“温通法”调控肠道菌群代谢对高脂血症性急性胰腺炎脂毒性诱导的内质网应激影响作用研究进展  

Research Progress on the Effect of“Wentong Method”Regulating Intestinal Flora Metabolism on Endoplasmic Reticulum Stress Induced by Hyperlipidemia Acute Pancreatitis Lipotoxicity

作　　者：孟宪萌[1] 许斌[1] 高允海[2] 陈维[2] MENG Xianmeng;XU Bin;GAO Yunhai;CHEN Wei(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;AffiliatedHospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《辽宁中医药大学学报》2022年第9期43-46,共4页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：科技部国家重点研发计划项目(2018YFE0195200);辽宁省教育厅面上项目(LJKZ0900)。

摘　　要：高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)可由高浓度的游离脂肪酸诱导内质网应激,内质网应激参与胰腺炎的病理过程,HLAP较单纯胰腺炎患者病情多趋向于严重化,并发其他疾病可能性更高,而内质网应激(endoplasmic reticulum stress,ERS)正是其加重胰腺炎的重要影响因素。抑制钙离子释放激活钙离子通道蛋白1(orai1)或核因子κB(NF-κB)蛋白可明显减轻内质网应激水平。人体肠道菌群及代谢产物直接影响脂类代谢,引起血液中游离脂肪酸升高,引起胰腺细胞脂毒性,通过NF-κB-Orai1通路诱导胰腺细胞ERS。结合HLAP临证特点,分析其病因病机为痰饮内停、阻碍气机、瘀血停滞为本,腑气不通、脏腑失和为标。根据痰瘀为致病特点,提出“温通法”,“温”指以温药温化痰饮,“通”则是通利腑气,条畅中焦脏腑气机,通过临证实践总结大柴胡汤合苓桂术甘汤合方应用,正是体现“温通法”治疗HLAP的理想方药,菌群紊乱由痰瘀致病而引起,通法作用于肠道,与菌群关系不可分割。该文就“温通法”调控肠道菌群代谢对HLAP脂毒性诱导的内质网应激作用进行综述。Hyperlipidemia acute pancreatitis has a high severity and complication rate.High concentrations of free fatty acids can destroy the endoplasmic reticulum,induce endoplasmic reticulum stress,and participate in the pathological process of pancreatitis.Compared with patients with simple pancreatitis,pancreatitis related to hyperlipidemia tends to become more severe and has a higher incidence of complications ERS is one of the important mechanisms of hyperlipidemia aggravating pancreatitis.Inhibition of Orai1 or NF-κB can significantly reduce the level of endoplasmic reticulum stress.Intestinal flora is an important part of the intestinal microecosystem.Its metabolites directly affect lipid metabolism,causing free fatty acids in the blood to increase,causing pancreatic cell lipotoxicity,and inducing the endoplasmic reticulum response of pancreatic cells through the NF-κB-Orai1 pathway.Combining with the clinical characteristics of hyperlipidemia pancreatitis,the etiology and pathogenesis of hyperlipidemia pancreatitis are analyzed as phlegm drinking,obstruction of Qi,blood stasis and stagnation.According to the pathogenic characteristics of phlegm and blood stasis,“Wentong method”is proposed.“Wen”refers to warming phlegm and drinking with warm medicine.To summarize the application of Dachaihu Decoction and Linggui Zhugan Decoction(大柴胡汤合苓桂术甘汤合方),it is an ideal prescription for the treatment of HLAP with“Wentong method”.Intestinal flora disorder is an important pathological factor of phlegm and blood stasis,and the method is closely related to intestinal flora.This article reviews the effect of“Wen tong method”on the regulation of intestinal flora metabolism on the endoplasmic reticulum stress induced by hyperlipidemia acute pancreatitis lipotoxicity.

关 键 词：高脂血症性急性胰腺炎 肠道菌群 温通法 内质网应激 

分 类 号：R576[医药卫生—消化系统]