慢性阻塞性肺疾病气道黏液高分泌的发病机制及中医药干预的研究进展  

Pathogenesis of Airway Mucus Hypersecretion in Chronic Obstructive Pulmonary Disease andIntervention of Traditional Chinese Medicine: A Review

作　　者：彭鑫 刘健[2] 栾哲宇 封继宏[2] PENG Xin;LIU Jian;LUAN Zheyu;FENG Jihong(Tianjin University of Traditional Chinese Medicine(TCM),Tianjin 301617,China;The Second Affiliated Hospital of Tianjin University of TCM,Tianjin 300250,China)

机构地区：[1]天津中医药大学,天津301617 [2]天津中医药大学第二附属医院,天津300250

出　　处：《中国实验方剂学杂志》2024年第4期228-239,共12页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(U20A20398);青年岐黄学者培养项目(国中医药人教函[2022]256号)。

摘　　要：慢性阻塞性肺疾病(COPD)是临床常见的呼吸系统慢性疾病之一,其病程长且难以治愈,严重威胁人类健康。气道黏液高分泌(AMH)是COPD发生的独立危险因素,对疾病的发展和预后有极大影响。综述发现杯状细胞异常增生、黏蛋白过度分泌是导致AMH的直接原因,其发病机制可能与吸入异质性颗粒、气道炎症反应、黏蛋白/水盐比例失衡及相关信号通路调控等密切相关。中医学认为COPD AMH属于肺胀病痰饮证范畴,对该病的治疗多在立足于肺胀病的基础上从痰论治。笔者对近年来中医药领域开展的相关研究总结后发现有效干预COPD AMH的单味中药以化痰类为主,中药有效成分以黄酮类、萜类、酚类、生物碱类为主,中药复方主要以清热化痰、温化寒痰、燥湿化痰、益气活血化痰、补益肺脾肾立法,其作用机制为直接抑制或通过抑制气道炎症反应、调节水通道蛋白以纠正黏蛋白/水盐比例失衡、调控信号通路等途径间接抑制气道上皮杯状细胞化生和黏蛋白表达,以改善COPD黏液过量分泌。但目前仍存在研究侧重中药复方而对中药及有效成分研究较少、作用机制研究不够深入透彻、各研究结果无法互通、基础研究临床转化率不足等问题。该文对中医药治疗COPD AMH研究现状进行了系统综述,并就存在的问题提出了思考,以期为临床合理用药及进一步研究提供参考。Chronic obstructive pulmonary disease(COPD)is one of the most common chronic diseases of the respiratory system in the clinic.The disease has a long course and is difficult to cure,which seriously threatens human health.Airway mucus hypersecretion(AMH)is an independent risk factor for COPD and has a significant impact on the development and prognosis of the disease.The review finds that the abnormal proliferation of goblet cells and the excessive secretion of mucin are the direct causes of AMH.The pathogenesis of AMH may be closely related to the inhalation of heterogeneous particles,airway inflammation,the imbalance of mucin/water salt ratio,and the regulation of related signaling pathways.Traditional Chinese medicine(TCM)believes that AMH of COPD belongs to the category of lung distension with phlegm-fluid retention syndrome,and the disease is mainly treated from phlegm on the basis of lung distension.This article summarizes the relevant research in the field of TCM in recent years and finds that the single TCM that effectively intervened AMH of COPD is mainly phlegm-resolving TCM,and the main active ingredients of TCM are flavonoids,terpenoids,phenols,and alkaloids.The main TCM compounds are mainly designed to remove heat-phlegm,warmly resolve cold-phlegm,dry dampness to eliminate phlegm,invigorate Qi,promote blood circulation and dispel phlegm,and invigorate lung,spleen,and kidney.Its mechanism of action may be direct inhibition or indirect inhibition of airway epithelial goblet cell metaplasia and mucin expression by inhibiting airway inflammation,regulating aquaporins to correct the imbalance of mucin/water salt ratio,and regulating signaling pathways,so as to reduce mucus oversecretion in COPD.However,there are still some problems.For example,the research mainly focuses on TCM compounds instead of the single TCM or its effective components.The research on the mechanism of action is not thorough enough,and the research results are not interoperable.The clinical transformation rate of basic research is insuf

关 键 词：慢性阻塞性肺疾病(COPD) 气道黏液高分泌(AMH) 发病机制 中医药 研究进展 

分 类 号：R2-0[医药卫生—中医学] R22R242R2-031R259R563R256.1