中医药治疗糖尿病胃肠病变的疗效及机制研究进展  

Curative Effect and Mechanism of Traditional Chinese Medicine in Treatment of Diabetic Gastroenteropathy:A Review

作　　者：尹瑞阳 张宇昕 张艳娇 方心怡 苗润宇 关惠芳 田佳星[1] YIN Ruiyang;ZHANG Yuxin;ZHANG Yanjiao;FANG Xinyi;MIAO Runyu;GUAN Huifang;TIAN Jiaxing(Institute of Metabolic Diseases,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China;Graduate School,Changchun University of Chinese Medicine,Changchun 130117,China)

机构地区：[1]中国中医科学院广安门医院代谢病研究所,北京100053 [2]北京中医药大学研究生院,北京100029 [3]长春中医药大学研究生院,长春130117

出　　处：《中国实验方剂学杂志》2024年第17期239-247,共9页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金青年科学基金项目(81904187);中国中医科学院广安门医院临床医学研究中心建设专项(2022LYJSZX12);中国中医科学院优秀青年科技人才培养专项(ZZ13-YQ-026)。

摘　　要：糖尿病胃肠病变是伴随糖尿病病程进展出现的严重慢性并发症,其对患者的生活质量和整体健康状态造成了严重的影响,近半数糖尿病患者出现恶心、呕吐、早饱感、腹胀和腹痛等症状,增加患者焦虑抑郁情绪,并使其频繁求医,从而进一步加重了医疗系统的负担,在对糖尿病胃肠病变发病机制的深入研究中,发现高血糖、自主神经及肠神经系统功能紊乱、胃肠激素分泌失常、巨噬细胞极化、脑肠轴失调、microRNA缺陷、氧化应激导致Cajal间质细胞(ICC)的功能受损和凋亡是发病机制的核心,当前临床治疗主要依赖于促动力和止吐药物,然而,其不可忽视的不良反应及长期使用所带来的逐渐降低疗效的问题亟待解决。中医药以其独特的理论体系和丰富的实践经验,整体观念和辨证施治原则指导组方选穴,逐渐成为治疗糖尿病胃肠病变的重要选择,许多研究证实其机制包括改善胃肠激素分泌,修复ICC损伤,调节神经系统、氧化应激及脑肠轴等,为糖尿病胃肠病变的治疗提供新的思路。该文通过总结糖尿病胃肠病变的发病机制和归纳近年来中药及针灸治疗糖尿病胃肠病变的研究中改善胃肠动力的相关机制,希望能够为糖尿病胃肠病变的临床治疗提供助益。未来仍需要进一步深入研究,探索综合、个体化的治疗方式,为糖尿病胃肠病变患者提供更好的治疗策略。Diabetic gastroenteropathy is a serious chronic complication that accompanies the progression of diabetes mellitus,severely impacting patients'quality of life and overall health.Nearly half of diabetic patients experience symptoms such as nausea,vomiting,early satiety,abdominal distension,and abdominal pain,which increases their anxiety and depression,prompting frequent medical visits and further burdening the healthcare system.In-depth research into the pathogenesis of diabetic gastroenteropathy has identified several core mechanisms,including hyperglycemia,autonomic and enteric nervous system dysfunction,abnormal secretion of gastrointestinal hormones,macrophage polarization,brain-gut axis dysregulation,microRNA deficiency,and oxidative stress-induced damage and apoptosis of interstitial cells of Cajal(ICC).Current clinical treatments mainly rely on prokinetic and antiemetic drugs.However,their notable adverse effects and diminishing efficacy with long-term use remain pressing issues.Traditional Chinese medicine(TCM),with its unique theoretical framework and extensive practical experience,potent in prescription formulation and acupoint selection guided by holistic concepts and syndrome differentiation,has gradually become an important option for treating diabetic gastroenteropathy.Numerous studies have confirmed that mechanisms include improving gastrointestinal hormone secretion,repairing ICC damage,regulating the nervous system,reducing oxidative stress,and modulating the brain-gut axis.These findings provide new insights into the treatment of diabetic gastroenteropathy.This article summarized the pathogenesis of diabetic gastroenteropathy and reviewed recent research on Chinese medicine and acupuncture-moxibustion therapy in improving gastrointestinal motility for diabetic gastroenteropathy treatment,aiming to offer clinical treatment insights and highlight the need for further research to explore comprehensive and individualized treatment approaches,providing better strategies for managing diabetic gastroen

关 键 词：中医药 糖尿病胃肠病变 胃肠动力 CAJAL间质细胞 胃肠激素 

分 类 号：R2-0[医药卫生—中医学] R22R242R285.5