参苓白术散干预腹膜透析后蛋白质能量消耗研究进展  

Research Progress of Shenling Baizhu Powder(参苓白术散)Intervention PEW in Peritoneal Dialysis

作　　者：魏琦 刘洋 王政 郝娜[1] WEI Qi;LIU Yang;WANG Zheng;HAO Na(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300382,China;Feicheng Hospital of Traditional Chinese Medicine,Feicheng 271600,Shandong,China)

机构地区：[1]天津中医药大学第一附属医院,国家中医针灸临床医学研究中心,天津300382 [2]肥城市中医院,山东肥城271600

出　　处：《辽宁中医药大学学报》2024年第12期88-92,共5页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家自然科学基金青年基金项目(81904141);湖北陈孝平科技发展基金会项目(CXPJJH122003-09);天津市科技计划项目(22KPHDRC00040)。

摘　　要：腹膜透析晚期并发症蛋白质能量消耗(protein energy wasting,PEW)发病率日益增加,在腹膜透析(peritoneal dialysis,PD)患者中PEW发生率为30%~65%,人们对PEW的关注度逐渐增加。PEW常表现为蛋白质能量受损,其与炎症状态和胃肠功能紊乱关系密切。目前,临床采用个体化和全方位治疗,通过补充营养物质、抗炎治疗和促进合成代谢等方式改善PEW,但其价格昂贵、不良反应较多,并且缺乏临床大规模应用。近年来,随着对该疾病关注度增加,人们发现中医药可通过多种途径干预腹膜透析并发症。研究发现,参苓白术散能够改善胃肠功能紊乱、双向调节胃肠动力、缓解炎症状态、干预氧化应激和调节水通道蛋白。参苓白术散可通过增加黏蛋白和紧密连接的分泌、增强Bcl-2表达和减少Bax表达、限制TLR5/MyD88/NF-κB信号通路、抑制NF-κB/p38信号通路、激活G1/PI3K/Akt-Nrf 2信号通路、下调AQP1/2/3/4表达,进而调节胃肠功能紊乱、炎症状态和PEW。文章就参苓白术散改善腹透患者PEW的机制做一综述,阐明其干预PEW的作用机制及相关信号通路的进展,加深对中草药治疗腹透并发症的认识,以期为中西医结合防治PEW提供有效参考价值。The incidence of emerging protein energy wasting(PEW),a late consequence of peritoneal dialysis(PD)that varies from 30%to 65%,is on the rise,and PEW is receiving a growing amount of attention.PEW,intimately associated with gastrointestinal dysfunction and inflammation,frequently presents as reduced protein energy.Through nutritional supplements,anti-inflammatory therapy,and the development of anabolism,individualized and holistic clinical treatments are utilized to enhance PEW;however,these approaches are expensive often cause unfavorable side effects,and have limited clinical use.It has been discovered that TCM can interfere in peritoneal dialysis difficulties through different mechanisms as awareness of the disease has increased in recent years.Research has shown that Shenling Baizhu Powder(参苓白术散,SBP)can improve gastrointestinal dysfunction by bidirectionally regulating gastrointestinal dynamics,alleviate inflammatory states,reduce oxidative stress and regulate water channel proteins.SBP can alleviate gastrointestinal dysfunction,inflammation and PEW by promoting tight junction and mucin production,upregulating Bcl-2 expression,downregulating Bax expression,restricting TLR5/MyD88/NF-κB signaling pathway,inhibiting NF-κB/p38 signaling pathway,activating G1/PI3K/Akt-Nrf2 signaling pathway,and down-regulating AQP1/2/3/4 expression.This article summarizes the mechanism of action and associated mechanisms of SBP in interfering with PEW and describes how ginsenoside improves PEW in patients receiving abdominal dialysis.To provide an effective reference value for the prevention and treatment of PEW by combining traditional Chinese and Western medicine,the article reviewed the mechanism of SBP to improve PEW in patients with abdominal dialysis,explained the mechanism of SBP intervention in PEW and the advancement of related signaling pathways,and deepened understanding of Chinese herbs in the treatment of abdominal dialysis complications.

关 键 词：营养不良 参苓白术散 作用机制 研究进展 

分 类 号：R289.5[医药卫生—方剂学]