动脉粥样硬化巨噬细胞泡沫化的“脉中积”理论探讨  

Discussion on"Maizhongji(脉中积)"Theory of Macrophage Foam in Atherosclerosis

作　　者：俞赟丰 杨欣雨 周曼丽 罗晓欣 简维雄 YU Yunfeng;YANG Xinyu;ZHOU Manli;LUO Xiaoxin;JIAN Weixiong('College of Chinese Medicine,Hunan University of Chinese Medicine,Changsha 410208;The First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 410007)

机构地区：[1]湖南中医药大学中医学院,长沙410208 [2]湖南中医药大学第一附属医院,长沙410007

出　　处：《中药药理与临床》2024年第10期85-90,共6页Pharmacology and Clinics of Chinese Materia Medica

基　　金：国家自然科学基金项目(编号:81973753)。

摘　　要：巨噬细胞泡沫化是动脉粥样硬化(Atherosclerosis,AS)发生发展的关键因素,也是防治AS的重要环节。“脉中积”理论认为AS以浊邪内生、心脉积滞为标,以正气不足、脉壁不固为本,对巨噬细胞泡沫化治疗具有一定的指导意义。正气亏虚,抗邪无力,则脉壁不固,经脉损伤,经脉损伤即是局部血管损伤,是低密度脂蛋白沉积和局部血管炎症反应的前提。正气不足,激发无力,则脾虚失运,痰浊内生,内生痰浊即是异常增加的低密度脂蛋白和炎性因子,是巨噬细胞泡沫化的基础。浊邪内生、心脉积滞是一个持续进展的过程,包括痰浊阻滞、痰瘀凝滞、心血瘀阻三个阶段。痰浊阻滞是低密度脂蛋白沉积于局部血管和促炎因子引发血管局部炎症反应的过程,痰瘀凝滞是巨噬细胞过量吞噬氧化低密度脂蛋白后转化为泡沫细胞的过程,心血瘀阻是泡沫细胞过量吞噬oxLDL死亡形成坏死中心,坏死中心继而介导持续炎症反应和氧化应激最终形成粥样斑块的过程。因此,中医药调控巨噬细胞泡沫化需标本兼治,以健脾益气治其本,祛痰化瘀治其标;若见痰瘀郁久、化生热毒者,当治以清热解毒之法。中药复方和中药单体均能调控巨噬细胞泡沫化,中药复方可分为益气活血类、益气化痰类、清热解毒类,主要通过改善巨噬细胞脂代谢,延缓泡沫细胞形成,以及抑制血管内皮细胞的炎症反应和减轻氧化损伤,改善血管微环境,从而抑制AS进展。Macrophage foam is a key factor in the occurrence and development of atherosclerosis(AS)and is also an important link in AS prevention and treatment.The"Maizhongji(脉中积)"theory suggests that AS is characterized by Xiezhuoneisheng(浊邪内生)and Xinmaijizhi(心脉积滞)as symptoms and Zhengqibuzu(正气不足)and Maibibugu(脉壁不固)as causes,which provides certain guidance for the macrophage foam.Zhengqibuzu can lead to Maibibugu and injuries to Jingmai(经脉).The injury to Jingmai refers to local vascular injury,which is a prerequisite for the deposition of low-density lipoprotein and local vascular inflammation.Zhengqibuzu can lead to Pixushiyun(脾虚失运)and Tanzhuoneisheng(痰浊内生).Tanzhuoneisheng refers to the abnormal increase in low-density lipoprotein and inflammatory factors,which serves as the basis for the macrophage foam.Zhuoxieneisheng(浊邪内生)and Xinmaijizhi(心脉积滞)are a continuous process,including three stages:Tanzhuozuzhi(痰浊阻滞),Tanyuningzhi(痰瘀凝滞),and Xinxueyuzu(心血瘀阻).Tanzhuozuzhi is the process of low-density lipoprotein deposition in local blood vessels and the initiation of local vascular inflammatory reactions by pro-inflammatory factors.Tanyuningzhi is the process of excessive phagocytosis of oxidized low-density lipoprotein by macrophages,which transform into foam cells.Xinxueyuzu is the process in which foam cells die by over-phagocytosis of oxLDL and form necrotic cores,which in turn mediate sustained inflammatory reactions and oxidative stress,eventually forming atherosclerotic plaques.Therefore,the regulation of macrophage foam in traditional Chinese medicine(TCM)requires a holistic approach,addressing both symptoms and causes.The treatment focuses on Jianpiyiqi(健脾益气)and Qutanhuayu(祛痰化瘀)to address symptoms,while Qingrejiedu(清热解毒)to address causes when the patients show long-term Tanyu(痰瘀)and Redu(热毒).Both TCM formulas and TCM drugs can regulate macrophage foam.TCM formulas can be classified into catego

关 键 词：动脉粥样硬化 巨噬细胞泡沫化 脉中积 中医药 

分 类 号：R259[医药卫生—中西医结合]