肠-脑-肝轴治疗糖尿病中西医病理机理  

Pathological Mechanism of Gut-brain-liver Axis for Treatment of Diabetes

作　　者：史小林[1,2] 龚雅婷 牛晶晶[1,2,3] 黄文瑾[1,3] 周铭月 沙雯君[1,3] 朱婷[1] 张军[5] 陈建峰[1,2,6] 周里钢[1,2,3] 

机构地区：[1]上海中医药大学附属曙光医院,上海201203 [2]上海中医药大学糖尿病研究中心,上海201203 [3]上海市浦东医院,上海201399 [4]美国加州大学圣芭芭拉分校生物科学系,美国加州93106 [5]上海公安高等专科学校警训部,上海201100 [6]上海市浦东新区唐镇社区卫生服务中心,上海201210

出　　处：《辽宁中医药大学学报》2014年第12期87-92,共6页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81370932);上海市教委东方学者基金项目;上海市科委浦江学者基金项目(PJ[2011]0000839);美国MERCK IISP基金项目(#40313 and#40309)

摘　　要：传统观点认为小肠只是消化和吸收营养物质的器官。最近这种观点有所改变,因为发现口腔黏膜和十二指肠等还能够感受营养物质触发负反馈回路,并且通过控制食物摄入量抑制葡萄糖生产来维持代谢平衡。此外,研究发现糖尿病和肥胖症患者的十二指肠营养感知存在缺陷,因而导致葡萄糖产生增加。相比之下,空肠营养感知功能的改变、介导减肥手术的早期抗糖尿病作用和肠道菌群组合物的改变,可能会改变肠道营养感应机制,可以使糖尿病和肥胖症患者能够长期有效地维持葡萄糖稳定。这一观点的重点是:肠道表面内的营养感应和反射机制可以维持葡萄糖稳定,并且可以靶向地改善糖尿病和肥胖病人的肠道营养感应机制,可能成为一个降低血糖浓度的治疗策略。中医观念认为消渴病与脾胃及舌象有着重要联系,而脾胃及舌象在消渴病的辨证论治过程中,起着关键作用,因而现代医学理论的小肠及口腔黏膜等还能够感受营养物质,触发营养和能量代谢的负反馈回路的新发现为古老的中医理论奠定了现代医学基础。The traditional view is that the role of the small intestine is to digest and absorb nutrients. This view has changed recently, in which the discovery of the oral mucosa and the duodenum can also feel the nutrients trigger negative feedback loop, and the control of food intake by inhibiting glucose production to maintain homeostasis. In addition, the study found patients with diabetes and obesity duodenal nutrient perception is flawed, resulting in increased production of glucose. In contrast, the perception of change function enteral nutritlon, bariatric surgery for early-mediated anti-diabetic effects, and change of the composition of the intestinal flora, may alter intestinal nutrient-sensing mechanism that enables patients to diabetes and obesity effective in maintaining long-term glucose stability. This perspective highlights nutrient-sensing mechanisms in the gut that regulate glucose homeostasis and the potential of targeting gut nutrient-sensing mechanisms as a therapeutic strategy to lower blood glucose concentrations in diabetes. Diabetes medicine concept that the tongue and stomach has important links, and stomach and the tongue in the process of diagnosis and treatment of diabetes plays a key role, and therefore oral mucosa of the small intestine and other modern medical theory also can feel the nutrients, nutrition and energy metabolism trigger a negative feedback loop for the discovered ancient Chinese medicine theory laid the foundation of modern medicine .

关 键 词：营养感应机制 肠-脑-肝轴 肠内菌群 十二指肠空肠旁路(DJB)手术 

分 类 号：R587.1[医药卫生—内分泌]