从“脾滋胎气”理论探讨蜕膜巨噬细胞极化在甲状腺自身免疫合并流产中的作用  

Discussion on the Role of Decidual Macrophage Polarization in TAI Complicated with Abortion Based on the Theory of“Spleen Nourishing Fetal Qi”

作　　者：李品[1,2] 张爽[2] 臧凝子[1] 李楠[2] 王献蔗[2] 杨潇 吕静[1] 高天舒[1] LI Pin;ZHANG Shuang;ZANG Ningzi;LI Nan;WANG Xianzhe;YANG Xiao;LYU Jing;GAO Tianshu(The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China;Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110034,Liaoning,China)

机构地区：[1]辽宁中医药大学附属医院,辽宁沈阳110032 [2]辽宁中医药大学,辽宁沈阳110847 [3]辽宁中医药大学附属第二医院,辽宁沈阳110034

出　　处：《中华中医药学刊》2024年第9期183-188,I0042,共7页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(8210150892)。

摘　　要：甲状腺自身免疫(Thyroid Autoimmunity,TAI)与妊娠不良结局相关性是该领域研究热点,其中单纯甲状腺抗体增高可不依赖促甲状腺激素(Thyroid Stimulating Hormone,TSH)降低而独立导致流产发生。中医学认为,脾脏象理论与TAI合并流产病机关系密切,其中脾主运化可滋养胞胎;脾气之升使胎附胞宫;脾气之卫可致胎无邪扰。因此,将脾脏象理论中“运化水谷”“脾气主升”和“脾旺不受邪”三方面统称为“脾滋胎气”理论。此与母胎界面中螺旋动脉形成、滋养细胞、免疫排斥与容受等功能颇具相似性。其中胚胎免疫细胞中的1型巨噬细胞(Type-1 Macrophage,M1)/2型巨噬细胞(Type-2 Macrophage,M2)极化失衡为TAI合并流产的潜在机制,M1、M2表现出来的独特表型在建立母胎相互作用的免疫学方面起着关键作用。因此对两者进行取象比类,以蜕膜巨噬细胞极化失衡为本病西医病理基础,“脾滋胎气”理论为中医基础,取“滋化源、举中气、御邪气”之意,探讨与蜕膜巨噬细胞极化中“螺旋动脉重塑、滋养细胞植入、母胎界面免疫耐受”功能之间的相关性,为中医药现代化研究提供可靠的依据,并为TAI合并流产的发病机制提供了新的研究思路。The correlation between thyroid autoimmunity(Thyroid Autoimmunity,TAI)and adverse pregnancy outcomes is a research hotspot in this field,in which simple thyroid antibody elevation can independently lead to miscarriage without relying on(Thyroid Stimulating Hormone,TSH)reduction.Traditional Chinese medicine believes that the spleen function is closely related to the pathogenesis of TAI combined with abortion,in which the main movement of the spleen can nourish the fetus.The rise of qi makes the fetus appendage the uterus;The guard of qi can cause the fetus to be innocent.Therefore,the three aspects of“transporting and transforming nutrients”,“rise of spleen qi”and“spleen prosperity free from evil”in the spleen theory are collectively referred to as the theory of“spleen nourishing fetal qi”.This is similar to the functions of spiral artery formation,trophoblasts formation,immune rejection and receptivity in the maternal-fetal interface.The polarization imbalance of the em-bryonic immune cell Type-1 Macrophage(M1)/Type-2 Macrophage(M2)is the potential mechanism of TAI induced abor-tion.The unique phenotypes exhibited by M1 and M2 play a key role in establishing the immunology of maternal-fetal interac-tion.Therefore,the two are compared with the polarization imbalance of deciduous macrophages as the pathological basis of West-ern medicine,the theory of“spleen nourishing fetal qi”as the basis of traditional Chinese medicine,and the meaning of“nour-ishing source,lifting spleen qi,and preventing evil qi”,and exploring the correlation between the functions of“spiral artery re-modeling,trophoblast implantation,and mother-fetal interface immune tolerance”in decidua macrophage polarization,which provides a reliable basis for the modern research of traditional Chinese medicine and provides new research ideas for the patho-genesis of TAI combined with abortion.

关 键 词：脾滋胎气 甲状腺自身免疫 流产 巨噬细胞极化 母胎免疫 

分 类 号：R271.1[医药卫生—中医妇科学]