2型糖尿病发病中炎症因子的作用和中医从湿热论治的研究进展  

Research Progress on the Role of Inflammatory Factors in the Pathogenesis of Damp-Heat Type-2 Diabetes and Traditional Chinese Medicine Treatment

作　　者：楼雨沁 蒋旭宏[1] LOU Yuqin;JIANG Xuhong(Zhejiang Chinese Medical University,Hangzhou(310053),China)

机构地区：[1]浙江中医药大学,杭州310053

出　　处：《浙江中医药大学学报》2024年第7期881-885,894,共6页Journal of Zhejiang Chinese Medical University

基　　金：浙江省自然科学基金项目(LY20H270010);浙江省中医药重点研究项目(2022ZZ016)。

摘　　要：[目的]归纳总结国内外对2型糖尿病(diabetes mellitus type 2,T2DM)发病中炎症因子作用的认识、T2DM湿热证与炎症的相关性以及从湿热证治疗T2DM的经验,以期为T2DM治疗提供新思路。[方法]查阅T2DM相关资料,阅读相关文献,总结国内外关于炎症因子在T2DM发病中作用的研究结果,总结湿热证与炎症的相关性以及中医从湿热论治T2DM的经验。[结果] T2DM的发病与炎症因子关系密切,T2DM患者血清中炎性因子如肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)等均高于正常水平。炎症因子在T2DM发病中的作用包括阻碍胰岛素受体底物(insulin receptor substrate,IRS)正常酪氨酸磷酸化,加速IRS与磷脂酸肌醇3-激酶(phosphatidylinositol 3-kinases,PI3K)解离以及IRS的降解,影响下游的PI3K磷酸化,干扰胰岛素信号经此通路下传,引发胰岛素抵抗(insulin resistance,IR);促进核因子-κB(nuclear factor-κB,NF-κB)活化,通过正反馈机制不断加重炎症状态,导致IR;直接或间接引起胰岛β细胞破坏和胰岛素分泌功能减退。中医辨证T2DM患者多为湿热证,湿热证T2DM的TNF-α、IL-6、超敏C反应蛋白(hypersensitive-C reactive protein,hs-CRP)水平更高,脂代谢紊乱、IR及炎症状态更为严重,提示T2DM湿热证与机体的炎症状态存在较强相关性。中医通过应用各种清热化湿中药复方与单药治疗T2DM湿热证,能够降低机体炎症因子水平。[结论] T2DM、炎症、湿热证之间存在相关性,T2DM多属于湿热证,运用清热化湿中药复方与单方治疗T2DM湿热证有效,从湿热论治T2DM可成为治疗T2DM的新思路。[Objective Objective]To summarize the research and understanding on the role of inflammatory factors in the onset of type-2 diabetes(T 2 DM)at home and abroad,the correlation between damp-heat syndrome and inflammation in T 2 DM,and the experience of traditional Chinese medicine(TCM)in treating T 2 DM from damp-heat syndrome,so as to provide new ideas for the treatment of T 2 DM.[Methods Methods]Reviewing relevant information on T 2 DM,reading relevant literature,summarizing the research results on the role of inflammatory factors in the pathogenesis of T 2 DM at home and abroad,summarizing the correlation between damp-heat syndrome and inflammation in TCM,and summarizing the experience of treating T 2 DM from the perspective of damp-heat in TCM.[Results Results]The onset of T 2 DM is closely related to inflammatory factors,inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)in the serum of T 2 DM patients are higher than normal levels.The role of inflammatory factors in the pathogenesis of T 2 DM includes hindering normal tyrosine phosphorylation in the insulin receptor substrate(IRS),accelerating the dissociation and degradation of IRS and phosphatidylinositol 3-kinases(PI 3 K),affecting downstream PI 3 K phosphorylation,interfering with insulin signaling through the pathway,and triggering insulin resistance(IR);promoting nuclear factor-κB(NF-κB)activation continuously exacerbates the inflammatory state through a positive feedback mechanism,promoting IR;directly or indirectly causing pancreatic isletsβcellular destruction and decreasing insulin secretion function.TCM syndrome differentiation of T 2 DM patients is mostly characterized by damp-heat syndrome,the levels of IL-6 and hypersensitive-C reactive protein(hs-CRP)in T 2 DM damp heat syndrome are higher.Lipid metabolism disorders,IR and inflammation are more severe.There is a strong correlation between T 2 DM damp-heat syndrome and the inflammatory state of the body.TCM can reduce the level of inflammatory factors in the body

关 键 词：2型糖尿病 炎症因子 胰岛素抵抗 胰岛β细胞功能受损 湿热证 中医药 

分 类 号：R587[医药卫生—内分泌]