从“运脾强卫”探讨中医药调节自身免疫性甲状腺炎维生素D代谢的作用机制  

Exploring Mechanism of TCM Regulating AIT Vitamin D Metabolism from Perspective of"Invigorating Spleen and Strengthening Health"

作　　者：周婵媛[1,2] 刘晓炜 高天舒 ZHOU Chanyuan;LIU Xiaowei;GAO Tianshu(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;The First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《中华中医药学刊》2023年第9期137-139,共3页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81874441)。

摘　　要：自身免疫性甲状腺炎(Autoimmune Thyroiditis,AIT)是一种常见的器官特异性自身免疫性疾病,临床以桥本甲状腺炎(Hashimoto Thyroiditis,HT)最为多见,属中医“瘿病”范畴。AIT患者普遍存在维生素D缺乏的现象,且缺乏程度与病情严重性相关,补充维生素D有助于降低甲状腺抗体水平、改善免疫失衡、延缓向甲状腺机能减退的进展。重点阐述了AIT发病机制与维生素D体内代谢的密切相关性,维生素D受体(Vitamin D Receptor,VDR)的表达是活性维生素D发挥免疫调控作用的决定因素。探究AIT中医病机,“脾者,主为卫”,脾失之卫、免疫调控异常、防御病邪能力下降为其主要病机,卫气亏虚、气行不畅、痰瘀壅结颈前为发病关键。维生素D作为脾所运化之精微物质,为后天免疫系统的完善奠定了物质基础,是发挥免疫调控作用的重要组成部分。临证治疗应以“运脾强卫”理论为指导,采用升清、散精、祛湿之法,健运脾气,调节维生素D代谢,纠正AIT免疫紊乱。Autoimmune thyroiditis(AIT)is a common organ specific autoimmune disease.Hashimoto thyroiditis(HT)is the most common clinical disease,which belongs to the category of"Yingbing"in traditional Chinese medicine.Vitamin D deficiency is common in AIT patients,and the degree of deficiency is related to the severity of the disease.Vitamin D supplementation is helpful to reduce thyroid antibody level,improve the immune imbalance and delay the progression to hypothyroidism.This article focuses on the close correlation between the pathogenesis of AIT and the metabolism of vitamin D in vivo.The expression of vita-min D receptor(VDR)is the decisive factor for active vitamin D to play an immunomodulatory role.Exploring the pathogenesis of AIT in traditional Chinese medicine,"the spleen is the main body".The main pathogenesis of AIT is that the spleen loses its health,immune regulation is abnormal,and the ability to defend against diseases and evils is reduced.The key of AIT is the defi-ciency of health Qi,the obstruction of Qi movement and the stagnation of phlegm and blood stasis in the neck.Vitamin D,as a fine substance transported by the spleen,has laid a material foundation for the improvement of the acquired immune system,and is an important component of immune regulation.The clinical treatment should be guided by the theory of"invigorating spleen and strengthening health",adopting the methods of ascending the clear,dispersing the essence and removing dampness,strengthening spleen,regulating the metabolism of vitamin D and correcting the AIT immune disorder.

关 键 词：维生素D AIT 运脾强卫 

分 类 号：R256.3[医药卫生—中医内科学]