补肾活血法治疗卵巢早衰作用机制的研究进展  

Mechanism of kidney-tonifying and blood-activating therapy for premature ovarian failure:a review

作　　者：马堃[1] 李佳妮 范晓迪[3] 张涵 马林纳 MA Kun;LI Jia-ni;FAN Xiao-di;ZHANG Han;MA Lin-na(China Academy of Chinese Medical Sciences,Beijing 100700,China;Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing 100091,China;Institute of Basic Medical Sciences,Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing 100091,China;Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]中国中医科学院,北京100700 [2]中国中医科学院西苑医院,北京100091 [3]中国中医科学院西苑医院基础医学研究所,北京100091 [4]天津中医药大学,天津301617

出　　处：《中国中药杂志》2023年第7期1808-1814,共7页China Journal of Chinese Materia Medica

基　　金：北京市自然科学基金项目(7212193);北京市科技计划项目(Z171100001017104);中国中医科学院科技创新工程项目(CI2021A02406)。

摘　　要：优生优育是提高人口素质的前提,卵巢早衰(POF)是当今女性生殖健康面临的重要问题,严重影响适龄女性的身心健康,增加远期罹患骨质疏松及心血管疾病等风险。中医认为肾虚是POF发病之根本,肾虚血瘀是POF重要的病因病机之一,且补肾活血中药在POF的治疗中起到确切的临床疗效。大量研究显示补肾活血中药具有调节下丘脑-垂体-卵巢轴神经内分泌功能,改善卵巢血流动力学和微循环,减少颗粒细胞凋亡,降低氧化应激损伤以及调节免疫平衡等作用。其作用机制与调节磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(Akt)、血管内皮生长因子(VEGF)、转化生长因子-β(TGF-β)/Smads、核因子E2相关因子2(Nrf2)/抗氧化反应原件(ARE)、核因子-κB(NF-κB)等信号通路密切相关。通过梳理总结补肾活血中药防治POF的病理机制,探寻其多途径、多靶点治疗POF所发挥的生物学基础,以期为临床应用补肾活血法防治卵巢衰老提供参考依据。Healthy birth and child development are the prerequisite for improving the overall quality of the population.However,premature ovarian failure(POF)threatens the reproductive health of women.The incidence of this disease has been on the rise,and it tends to occur in the young.The causes are complex,involving genetics,autoimmune,infectious and iatrogenic factors,but most of the causes remain unclear.At the moment,hormone replacement therapy and assisted reproductive technology are the main clinical approaches.According to traditional Chinese medicine(TCM),kidney deficiency and blood stasis are one of the major causes of POF,and TCM with the effects of tonifying the kidney and activating blood has a definite effect.Through clinical trials,TCM prescriptions for POF have excellent therapeutic effect as a result of multi-target regulation and slight toxicity.In particular,they have no obvious side effects.A large number of studies have shown that the kidney-tonifying and blood-activating TCM can regulate the neuroendocrine function of hypothalamicpituitary-ovarian axis,improve ovarian hemodynamics and microcirculation,reduce the apoptosis of granulosa cel ls,alleviate oxidative stress injury,and modulate immunologic balance.The mechanism is that it regulates the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt),vascular endothelial growth factor(VEGF),transforming growth factor(TGF)-β/Smads,nuclear factor E2-related factor 2(Nrf2)/antioxidant response element(ARE),and nuclear factor-kappa B(NF-κB)signaling pathways.This article summarized the pathological mechanisms of kidney-tonifying and blood-activating TCM in the prevention and treatment of POF and explored the biological basis of its multi-pathway and multi-target characteristics in the treatment of this disease.As a result,this study is expected to serve as a reference for the treatment of POF with the kidn eytonifying and blood-activating therapy.

关 键 词：卵巢早衰 补肾活血法 肾虚血瘀 生物学基础 信号通路 

分 类 号：R271.9[医药卫生—中西医结合]