. https://www.frontiersin.org/articles/10.3389/fendo.2020.00591/full.
SAMSU N. Diabetic Nephropathy: Challenges in Pathogenesis, Diagnosis, and Treatment[J/OL].Biomed Res Int,2021,2021:1497449.https://www.hindawi.com/journals/bmri/2021/1497449/.
LASSEN E, DAEHN IS. Molecular Mechanisms in Early Diabetic Kidney Disease: Glomerular Endothelial Cell Dysfunction[J/OL]. Int J Mol Sci,2020,21(24):9456[2023-01-11]. https://www.mdpi.com/1422-0067/21/24/9456.
CHEN SJ, LV LL, LIU BC, et al. Crosstalk between tubular epithelial cells and glomerular endothelial cells in diabetic kidney disease[J/OL]. Cell Prolif,2020,53(3):e12763[2023-01-12]. https://onlinelibrary.wiley.com/doi/10.1111/cpr.12763.
黄小燕,王宇光,王怡,等.麦冬皂苷D通过上调CYP2J2/EETs抗Ang Ⅱ诱导的内皮细胞凋亡[J]. 中国中药杂志,2018,43(2):377-384.
陆春红,许惠琴,刘凯,等.生地环烯醚萜苷类成分对AGEs损伤HUVEC的保护作用[J]. 南京中医药大学学报,2015,31(1):55-59.
陈士铎.本草新编[M].文红旗,裴效华,张姣兰,等,点校.太原:山西科学技术出版社,2011:179.
孙星衍,孙冯翼.神农本草经[M]. 周劲草,李辰,郝洋,等,校注.太原:山西科学技术出版社,2018:82.
吴浩然,仝小林,田佳星.蒲黄、三七、仙鹤草治疗糖尿病瘀血阻络型眼底出血经验:仝小林三味小方撷萃[J]. 吉林中医药,2020,40(8):1001-1003.
0
浏览量
27
下载量
1
CSCD
关联资源
相关文章
相关作者
相关机构