中药有效成分及复方调控巨噬细胞治疗腰椎间盘突出症研究进展  

Research Progress in the Regulation of Macrophages by Active Components and Compound Formulas of Chinese Drugs in the Treatment of Lumbar Disc Herniation

作　　者：李哲毅 周学龙[1] 赵乐[1] 张建凤 LI Zheyi;ZHOU Xuelong;ZHAO Le;ZHANG Jianfeng(Guangxi University of Chinese Medicine,Nanning,Guangxi,China,530200)

机构地区：[1]广西中医药大学,广西南宁530200

出　　处：《河南中医》2024年第9期1446-1453,共8页Henan Traditional Chinese Medicine

摘　　要：腰椎间盘突出症(lumbar disc herniation,LDH)多由风寒湿热邪侵袭或年老失养,肝肾亏虚;或因跌扑损伤,气血凝滞,经脉不利所致。故病机总属本虚标实,治疗应注重祛风除湿散寒、清热利湿、活血通络治其标,补益肝肾、强筋壮骨治其本。巨噬细胞极化在LDH发生进展中占有重要地位,能改善局部炎性微环境状态,发挥镇痛作用,是治疗LDH的潜在靶点。LDH中巨噬细胞相关的信号通路有:核因子-κB信号通路、NOD样受体热蛋白结构相关蛋白3炎症小体信号通路、丝裂原活化蛋白激酶信号通路、Notch信号通路等。中药有效成分及复方能够通过多途径调节巨噬细胞极化状态,恢复促炎/抗炎因子平衡,减缓LDH的进展。中药提取有效成分有:芦荟中的芦荟醇,骨碎补中的柚皮苷,姜黄中的姜黄素,秦艽、威灵仙中的木兰花苷,黄连中的小檗碱等。三痹汤、宣痹汤、血府逐瘀汤、独活寄生汤等为治疗LDH的代表复方。中药具有多靶点、多机制、疗效高、质优价廉、副作用少等的特点,靶向调控巨噬细胞极化,恢复腰椎间盘突出物局部炎症微环境平衡,可能是未来治疗LDH的潜在方向。目前,中药有效成分及其复方靶向调控巨噬细胞治疗LDH的研究中,对其作用机制的研究还非常有限,缺乏深层标准化的临床前证据与基础实验。因此,在未来的研究中,需加强中药有效成分与复方对调控巨噬细胞极化的研究,明确中药复方调控巨噬细胞治疗LDH的具体作用机制,为研制延缓腰椎间盘退变的新型药物,以及中医药更好的应用提供可靠依据。Lumbar Disc Herniation(LDH) often results from the invasion of pathogenic wind,cold,dampness,and heat,or from aging-related deficiencies,particularly in the liver and kidneys.It can also be caused by trauma,stagnation of qi and blood and impaired meridian circulation.Thus,the pathogenesis generally involves a root deficiency with secondary excess.Treatment should focus on expelling wind,eliminating dampness,dispersing cold,clearing heat,draining dampness,invigorating blood,and unblocking meridians to address the symptoms,while nourishing the liver and kidney,and strengthening the tendons and bones is essential to treat the underlying cause.Macrophage polarization plays a crucial role in the development and progression of LDH,as it can improve the local inflammatory microenvironment and exert analgesic effects,making it a potential therapeutic target for LDH.Macrophage-related signaling pathways involved in LDH include the NF-κB signaling pathway,NLRP3 inflammasome signaling pathway,MAPK signaling pathway,and Notch signaling pathway.Active components and compound formulas of Chinese drugs can regulate macrophage polarization through multiple pathways,restore the balance between pro-inflammatory and anti-inflammatory factors,and slow the progression of LDH.Active components extracted from Chinese drugs include aloin from Luhui(Aloe),naringin from Gusuibu(Rhizoma Drynariae),curcumin from Jianghuang(Rhizoma Curcumae Longae),magnoloside from Qinjiao(Radix Gentianae Macrophyllae) and Weilingxian(Radix et Rhizoma Clematidis),and berberine from Huanglian(Rhizoma Coptidis).Representative compound formulas include Three Impediments Decoction,Impediment-Removing Decoction,Blood Mansion Stasis-Expelling Decoction,Pubescent Angelica and Mistletoe Decoction.Chinese drugs have the advantages of multiple targets,multiple mechanisms,high efficacy,good quality,affordability,and minimal side effects.Targeted regulation of macrophage polarization to restore the balance of the local inflammatory microenvironment in LDH may be a pote

关 键 词：腰椎间盘突出症 中药有效成分 中药复方 巨噬细胞 巨噬细胞极化 信号通路 三痹汤 宣痹汤 血府逐瘀汤 独活寄生汤 

分 类 号：R274.981.53[医药卫生—中西医结合]