基于虚痰瘀探讨细胞焦亡与腰椎间盘退行性疾病的相关性  

Exploration on Correlation Between Pyroptosis and Degenerative Disease of Lumbar Intervertebral Disc Based on Deficiency,Phlegm and Stasis

作　　者：陈双 谢林[1,2] CHEN Shuang;XIE Lin(The Third Clinical College of Nanjing University of Chinese Medicine,Nanjing 210029,China;Affiliated Hospital of Integrative Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,China)

机构地区：[1]南京中医药大学第三临床医学院,江苏南京210029 [2]南京中医药大学附属中西医结合医院,江苏南京210028

出　　处：《山东中医杂志》2024年第3期258-263,共6页Shandong Journal of Traditional Chinese Medicine

基　　金：江苏省中医药领军人才培养项目(编号:SLJ0210);江苏省中医药科技发展计划项目(编号:ZD202008);江苏省名老中医药专家传承工作室建设项目(批文号:苏中医科教〔2021〕7号);江苏省研究生科研与实践创新计划项目(编号:SJCX23-0910)。

摘　　要：腰椎间盘退行性疾病属本虚标实之证,以正气亏虚为本,腰府失养,不荣则痛;以痰浊、瘀血互结为标,痹阻经脉,不通则痛。细胞焦亡是一种由炎症小体介导,依赖半胱天冬氨酸蛋白酶(Caspase)调控的程序性死亡,能导致细胞渗透性肿胀崩解,迅速释放出大量的炎症因子。细胞焦亡及其相关的炎症因子可引起局部气血运行障碍,津液停聚,痹阻经脉,痰瘀互结,停聚腰府,导致责任椎间盘功能紊乱,促使腰椎间盘发生退行性改变。提出髓核细胞焦亡、细胞外基质降解是虚证的微观体现,而炎症因子的表达是痰浊、瘀血的微观体现。鉴于此,从虚痰瘀病机探讨细胞焦亡在腰椎间盘退行性疾病中的作用,通过补肾通络、化痰祛瘀等中药作用于细胞焦亡,发挥防治椎间盘退变的作用,可为中西医结合防治腰椎间盘退行性疾病提供新思路。The degenerative disease of lumbar intervertebral disc is a syndrome of asthenia in origin and sthenia in superficiality,with the deficiency of the healthy qi as the basis,and the loss of nourishnent of the waist leads to pain;phlegm turbid,blood stasis and the interlocking of them are the symptoms,which block meridians and lead to pain.Pyroptosis is a programmed death mediated by inflammatory bodies and dependent on the regulation of Caspase,which can lead to the collapse of osmotic swelling of cells and the rapid release of a large number of inflammatory factors.Pyroptosis and its related inflammatory factors can cause local qi and blood dysfunction,body fluid stasis,obstruction of meridians,phlegm and blood stasis interjunction,which stops and gathers around the waist,resulting in the dysfunction of responsible intervertebral disc,and promotes degenerative changes in lumbar intervertebral disc.It is suggested that pyroptosis of nucleus pulposus and degradation of extracellular matrix are the microscopic manifestations of deficiency syndrome,and the expression of inflammatory factors is the microscopic manifestations of phlegm turbidity and blood stasis.In view of this,exploring the role of pyroptosis in degenerative disease of lumbar intervertebral disc from the pathogenesis of deficiency,phlegm and stasis,and letting it play a role in preventing and treating disc degeneration by tonifying kidney and clearing collaterals,eliminating phlegm and removing blood stasis,etc.,can provide a new idea for the prevention and treatment of the degenerative disease of lumbar intervertebral disc by combining traditional Chinese and Western medicine.

关 键 词：虚痰瘀 腰椎间盘退行性疾病 细胞焦亡 炎症因子 病机 微观辨证 

分 类 号：R274.9[医药卫生—中西医结合]