从胆汁酸核受体FXR探讨土壅木郁理论与2型糖尿病胰岛素抵抗的关系  

Exploration of the correlation between the theory of earth stagnation and wood depression and insulin resistance in type 2 diabetes mellitus associated with the nuclear bile acid receptor FXR

作　　者：李嘉鑫 杨宇峰[1] 石岩[1] LI Jiaxin;YANG Yufeng;SHI Yan(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,China)

机构地区：[1]辽宁中医药大学,沈阳110847

出　　处：《北京中医药大学学报》2022年第1期81-86,共6页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家重点基础研究发展计划项目(No.2013CB532004);辽宁省“百千万人才工程”资助项目(No.2020921039);辽宁省“兴辽英才计划”青年拔尖人才资助项目(No.XLYC1807145);辽宁省自然科学基金重点项目(No.20170540598)。

摘　　要：2型糖尿病是以胰岛素抵抗(IR)为特征的慢性疾病。多项研究表明,胆汁酸核受体FXR与其关系密切,FXR的激活或抑制影响着疾病的发生发展。中医认为肝胆属木,脾胃属土,土与木在五行中属相克关系,土弱而不能达木,则木气郁塞,即土壅木郁。土壅是IR的始动因素,脾土壅滞,则水谷不化,可酿生痰、湿、瘀等病理产物,导致中满内热,伤津化燥,发为消渴。土壅木郁为IR的病机关键,土壅不能运化水谷精微以滋养肝木,肝失濡养,则疏泄功能失常,导致肝气郁结。日久又可化热,耗伤津液,亦发为消渴。FXR是阐释土壅木郁理论科学内涵的切入点,其主要分布在肝脏与肠道中,可以通过促进胰高血糖素样肽-1(GLP-1)的分泌,调节糖原合成、糖异生、糖转运等胰岛素信号通路以及抑制氧化应激和炎症反应等,从而治疗IR。因此,本研究从FXR出发探讨土壅木郁理论导致2型糖尿病IR的现代生物学基础,为土壅木郁理论提供新的科学内涵。Type 2 diabetes is a chronic disease characterized by insulin resistance(IR). A number of studies have shown that the nuclear bile acid receptor Farnesoid X receptor(FXR) is closely related to diabetes, and activation or inhibition of FXR affects the occurrence and development of the disease. According to traditional Chinese medicine, the liver and gallbladder belong to wood, whereas spleen and stomach belong to soil, and soil and wood are related to each other. If soil is weak and cannot reach wood, wood will be stagnant in qi, that is, earth stagnation and wood depression. Soil stagnation is the initiating factor of IR. If the spleen soil stagnates, the water and valleys will not be transformed, which can lead to pathological products, such as phlegm, dampness, and blood stasis, which can lead to internal heat, damage to fluids, and transformtion to dryness, and cause Xiaoke. Earth stagnation and wood depression is key to the pathogenesis of IR. Soil cannot transport the essence of water and valley to nourish the liver. If the liver is not nourished, the function of dredging will become abnormal, leading to stagnation of liver qi. Over time, it can dissipate heat, consume injury and body fluid, and cause Xiaoke. FXR is mainly distributed in the liver and intestines. It is the entry point to explain the scientific connotation of the theory of earth stagnation and wood depression. It can promote the secretion of glucagon-like peptide-1(GLP-1) and regulate sugar. Insulin signaling pathways such as pro-synthesis, gluconeogenesis, sugar transport, and inhibition of oxidative stress and inflammation can improve IR. Therefore, this study starts from the FXR to explore the modern biological basis of type 2 diabetes IR, which is caused by earth stagnation and wood depression, and it provides new scientific connotation for the theory of earth stagnation and wood depression.

关 键 词：胆汁酸核受体FXR 土壅木郁 2型糖尿病 胰岛素抵抗 

分 类 号：R259[医药卫生—中西医结合]