基于凋亡-自噬稳态失衡论骨髓增生异常综合征正虚邪实病机演变  

A Discussion on Evolution of Pathogenesis of Simultaneous Presentation of Sthenia and Asthenia in Myelodysplastic Syndromes Based on the Homeostasis imbalance of Apoptosis-autophagy

作　　者：许鸣 许勇钢[2] 胡晓梅[2] 陆嘉惠[3] XU Ming;XU Yonggang;HU Xiaomei;LU Jiahui

机构地区：[1]桐乡市第一人民医院,浙江桐乡314500 [2]中国中医科学院西苑医院,北京100091 [3]上海中医药大学附属市中医医院,上海200071

出　　处：《新中医》2018年第12期252-255,共4页New Chinese Medicine

基　　金：国家中医临床研究基地业务建设第二批科研专项课题(JDZX2015260)(依托基地:中国中医科学院西苑医院);国家自然科学基金资助项目(81573928);上海市促进市级医院临床技能与临床创新能力三年行动计划项目(16CR2040B)

摘　　要：中医理论认为,人体是能进行自我调节和控制的整体系统,病机学说侧重从动态功能和整体结构研究疾病的生理。骨髓增生异常综合征(Myelodysplastic syndromes,MDS)是一组造血干细胞恶性克隆性疾病,不同危度分层间具有极大差异,易转化为急性髓系白血病。一般认为,MDS疾病初期或低危型MDS以"正虚"证型为主间或夹有"瘀毒"症状;MDS疾病后期或高危型MDS以"瘀毒"证型为主,同时表现出正气受损甚或衰极现象。随着现代分子生物学研究的进展,中医证型的物质基础逐渐被揭示与阐明,不同危度MDS患者的骨髓单个核细胞凋亡和自噬水平的差异性表达与不同中医证型之间具有高度相关性。低危MDS凋亡过度和(或)自噬减少均符合正虚型患者的中医证候表现及病机特点,而低危向高危转化的过程中凋亡减少及自噬进一步受抑制则与瘀毒型患者证候表现及病机特点相符。According to the Chinese medicine theory,the human body is an integral system capable of self-regulation and control, while the theory of pathogenesis focuses on studying the physiology of disease from dynamic function and whole structure. Myelodysplastic syndromes (MDS)are a group of hematopoietic stem cell malignant cloned diseases, in which the risk stratification differs greatly,and it is easy to transform into acute myeloid leukemia. Generally,MDS at early stage or with low risk are mainly characterized by "positive qi become weak " syndrome types or accompanied with "stasis-toxin" symptoms. MDS at advanced stage or with high risk are mainly characterized by "stasis-toxin" syndrome types,and the damage or even degeneration of healthy qi is presented meanwhile. With the development of modern molecular biology,the material basis of Chinese medicine syndrome types is gradually revealed and clarified:the differential expression of apoptosis and autophagy of bone marrow mononuclear cells in patients with MDS with different risks is highly correlated with different Chinese medicine syndrome types. The excessive apoptosis and/or reduction of autophagy in low-risk MDS all conform to the characteristics of Chinese medicine syndrome types and pathogenesis in patients with positive qi become weak syndrome types,while the decrease of apoptosis and further inhibition of autophagy during the transformation from low risk to high risk are consistent with the symptoms and pathogenesis of patients with stasis-toxin syndrome types.

关 键 词：骨髓增生异常综合征 凋亡 自噬 正虚 瘀毒 病机演变 

分 类 号：R551.3[医药卫生—血液循环系统疾病]