基于络病理论探讨椎基底动脉延长扩张症与脑小血管病的共病机制  

Comorbidity Mechanism of Vertebrobasilar Dolichoectasia and Cerebral Small Vessel Disease Based on Collateral Disease Theory

作　　者：张永辉 张道培 ZHANG Yonghui;ZHANG Daopei(The First Clinical Medical School,Henan University of Chinese Medicine,Zhengzhou 450000,China;The First Affiliated Hospital of Henan University of Chinese medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一临床医学院,郑州450000 [2]河南中医药大学第一附属医院,郑州450000

出　　处：《中国实验方剂学杂志》2024年第13期192-201,共10页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省高等学校重点科研项目(22A320036);河南省科技研发计划联合基金项目(222301420080);河南省中医药科学研究专项(2023ZY2023,2024ZY1008)。

摘　　要：椎基底动脉延长扩张症(VBD)共病脑小血管病(CSVD)增加患者的不良预后,阐释二者共病的机制有助于探索有效的治疗策略。血管在解剖形态、生理病理上与中医学“络脉”具有同一性,因此以络病理论为切入点,结合中西医对二者认识的病机理论和研究进展,提出二者病位均在脑络,属本虚标实。共病的主要病机以元气亏虚,脑络空虚为本,对应现代医学的内皮细胞和神经-内分泌-免疫网络功能障碍;以脑络瘀阻,脑络闭塞,毒损脑络为标,对应现代医学的脑血管动脉粥样硬化、血流动力学改变、低灌注和毒性代谢产物损伤脑白质。基于络病理论,探讨二者共同的病机,可望探索建立中医药治疗的理法方药,改善患者的临床预后。The comorbidities of vertebrobasilar dolichoectasia(VBD)and cerebral small vessel disease(CSVD)increase the poor prognosis of patients,and elucidating the mechanism underlying their comorbidities helps to explore effective treatment strategies.Therefore,based on the collateral disease theory and combining with the pathogenesis and research progress of traditional Chinese and Western medicine on the understanding of the two,this study proposes that both the disease locations are in the brain collaterals and the pathogenesis is deficiency in foundation and excess in symptoms.The main pathogenesis roots in the deficiency of original Qi and the emptiness of brain collaterals,which corresponds to the dysfunction of endothelial cells and neuroendocrino-immune networks in modern medicine.The symptoms are cerebral blood stasis,occlusion of cerebral arteries and toxic lesion of cerebral arteries,corresponding to cerebrovascular atherosclerosis,hemodynamic changes,hypoperfusion and toxic metabolites-induced injury of white matter in modern medicine.Based on the collateral disease theory,exploring the common pathogenesis of the VBD and CSVD is expected to facilitate the establishment of TCM treatment scheme including the principles,methods and medicines,and improve the clinical prognosis of patients.

关 键 词：络病理论 络脉 椎基底动脉延长扩张症 脑小血管病 

分 类 号：R2-0[医药卫生—中医学] R22R285.5R2-031R743