从上皮间充质转化探讨“态靶辨治”糖尿病足溃疡的机制  

Discussion on Mechanisms of"State-Target Differentiation and Treatment"for Diabetic Foot Ulcers from the Perspective of Epithelial-Mesenchymal Transition

作　　者：柳国斌[1] CHEN Hong;FAN Weijing;HUANG Renyan;LIU Guobin(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,201203)

机构地区：[1]上海中医药大学附属曙光医院,上海浦东201203

出　　处：《中医杂志》2025年第1期23-29,共7页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82305245,82274528);上海市2021年度“科技创新行动计划”医学创新研究专项项目(21Y21920200);上海中医药大学科技发展基金(23KFL107)。

摘　　要：结合仝小林院士提出的态靶辨治理论,认为糖尿病足溃疡属于络损期,湿、热、瘀、虚、损五个态型贯穿其中。上皮间充质转化(EMT)的动态生物学过程与糖尿病足溃疡的愈合过程密切相关,从“态靶辨治”的角度分期论治糖尿病足溃疡,不仅为临床精准治疗提供依据,还为进一步揭示EMT在不同态型中的调控作用及干预靶点提供思路。湿态通常出现在炎症期,创面局部炎症和体液代谢紊乱诱导EMT发生,治疗上以利湿消肿为主,促进局部微循环,改善组织缺氧状态。热态通常提示局部急性炎症反应,治疗以清热解毒为主,通过调控EMT过程,减轻炎症反应,有助于控制感染,缓解局部红肿热痛。瘀态主要出现在增殖期,治疗以活血化瘀、通经活络为主,通过EMT实现细胞外基质的重塑,促进组织的修复和血管新生。虚态多见于慢性阶段,治疗以益气养血、扶正祛邪为主,调控EMT的关键在于恢复局部组织的代谢功能和微环境改善,提高组织修复能力。损态为病情持续恶化,治疗应以气血阴阳并补、生肌强筋壮骨为主,佐以解毒化瘀,EMT通过调节细胞外基质的降解酶的活性,防止过度组织修复和瘢痕形成,促进正常组织结构的重建。Building on the theory of"state-target differentiation and treatment"proposed by Academician TONG Xiaolin,diabetic foot ulcers(DFUs)are considered to belong to the"collateral injury"stage,characterized by the interplay of five states,i.e.dampness,heat,stasis,deficiency,and impairment.The dynamic biological process of epithelial-mesenchymal transition(EMT)is closely associated with the healing process of DFUs.The treatment of DFUs through staged differentiation under the"state-target differentiation and treatment"theory not only provides a basis for precise clinical treatment,but also offers insights into the regulatory roles of EMT in different states and potential intervention targets.The dampness state typically exits during the inflammatory phase,local inflammation and fluid metabolism disorders inducing EMT.Treatment focuses on draining dampness and alleviating edema,promoting local microcirculation,and improving tissue hypoxia.The heat state often reflects acute local inflammatory responses.Treatment emphasizes clearing heat and resolving toxins,regulating the EMT process to reduce inflammation,control infection,and alleviate redness,swollen,heat,and pain in the affected area.The stasis state mainly occurs during the proliferation phase.Treatment centers on invigorating blood and dissolving stasis,and unblocking the channels and quickening the collaterals.EMT plays a role in remodeling the extracellular matrix,promoting tissue repair and angiogenesis.The deficiency state is common in chronic phase,where treatment prioritizes tonifying qi and nourishing blood while reinforcing healthy qi and dispelling pathogens.EMT regulation focuses on restoring local tissue metabolism and improving the micro-environment to enhance tissue repair capacity.The impairment state represents the progression of disease deterioration.Treatment should focus on supplementing qi,blood,yin,and yang,and also promoting muscle growth and strengthening bones,supplementing by resolving toxins and stasis.EMT plays a role by regulating the ac

关 键 词：糖尿病足溃疡 态靶辨治 上皮间充质转化 络损 

分 类 号：R259[医药卫生—中西医结合]