基于瘀毒理论与细胞胞葬的关系探讨动脉粥样硬化易损斑块的病机  

Pathogenesis of Atherosclerotic Vulnerable Plaque Based on Relationship Between Theory of“Stasis and Toxin”and Efferocytosis

作　　者：陈纪烨 李晓雅 于宗良 李昕 胡岚清 孙长鑫 刘龙涛[1,2] CHEN Jiye;LI Xiaoya;YU Zongliang;LI Xin;HU Lanqing;SUN Changxin;LIU Longtao(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;National Clinical Research Center for Chinese Medicine Cardiology,Beijing 100091,China;Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]国家中医心血管病临床医学研究中心,北京100091 [3]北京中医药大学研究生院,北京100029

出　　处：《中国实验方剂学杂志》2023年第1期188-193,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金面上项目(81973689,82074254);北京自然科学基金项目(7202176)。

摘　　要：动脉粥样硬化是一种以病态血管细胞和凋亡细胞碎片产生病理性蓄积形成的动脉闭塞为特征的血管疾病,动脉粥样硬化易损斑块是诱发严重血栓性心血管事件的重要病理基础,对于其病因病机的探讨一直是心血管研究领域的热点问题。细胞胞葬是一种新型的程序性死亡细胞清除方式,指巨噬细胞将凋亡细胞吞噬、降解,防止继发性坏死的过程,是机体生理过程中一种关键的稳态机制。在病理状态下,胞葬功能障碍造成凋亡细胞、坏死碎片病理性蓄积,导致继发性细胞坏死发生和细胞内毒性内容物不断释放,诱导炎症消退障碍和胆固醇代谢紊乱,与动脉粥样硬化易损斑块的发生发展密切相关。“瘀毒”理论是中医学阐释动脉粥样硬化发生发展的重要学说,动脉粥样硬化始于血液凝滞不畅的病理状态,血凝日久,成瘀生毒,瘀毒交互为患,壅塞血脉,从而形成斑块附着脉管,而“瘀毒致变”之论是对急性心血管事件发病和疾病演变的的重要认识。从中医理论角度,细胞胞葬的病理生理机制与中医“瘀毒”的病因病机存有相似之处。因此,该文以“瘀毒”理论为切入点,探讨细胞胞葬在动脉粥样硬化易损斑块中的作用机制,并提出运用解毒活血法调控细胞胞葬防治动脉粥样硬化易损斑块的研究策略,旨在为解毒活血法防治动脉粥样硬化提供新的思路和理论依据。Atherosclerosis is a vascular disease characterized by arterial occlusion formed by the pathological accumulation of pathological vascular cells and apoptotic cell debris.Atherosclerotic vulnerable plaque is an important pathological basis for inducing severe thrombotic cardiovascular events,and the study of its etiology and pathogenesis has always been a hot issue in the field of cardiovascular research.Efferocytosis is a new type of programmed death cell removal,which refers to the process of macrophages phagocytosing and degrading apoptotic cells to prevent secondary necrosis.It is a key homeostatic mechanism in the body’s physiological process.In the pathological state,the dysfunction of efferocytosis causes the pathological accumulation of apoptotic cells and necrotic debris,leading to the occurrence of secondary cell necrosis and the continuous release of intracellular toxic content and inducing inflammatory regression disorders and cholesterol metabolism disorders,which are closely related to the occurrence and development of atherosclerotic vulnerable plaques.The theory of’’blood stasis and toxin’’is an important theory of traditional Chinese medicine(TCM)to explain the occurrence and development of atherosclerosis.Atherosclerosis starts from the pathological state of blood stagnation.Prolonged blood stagnation leads to blood stasis and toxic substances.Blood stasis and toxic pathogens interact with each other in blood vessels and eventually form plaques in blood vessels.The theory of’’blood stasis and toxin causing a catastrophe’’is an important understanding of the occurrence and development of acute cardiovascular events.From the perspective of TCM theory,the pathophysiological mechanism of efferocytosis is similar to the etiology and pathogenesis of the’’blood stasis and toxin’’in TCM.Therefore,this paper took the theory of’’blood stasis and toxin’’as the breakthrough point to explore the mechanism of efferocytosis in atherosclerotic vulnerable plaques,and proposed a

关 键 词：动脉粥样硬化 细胞胞葬 易损斑块 瘀毒 病机 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学] R2-031R285.5