孕期胸腺退化与产后再生的机制研究进展及产后方剂用药规律挖掘  

Mechanism of pregnancy-induced thymus involution and regeneration and medication rules of postpartum prescriptions

作　　者：舒耀莹 许勰 张卓文[2] 高建莉 SHU Yao-ying;XU Xie;ZHANG Zhuo-wen;GAO Jian-li(School of Pharmaceutical Sciences,Zhejiang Chinese Medical University,Hangzhou 311499,China;School of Basic Medical Sciences,Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学药学院,浙江杭州311499 [2]浙江中医药大学基础医学院,浙江杭州310053

出　　处：《中国中药杂志》2023年第16期4275-4284,共10页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金面上项目(82274621)。

摘　　要：为防止母体对半同种异体胎儿的免疫反应,孕期机体会出现以胸腺急性退化为代表的特殊适应性免疫系统改变,并能于产后快速修复。这种妊娠期胸腺急性退化(acute thymic involution,ATI)与性激素水平有关,主要由孕激素引起,表现在胸腺体积,特别是皮质部分持续缩小,被膜下皮质上皮细胞(cortical thymic epithelial cells,cTECs)起皱并出现吞噬能力,其他胸腺上皮细胞(TECs)相对不变。而产后胸腺由转录因子叉头框N1(forkhead box N1,FOXN1)及其靶基因趋化因子(C-C基元)配体25[chemokine(C-C motif)ligand 25,CCL25]、趋化因子(C-X-C基元)配体12[chemokine(C-X-C motif)ligand 12,CXCL12]、δ样蛋白4(delta-like 4,DLL4)、组织蛋白酶L(cathepsin L,CTSL)、丝氨酸蛋白酶16(serine protease,PRSS16)等共同介导再生,一旦产后胸腺修复不良,会导致母体免疫功能失调并罹患产褥疾病,严重危及母体及其后代的生存。中医学认为气血为胎孕的基石,而胸腺发挥关键的气血调控作用。由此可知孕产期的气虚血弱与孕期的ATI和产后胸腺再生不良息息相关。在此理论基础上,中医产后调理累积了丰富的学术思想和临床经验,该综述在系统阐述妊娠期ATI机制修复过程的基础上,通过数据挖掘分析2部中医经典女科著作《万氏女科》《傅青主女科》,发现产后常用中药有当归、人参、甘草、川芎,其中人参、当归、川芎是高频中药,对产后康复具有积极作用,而这些中药如何促进产后胸腺再生尚需进一步深入研究。In order to prevent the maternal immune defenses to the semi-allogeneic fetus,the maternal body will present a special adaptive immune system change represented by acute thymic involution(ATI)during pregnancy,which can be quickly regenerated after delivery.The ATI during pregnancy is related to the level of sex hormones,which is mainly caused by progesterone.Pregnancy-induced ATI is manifested as the continuous shrinkage of thymus volume,especially the cortex,and the wrinkle and phagocytosis of the subcapsular cortical thymic epithelial cells(cTECs),while other thymic epithelial cells(TECs)remain unchanged.The postpartum thymus is regenerated by the co-mediation of forkhead box N1(FOXN1)as well as its target genes chemokine(C-C motif)ligand 25(CCL25),chemokine(C-X-C motif)ligand 12(CXCL12),δ-like ligand 4(DLL4),cathepsin L(CTSL),and serine protease 16(PRSS16).Once the postpartum thymus is poorly repaired,immune dysfunction of the maternal body and several puerperal diseases will be induced,seriously endangering the survival of the mother and the newborn.In traditional Chinese medicine(TCM),Qi and blood are the cornerstone of pregnancy,and the thymus plays a key role in regulating Qi and blood.The deficiency of Qi and blood during pregnancy and childbirth is closely related to the abnormal ATI during pregnancy and the poor regeneration of the postpartum thymus.Based on this theory,TCM has profound academic ideas and rich clinical experience in postpartum recuperation.Based on the systematic description of the mechanism of ATI regeneration during pregnancy,as well as data mining and analysis of two classic gynecological works of TCM,Wan′s Gynecology and Fu Qing-zhu′s Treatise on Gynecology,this study found that the commonly used TCM for postpartum included Angelicae Sinensis Radix,Ginseng Radix et Rhizoma,Glycyrrhizae Radix et Rhizoma,and Chuanxiong Rhizoma.Among them,Ginseng Radix et Rhizoma,Angelicae Sinensis Radix,and Chuanxiong Rhizoma are high-frequency TCMs with positive effects on postpartum recovery.Ho

关 键 词：胸腺退化 妊娠 胸腺再生 当归 人参 

分 类 号：R271.4[医药卫生—中医妇科学]