基于痰瘀相关理论探讨冠心病脂质浸润机制及痰瘀同治的研究进展  

Research advances in mechanism of lipid infiltration of coronary heart disease and simultaneous treatment of phlegm and blood stasis based on phlegm-blood stasis correlation theory

作　　者：钟森杰 李静 王陵军[1,2] 陈梓欣[1,2] 吴辉 陈洁[1] 方红城[5] 冼绍祥 ZHONG Sen-jie;LI Jing;WANG Ling-jun;CHEN Zi-xin;WU Hui;CHEN Jie;FANG Hong-cheng;XIAN Shao-xiang(the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Lingnan Medical Research Center,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Postdoctoral Research Station of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Diagnosis Institute of Traditional Chinese Medicine,Hunan University of Chinese Medicine,Changsha 410208,China;Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,Shenzhen 518104,China)

机构地区：[1]广州中医药大学第一附属医院,广东广州510405 [2]广州中医药大学岭南医学研究中心,广东广州510405 [3]广州中医药大学博士后科研流动站,广东广州510006 [4]湖南中医药大学中医诊断研究所,湖南长沙410208 [5]深圳市中西医结合医院,广东深圳518104

出　　处：《中国中药杂志》2023年第6期1431-1437,共7页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金项目(82174316,82004293,81973777);冼绍祥岐黄学者工作室;广州市校(院)联合资助项目基础与应用基础研究项目(202201020342);广州市科技局2022年重点研发项目(2060404);深圳市“医疗卫生三名工程项目”(SZZYSM202106006)。

摘　　要：动脉粥样硬化(AS)是冠心病(CHD)的关键病理学基础,脂质浸润则是阐释AS病理机制的经典学说,强调该病的发生发展与脂质代谢异常密切相关,本质是脂质从血浆侵入动脉内膜所引发的病理反应。痰瘀生理同源、病理同病,痰瘀相关是诠释CHD病机特点的基础理论,对揭示CHD脂质浸润机制具有重要指导意义。痰是体内气血津液代谢失常形成的病理产物,是一系列异常表达的脂质物质的总概括,痰浊侵袭心脉,逐渐积蓄而聚集凝结,达到“无形之邪”发展至“有形之邪”的质变,与脂质迁移并沉积于血管内膜的机制相对应,为疾病的启动因素。瘀是痰的延续发展,是血液的流动性下降、凝聚性增高、流变性异常等病理状态的总结,因痰致瘀符合“脂质异常-循环障碍”的病理过程,为疾病的中心环节。痰与瘀互为加剧,胶结不解,既成痰瘀互结之邪,共同致病,为疾病的必然结局。立足痰瘀相关理论,确立痰瘀同治法,研究发现该治法可同步调节血脂、降低血黏度与改善血液循环等,双向兼顾,从根本上截断痰瘀之间互化转归的生物学物质基础,从而发挥显著疗效。Atherosclerosis(AS)is the key pathological basis of coronary heart disease(CHD),and lipid infiltration is a classical theory to explain the pathological mechanism of AS.The theory highlights that the occurrence and development of AS are closely related to abnormal lipid metabolism,with the essence of the pathological reaction caused by the invasion of lipids into arterial intima from plasma.Phlegm and blood stasis are physiologically homologous and subject to pathological co-existence.Phlegm-blood stasis correlation is the basic theory to explain the pathogenesis characteristics of CHD and has important guiding significance for revealing the mecha-nism of lipid infiltration of CHD.Phlegm is the pathological product of abnormal metabolism of Qi,blood,and body fluid,and a gene-ral summary of a series of abnormally expressed lipid substances.Among them,turbid phlegm invades the heart vessels,gradually accumulates,and condenses to achieve the qualitative change from"invisible pathogen"to"tangible pathogen",which corresponds to the mechanism of lipid migration and deposition in the intima of blood vessels,and is the starting factor of the disease.Blood stasis is the continuous development of phlegm,and it is a result of pathological states such as decreased blood fluidity,increased blood coagulation,and abnormal rheology.The fact that blood stasis caused by phlegm accords with the pathological process of"lipid abnormality-circulatory disturbance"and is the central link of the disease.Phlegm and blood stasis aggravate each other and lead to indissoluble cementation.The phlegm-blood stasis combination serves as common pathogen to trigger the disease,which is the inevitable outcome of the disease.Based on the phlegm-blood stasis correlation theory,the simultaneous treatment of phlegm and blood stasis is established.It is found that this therapy can simultaneously regulate blood lipid,reduce blood viscosity,and improve blood circulation,which can fundamentally cut off the biological material basis of the reciprocal transf

关 键 词：动脉粥样硬化 冠心病 脂质代谢 痰瘀相关 痰瘀同治 

分 类 号：R259[医药卫生—中西医结合]