急性肺损伤肺泡液转运障碍的发生机制和中医治疗进展  

Mechanism of Alveolar Ion Transport Disorder during Acute Lung Injury and Progress in Traditional Chinese Medicine Treatment

作　　者：苏子珊 刘佳欣 张文凤 林琳[1,2] 刁换胜[1,2] 陈远彬[1,2] SU Zi-Shan;LIU Jia-Xin;ZHANG Wen-Feng;LIN Lin;DIAO Huan-Sheng;CHEN Yuan-Bin(The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120 Guangdong,Chin)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510006 [2]广东省中医院,广东广州510120

出　　处：《广州中医药大学学报》2022年第9期2212-2218,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81503511);广州中医药大学“双一流”与高水平大学学科协同创新团队项目(编号:2021xk27);广东省中医院周仲瑛学术经验传承工作室建设项目(中医二院[2014]89号)。

摘　　要：急性肺损伤(ALI)可致急性肺水肿,进一步恶化可导致急性呼吸窘迫综合征或多器官功能障碍综合征。肺泡液转运障碍是ALI的重要病理基础。急性肺损伤肺泡液转运障碍的主要机制包括肺泡毛细血管屏障通透性增加和肺泡上皮清除水肿能力下降两个环节。ALI发生时,肺内皮细胞和上皮细胞直接受损,肺泡毛细血管屏障完整性被破坏,通透性增加,上皮间渗透梯度改变,水再吸收的驱动力丧失;同时,因大量中性粒细胞浸润而产生的促炎因子和活性氧可破坏毛细血管屏障,改变上皮紧密连接,同时使上皮细胞钠离子通道(ENaC)、Na+-K+-ATP酶表达减少,诱导水通道蛋白(AQPs)的表达减少,加重肺水肿程度。中医药疗法干预ALI肺泡液转运障碍方面的基础研究涉及单味中药、中药复方以及电针治疗等。单味中药影响肺泡液转运主要通过以下两条路径实现:一是降低炎症因子的表达而表现出明显的抗炎作用,减轻炎性细胞因子对ENaC、AQPs的抑制,从而保护肺组织;二是调控ENaC、AQPs、紧密连接蛋白的表达,促进肺泡液转运,从而改善肺水肿状态。中药复方和电针则通过多路径协同改善ALI,其具体作用取决于选药与配穴。中药所呈现的多靶点作用潜力,可能为中医药在ALI的预防和治疗中的应用提供新的思路。Acute lung injury(ALI)leads to acute pulmonary edema,and then deteriorates into acute respiratory distress syndrome(ARDS)or multiple organ dysfunction syndrome(MODS).Alveolar ion transport disorder contributes to the pathological basis of ALI.The mechanism of alveolar ion transport disorder in ALI involves two aspects,i.e.,the increase of permeability of alveolar capillary barrier and the edema clearance of the alveolar epithelial cells.During the onset of ALI,the pulmonary endothelial cells and epithelial cells are directly injured,and the integrity of alveolar capillary barrier is damaged,the permeability is increased,inter-epithelial osmotic gradient alters,and the driving force for fluid reabsorption loses.Meanwhile,the infiltration of a large amount of neutrophils results into the production of proinflammatory factors and active oxygen,which leads to the distroy of capillary barrier and alteration of epithelial tight junctions,causes the decrease of epithelial Na+channels(ENaC)and Na+-K+-ATPase expression together with the expression aquaporins(AQPs),and then makes pulmonary edema deterioration.The fundamental research of traditional Chinese medicine intervention of alveolar ion transport disorder in ALI covered the study of single herb,Chinese herbal complex prescriptions and electro-acupuncture for alveolar ion transport disorder in ALI.There are two approaches of single herb for the intervention of alveolar ion transport disorder in ALI.Firstly,single herb has obvious anti-inflammatory effect by down-regulating the inflammatory factors which can inhibit the function of ENaC and AQPs,thus to protect the lung tissue.Secondly,single herb can regulate the expression of ENaC,AQPs and tight junctional protein and promote the transportation of alveolar fluid,thus to improve the pulmonary edema.Chinese herbal complex prescriptions and electroacupuncture can improve ALI through multiple approaches,and their efficacy depends on the utilization of medicines and the selection of acupoints.The multi-target potential o

关 键 词：急性肺损伤 急性肺水肿 肺泡液转运 毛细血管屏障 上皮紧密连接 促炎因子 活性氧 水通道蛋白 中医治疗 

分 类 号：R563.8[医药卫生—呼吸系统]