基于脾肾两脏探讨脑常染色体显性动脉病变伴皮层下梗死和白质脑病的研究思路  

Study on the cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy base on the spleen and kidney

作　　者：邰凯瑜 刘彩芳 翟磊[2] 武继涛(指导)[1] Tai Kaiyu;Liu Caifang;Zhai Lei;Wu Jitao

机构地区：[1]河南中医药大学,河南郑州450000 [2]南阳市第一人民医院,河南南阳473000

出　　处：《中医临床研究》2019年第33期20-22,共3页Clinical Journal Of Chinese Medicine

摘　　要：脑常染色体显性动脉病变伴皮层下梗死和白质脑病(Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy,CADASIL),是一种非动脉硬化性、非淀粉样变形的基因遗传性脑血管疾病,其临床主要表现为头痛、认知功能减退、精神异常等症状。目前公认此病是由Notch3基因突变导致平滑肌细胞退行性病变,只能对症治疗,没有特色疗法能够治愈。中医学认为本病的病位在脑,病因可责之于脾肾两脏。肾中所藏之精为脏腑阴阳的根本,其依赖于后天水谷精微充养,方能生生不息而不致匮乏;而后天的脾之精气有赖于肾中精气对脾气及脾阴脾阳的推动和资助,才能不断地化生,以输布全身,营养脏腑及形体官窍。根据脾肾相关理论也系统阐述了脾肾两脏在生理及病理上的互相影响的关系。肾为先天之本,肾中精气的盛衰影响着子代的先天禀赋与生长发育,与遗传物质关系密切;脾为后天之本,脾之精气来源于水谷精微,其功能易受饮食、环境影响,与基因遗传机制有一定关联。本文主要从中医角度论述CADASIL与脾肾两脏的关系以及通过对其病理机制的研究,也提出了先后天之本与本病的自然病程的渐进性是相关的,以及健脾固肾法在治疗过程中是必不可少的,为CADASIL的治疗也提供了新的治疗方向。Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL)is a non-arteriosclerotic,non-amyloid-deformed genetic hereditary cerebrovascular disease.Its clinical manifestations include headache,cognitive dysfunction,mental disorders and so on.It is currently recognized that this disease is caused by the mutation of Notch3 gene,which is a degenerative disease of smooth muscle cells.It can only be treated symptomatically,and no special therapy can cure it.Traditional Chinese medicine believes that the disease is located in the brain,and the cause can be blamed on the spleen and kidney.The essence of the kidney is the root of the viscera and yin and yang.It depends on the postnatal water or food,so that it can be born without endlessness.The postnatal essence depends on the essence of the kidney to bloom.The promotion and funding can continue to metaplasia,to spread the whole body,nutrition and viscera and physical bureaucracy.According to the theory of spleen and kidney,the relationship between the spleen and kidney in physiological and pathological aspects is also systematically expounded.That the kidney is the origin of nature,and the rise and fall of kidney essence affects the natural endowment and growth of the offspring,which is closely related to genetic material;the spleen is the postnatal origin,and the spleen essence comes from cereal essence,whose function is easily susceptible to diet and environment,and is related to genetic mechanism.This article mainly discusses the relationship between CADASIL and the spleen and kidneys from the perspective of TCM,and through the study of its pathological mechanism,it also proposes that the disease developing course is related to them,and strengthening spleen and nourishing kidney is indispensable.It is also essential in the treatment process and provides a new therapeutic direction for the treatment of CADASIL.

关 键 词：脑常染色体显性动脉病变伴皮层下梗死和白质脑病 先天之本 后天之本 基因遗传 健脾固肾法 

分 类 号：R259[医药卫生—中西医结合]