基于“脾失运化”探讨运脾法调节多囊卵巢综合征内质网应激作用  

Exploring the Regulating Endoplasmic Reticulum Stress in Polycystic Ovary Syndrome through the Application of the “Spleen Lossing Its Transportation and Transformation” Principle

作　　者：任雪[1] 潘赐明 孙畅[1] 李婧 凃庆丽 匡洪影[5] REN Xue;PAN Ciming;SUN Chang;LI Jing;TU Qingli;KUANG Hongying(Heilongjiang University of Chinese Medicine,Harbin 150040,China;Yunnan University of Chinese Medicine,Kunming 650500,China;Shanghai University of Chinese Medicine,Shanghai 201203,China;Leshan Traditional Chinese Medicine Hospital Gynecology Department,Leshan 614000,China;The First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学,哈尔滨150040 [2]云南中医药大学,昆明650500 [3]上海中医药大学,上海201203 [4]乐山市中医院妇科,乐山614000 [5]黑龙江中医药大学附属第一医院,哈尔滨150040

出　　处：《世界中医药》2024年第3期356-361,367,共7页World Chinese Medicine

基　　金：国家自然科学基金面上项目(82174422)——AMH介导的组织特异性AMHR2在PCOS病因和代际效应中的研究及补肾化痰方的疗效新机制;2018年黑龙江省博士后科研启动金(LBHQ18119)——小檗碱治疗PCOS“痰壅胞宫”的作用机制研究。

摘　　要：多囊卵巢综合征(PCOS)是临床常见的异质性疾病,生殖障碍和代谢异常为本病两大病理特征。内质网应激指的是由于多种因素导致未折叠和(或)蛋白质聚集,通过恢复蛋白质正确的折叠方式的一种真核细胞的适应性反应。通过对脾主运化理论的古籍文献梳理发现,脾脏运化水谷,将精微物质布散周身的功能与现代医学中内质网在细胞中的重要作用有着类似之处,即通过承担蛋白质折叠和钙储存等多项任务,保证细胞能够正常发挥生理功能。若脾失运化,痰湿阻滞是本病的核心病机,现代研究认为内质网应激能够较好地阐释脾失运化的发生学原理,这与中医学的病机认识相同。因本病的发病机制与内质网应激存在相似之处,即其发生发展均与炎症、氧化应激、雄激素过多和胰岛素合成及分泌异常等相关。内质网应激的发生可能在PCOS的疾病进展中扮演着重要角色。运脾法能够延缓内质网应激的发生,同时也可有效缓解PCOS的肥胖、胰岛素代偿性增高等相关特征。因此,缓解内质网应激有望成为治疗本病的新思路。健运脾气,补益脾阳为本病治疗大法,从恢复脾运的角度调控内质网应激,以期为改善PCOS相关临床症状提供不同的治疗角度。Polycystic ovary syndrome(PCOS) is a clinically common heterogeneous disease characterized by reproductive disorders and metabolic abnormalities.Endoplasmic reticulum stress refers to an adaptive response of eukaryotic cells due to various factors leading to the misfolding and/or aggregation of proteins.By reviewing ancient literature on the theory of spleen governing transportation and transformation,it was found that the function of the spleen in transporting and transforming water and grains,dispersing nutriment throughout the body is similar to the important role of the endoplasmic reticulum in cells in modern medicine.Both are involved in tasks such as protein folding and calcium storage to ensure normal cellular physiological functions.If the spleen loses its transportation and transformation function,phlegm-damp obstruction is the core pathogenesis of this disease.Modern scientific research believes that endoplasmic reticulum stress can better explain the pathogenesis of spleen dysfunction,which is consistent with the understanding of pathogenesis in traditional Chinese medicine.Given the similarities between the pathogenesis of PCOS and endoplasmic reticulum stress,both associated with inflammation,oxidative stress,excessive androgen,and abnormal insulin synthesis and secretion,endoplasmic reticulum stress may play an important role in the PCOS progression.The application of spleen-governing transportation and transformation principle can delay the occurrence of endoplasmic reticulum stress,and also can effectively alleviate the related characteristics related to PCOS,such as obesity and compensatory increase in insulin.Therefore,alleviating endoplasmic reticulum stress is expected to become a new idea for the treatment of PCOS.Nourishing and regulating the spleen,and supplementing spleen yang,serve as the primary methods for treating this condition.Adjusting endoplasmic reticulum stress from the perspective of restoring spleen function offers a different therapeutic angle to improve clinical symptoms ass

关 键 词：脾失运化 运脾法 多囊卵巢综合征 内质网应激 胰岛素抵抗 慢性低度炎症 肥胖 雄激素过多 

分 类 号：R271.9[医药卫生—中西医结合]