基于“栓炎反应”探讨缺血性中风瘀热证的生物学实质及中医药防治研究现状  

Exploring biological essence of blood stasis-heat syndrome in ischemic stroke from insight of thromboinflammation

作　　者：周静 梅志刚 ZHOU Jing;MEI Zhi-gang(Institute of Basic Theory on Integrated Traditional Chinese and Western Medicine,College of Integrated Traditional Chinese Medicine and Western Medicine,Hunan University of Chinese Medicine,Changsha 410208,China)

机构地区：[1]湖南中医药大学中西医结合学院中西医结合基础理论研究室,湖南长沙410208

出　　处：《中国中药杂志》2024年第23期6533-6540,共8页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金项目(82174167);国家中医药管理局青年岐黄学者培养项目;湖南省“十四五”第二批中医药学科带头人培养项目。

摘　　要：瘀热证是缺血性中风常见的证型之一,患者病变过程中易出现“瘀”“热”交互之证,是疾病进展的重要表象,目前缺乏对其生物学实质的系统研究。血栓炎症(thromboinflammation)病理反应是新近提出的关于血栓形成与炎症反应相互关联的病理概念,是指在血管性血友病因子(von Willebrand factor, vWF)与激肽释放酶-激肽系统的介导下,血栓形成和炎症反应相互影响,T细胞及中性粒细胞活化进而加剧血栓形成,恶化缺血性中风病理进展,颇具中医瘀热证之瘀热相搏的特点。该文基于血栓炎症病理反应(简称栓炎反应)的相关研究进展,结合缺血性中风瘀热证临床证候特征及生物标志物,提出栓炎反应可能是缺血性中风瘀热证的生物学基础的观点;同时,系统梳理了活血化瘀及清热解毒功效的中药单体或复方应用现状及机制研究,发现其药理机制与栓炎反应相关生物标志物的调控密切相关,进一步反证了缺血性中风瘀热证的生物学基础是栓炎反应。该文旨在为以栓炎反应为靶标的缺血性中风中医药防治策略提供科学依据。Blood stasis and heat syndrome is one of the common syndromes of traditional Chinese medicine(TCM)in ischemic stroke,which manifests as"blood stasis"and"heat"during the pathological process of patients with ischemic stroke,representing an important manifestation of disease progression.Ischemic stroke is clinically characterized by the symptoms such as mental confusion,restlessness,hemiplegia,deⅥation of mouth and tongue,slurred speech,fever,constipation,abdominal distension,hematemesis,melena,dark purple complexion,red or dark purple tongue,yellow and dry tongue fur,taut and rapid pulse or nodal pulse.However,the current medical community lacks a comprehensive and systematic understanding of the specific biological mechanisms behind the syndrome of blood stasis and heat.Thromboinflammation,a newly proposed pathological evolution mechanism highly associated with thrombosis and inflammatory response in ischemic cardio-cerebrovascular diseases,refers to the process where platelets adhere to the site of vascular injury through glycoproteinⅥ(GPⅥ),facilitating the binding of glycoproteinⅡb/Ⅲa(GPⅡb/Ⅲa),fibrinogen(FIB),and von Willebrand factor(vWF),thereby promoting thrombosis.Meanwhile,activated platelets also activate factorⅫ(FⅫ),promoting the activation of the kallikrein-kinin system and triggering secondary inflammatory reactions.Concurrently,T cells,in turn,activate coagulation through the interaction of CD40 and CD40 ligand(CD40/CD40L),the binding of P-selectin glycoprotein ligand-1(PSGL^(-1))with vWF,and the activation of thrombin by neutrophilsⅥa the tissue factor/fac torⅦa(TF/FⅦa)pathway and the activation of factorⅢ(FⅢ)by cathepsin G,thereby exacerbating thrombosis.This pathological process exacerbates the pathological progression of ischemic stroke,exhibiting similar characteristics to the syndrome of blood stasis and heat in traditional Chinese medicine. Based on the aforementioned theoretical advancements, this paper proposes that thrombo -inflammatory response may constitute a �

关 键 词：缺血性中风 瘀热证 血栓炎症 生物学实质 药物靶点 

分 类 号：R277.7[医药卫生—中医学]