从“肠-脑轴”角度探讨补肾活血法治疗帕金森病  

Therapeutic Effect of Tonifying Kidney and Activating Blood Circulation Method on Parkinson's Disease from“Gut-Brain Axis”

作　　者：李敏 栾振先 王鹏[2] 杨明会 LI Min;LUAN Zhenxian;WANG Peng;YANG Minghui(Department of Traditional Chinese Medicine,The Sixth Medical Center of PLA General Hospital,Beijing 100048,China;Graduate School of PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第六医学中心中医医学部,北京100048 [2]中国人民解放军总医院研究生院,北京100853

出　　处：《中华中医药学刊》2023年第6期143-146,I0022,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金重点项目(82130117);国家自然科学基金面上项目(82274613);军队保健课题重点项目(20BJZ41)。

摘　　要：帕金森病(Parkinson's disease,PD)起病隐匿,发病机制不清。便秘是PD常见的临床前驱症状,与病情发生发展密切相关。“肾司二便”,肾精不足导致肾阴、肾阳不能濡养或温煦肠道导致便秘。肾主藏精,精生髓,髓生脑,肾脑相关。肾虚在前,PD发生在后,这与便秘是PD的临床前驱症状相吻合。PD便秘与中医肾虚有密切关系。肠道菌群失调是便秘的发病机制之一,且可导致α-突触核蛋白(alpha-Synaptonucleoprotein,α-Syn)在肠神经系统中沉积,并通过迷走神经传导进入脑黑质积聚,进而促进PD发生发展。肠道菌群-肠道-脑轴理论与肾脑相关理论有高度契合性。肾虚血瘀是PD发生、发展的根本病因病机。补肾活血法治疗PD疗效确切,能改善PD患者便秘等胃肠功能障碍症状,提高脑内多巴胺(Dopamine,DA)水平。这可能与通过调节肠道菌群、改善肠道炎症、修复肠道屏障功能以及DA能神经元炎症反应有关。对补肾活血法治疗PD内涵的进一步阐释,可为临床治疗PD提供新思路、开辟新策略。Parkinsons disease(PD)has a hidden onset and unclear pathogenesis.Constipation is a common clinical precur-sor symptom of PD,closely related to the occurrence and development of the condition.Kidney is responsible for urination and defecation.Insufficient kidney essence leads to the inability to nourish kidney Yin and Yang,or warming the intestines leads to constipation.Kidney deficiency occurs first and PD occurs later,which is consistent with constipation as a clinical precursor symptom of PD.PD constipation is closely related to kidney deficiency in traditional Chinese medicine.Intestinal microbiota im-balance is one of the pathogenesis of constipation and can lead to alpha-synaptonucleoprotein(α-Syn)deposits in the enteric nervous system and accumulates in the substantia nigra through vagus nerve conduction,thus promoting the occurrence and devel-opment of PD.The gut-microbiota-gut brain axis theory is highly compatible with the kidney and brain being related theory.We believe that kidney deficiency and blood stasis are the fundamental etiology and pathogenesis of PD.The method of tonifying kidney and promoting blood circulation has a definite therapeutic effect on PD,which can improve gastrointestinal dysfunction symptoms such as constipation in PD patients and increase dopamine(DA)levels in the brain.This may be related to regulating intestinal microbiota,improving intestinal inflammation,repairing intestinal barrier function and inflammatory response of DA neu-rons.Further explanation of the connotation of tonifying kidney and activating blood circulation therapy for treating PD can pro-vide new ideas and strategies for clinical treatment of PD.

关 键 词：帕金森病 补肾活血法 肠-脑轴 肠道菌群 

分 类 号：R277.742.5[医药卫生—中医学]