从“阳明有余”理论探讨“肠道-宿主免疫”失衡在糖尿病大血管病变中的作用  

Role of Imbalance of "Gut-Host Immunity" in Diabetic Macroangiopathy:An Exploration Based on Theory of "Superabundance of Yangming"

作　　者：冯皓月 李慧 刘天一 许趁意 马喜桃[1] 岳仁宋[1] FENG Hao-yue;LI Hui;LIU Tian-yi;XU Chen-yi;MA Xi-tao;YUE Ren-song(Hospital of Chengdu University of Traditional Chinese Medicine(TCM),Chengdu 610072,China;School of Acupuncture and Moxibustion,Hospital of Chengdu University of TCM,Chengdu 610097,China;Chongqing Fuling People׳s Hospital,Chongqing 408000,China)

机构地区：[1]成都中医药大学附属医院,成都610072 [2]成都中医药大学附属医院针灸学校,成都610097 [3]重庆市涪陵区人民医院,重庆408000

出　　处：《中国实验方剂学杂志》2021年第24期219-226,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金面上项目(81774279);四川省科学技术厅重点研发项目(2021YFS0037)。

摘　　要：糖尿病大血管病变是以大血管床内持续动脉粥样硬化(AS)为特点的糖尿病主要并发症之一。糖脂代谢紊乱诱发的大血管区域内皮损伤是糖尿病继发AS的始动因素,其与糖尿病和AS已知的共同病理基础——免疫炎症之间的相互作用是糖尿病大血管病变进程中的关键环节。人类饮食模式的转变,导致与能量稳态相关的糖尿病及其并发症发病率急剧增加。最近的研究表明,肠道微生物群的组成和功能及相关衍生分子的改变伴随着糖尿病继发AS,而"肠道-宿主免疫"失衡可能是诱发大血管并发症的重要途径。中医药对糖尿病及其并发症的研究已形成独特的理论和临床体系,其中"阳明"在分布及功能上与肠道微生态类似。糖尿病起于阳明炽盛,糖尿病大血管病变继发于糖尿病,始动之因亦在阳明,即肠道微生态系统。阳明失约,燥气亢盛,可能促使宿主免疫细胞增殖,释放大量炎症介质弥漫脉道,阻碍血流运行,化生瘀血与脉中留滞的糖脂浊邪交织,最终形成斑块附着脉壁。因此,以《黄帝内经》"阳明有余,病脉痹"理论为切入点,从宏观及微观角度剖析肠道微生态与免疫炎症交互作用对糖脂代谢的影响,将有助于揭示中医药通过调控"肠道-宿主免疫"治疗糖尿病大血管病变的科学内涵并指导临床组方思路。Diabetic macroangiopathy is one of the main complications of diabetes characterized by persistent atherosclerosis(AS)within the macrovascular bed.The endothelial injury in the macrovascular region induced by glucose and lipid metabolism disorders acts as the initiating factor of AS secondary to diabetes,and its interaction with immune inflammation,the known common pathological basis of diabetes and AS,is a vital link in the progression of diabetic macroangiopathy.Changes in human dietary patterns have significantly elevated the incidence of diabetes associated with energy homeostasis and its complications.As revealed by recent studies,the composition and function of intestinal microbiota and related derived molecules change with the progression of diabetes into AS,and the imbalance of "gut-host immunity" may be a critical route for inducing macrovascular complications.A unique theoretical and clinical system has been formed in research of traditional Chinese medicine(TCM)against diabetes and its complications.The distribution and function of"Yangming" are similar to those of intestinal microecology.Diabetes results from Yangming exuberance.Diabetic macroangiopathy is secondary to diabetes,implying that it is also related to Yangming,namely intestinal microecology.The dysfunction of Yangming and dryness Qi exuberance may trigger the proliferation of host immune cells and the release of a large number of inflammatory mediators to diffuse the vessel,thus blocking blood circulation.The interaction of the newly generated static blood with the stagnant glycolipid turbidity in the vessel will eventually result in plaque attached to the wall.Therefore,with the theory that "surplus of Yangming leads to vessel impediment" in Huangdi’s Internal Classic《黄帝内经》as the entry point,this paper has microscopically and macroscopically analyzed the influence of the interaction between intestinal microecology and immune inflammation on glucose and lipid metabolism,which helps to reveal the scientific connotation of TCM i

关 键 词：糖尿病大血管病变 肠道微生态 宿主免疫 炎症反应 糖脂代谢紊乱 阳明有余 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]