基于胃癌“脾虚瘀毒”理论探讨CD8^(+)T细胞耗竭中医病机的科学内涵  

Scientific connotation of CD8^(+)T cell exhaustion in traditional Chinese medicine based on the theory of“spleen deficiency and stasis toxin”in gastric cancer

作　　者：李秋蓉 杨培培 黄雯洁 徐媛媛[1] 姜超 舒鹏[1] LI Qiurong;YANG Peipei;HUANG Wenjie;XU Yuanyuan;JIANG Chao;SHU Peng;无(Department of Medical Oncology,Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province,Nanjing210029,China;Department of Surgical Gastrointestinal Oncology,Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province,Nanjing210029,China)

机构地区：[1]南京中医药大学附属医院肿瘤内科,江苏南京210029 [2]南京中医药大学附属医院消化系肿瘤外科,江苏南京210029

出　　处：《中国医药导报》2024年第31期136-139,148,共5页China Medical Herald

基　　金：国家自然科学基金资助项目(82374539);江苏省中医药科技发展计划(ZD202214、YB201916);江苏省研究生实践创新计划项目(SJCX24_0977)。

摘　　要：胃癌“脾虚瘀毒”理论认为脾虚为胃癌病机根本,气滞、痰凝、血瘀于脾虚基础上渐生,日久交错形成癌毒,“脾虚瘀毒”形成的正虚毒结内环境与肿瘤微环境中缺氧、新生血管、间质重构、营养消耗、脂质堆积、高乳酸水平等有内在联系,其通过多种途径致使CD8^(+)T细胞出现营养剥夺、线粒体缺陷、糖代谢、脂代谢、氨基酸代谢等物质能量代谢紊乱,导致T细胞耗竭的发生。“脾胃虚弱为本,瘀毒留滞为标”可能是胃癌免疫微环境中T细胞耗竭的核心病机。本文基于胃癌“脾虚瘀毒”病机理论,聚焦肿瘤微环境中CD8^(+)T细胞耗竭探讨其科学内涵,为中医药抗胃癌的治疗策略提供新思路。According to the theory of“spleen deficiency and stasis toxin”,spleen deficiency is the root of gastric cancer,and qi stagnation,phlegm coagulation,and blood stasis occur gradually on the basis of spleen deficiency,and the internal environment caused by stasis toxin is intrinsically related to the tumor microenvironment with hypoxia,neovascularization,interstitial remodeling,nutritional depletion,lipid accumulation,and high lactic acid level,etc.,which leads to the exhaustion of CD8^(+)T cells through various pathways.Nutritional deprivation,mitochondrial defects,disorders of glucose metabolism,lipid metabolism,amino acid metabolism,and other material and energy metabolism,leading to the occurrence of T cell exhaustion.“Spleen deficiency and stasis toxin”may be the core pathogenesis of T cell exhaustion in the immune microenvironment of gastric cancer.Based on the theory of“spleen deficiency and stasis toxin”in gastric cancer,this paper focuses on CD8^(+)T cell exhaustion in tumor microenvironment and discusses its scientific connotation,so as to provide a new perspective for the treatment of gastric cancer by traditional Chinese medicine.

关 键 词：脾虚瘀毒 肿瘤微环境 T细胞耗竭 胃癌 

分 类 号：R273[医药卫生—中西医结合]