基于肿瘤相关巨噬细胞代谢重编程探讨大肠癌“脾虚瘀毒”病机  

Pathogenesis of Colorectal Cancer Based on Metabolic Reprogramming in Tumor-associated Macrophage

作　　者：王皓月 艾静[3] 程悦蕾[3] 周志刚 温俊凯 高嘉敏 陈鑫[1,2] 邓皖利 WANG Haoyue;AI Jing;CHENG Yuelei;ZHOU Zhigang;WEN Junkai;GAO Jiamin;CHEN Xin;DENG Wanli(Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai China 200062;Shanghai University of Traditional Chinese Medicine,Shanghai China 201203;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai China 201203;Yunlin Street Community Health Service Center of Xishan District of Wuxi City,Wuxi Jiangsu China 214000)

机构地区：[1]上海中医药大学附属普陀医院,上海200062 [2]上海中医药大学,上海201203 [3]上海中医药大学附属曙光医院,上海201203 [4]无锡市锡山区云林街道社区卫生服务中心,江苏无锡214000

出　　处：《中医学报》2025年第3期481-487,共7页Acta Chinese Medicine

基　　金：上海市普陀区卫生系统临床专业学科项目(2021tszk01);上海市普陀区科技创新卫生系统项目(ptkwws202002);上海市普陀区中医药临床专业学科项目(ptzyzk2101);上海市卫生健康委员会上海市进一步加快中医药事业发展三年行动计划项目{ZY〔2021-2023〕-0302}。

摘　　要：脾为气血生化之源,能量代谢与脾主运化的功能密切相关。大肠癌以脾虚失健为病机根本,瘀毒于脾虚基础上渐生,是大肠癌最为重要的病理因素。大肠作为维护机体代谢平衡的关键器官,其病变与代谢失调有着密切的联系。在大肠癌病变过程中,肿瘤细胞与肿瘤微环境中多种代谢物质以代谢重编程为主发生改变,重构肿瘤相关巨噬细胞表型及功能,而代谢重编程造成的免疫失衡被视为“脾虚”的生物学基础。肿瘤相关巨噬细胞代谢重编程是指湿热、痰浊、瘀毒等机体代谢物长期蓄留形成的癥瘕积聚,耗伤脏腑经络、气血阴阳,促进大肠癌进展。从脾论治大肠癌应益脾气、温脾阳、滋脾阴以补脾虚、运脾湿、理脾气、祛热毒以泻脾实,进而重编程机体能量代谢,以治其病变根本。Spleen is the source of Qi and blood production,and energy metabolism is closely related to the function of Spleen being responsible for nutrition transforming.Colorectal cancer is characterized by Spleen deficiency and loss of health as the root of the pathogenesis.Stasis and Toxin are the most important pathological factors of colorectal cancer,as they are generated based on Spleen deficiency.As a key organ to maintain the metabolic balance of the body,the lesions of colon cancer are closely related to metabolic disorder.In the process of colorectal cancer,many metabolic substances in tumor cells and tumor microenvironment are altered by metabolic reprogramming,which reconstructs the phenotype and function of tumor-associated macrophages,and the imbalance of immunity caused by metabolic reprogramming is regarded as the biological basis of"Spleen deficiency".Metabolic reprogramming of tumor-associated macrophages refers to the accumulation of mass in the abdomen caused by the long-term retention of metabolites such as Dampness-Heat,Phlegm and Turbidity,stasis,and Toxin,which depletes Qi,blood,Yin and Yang of the internal organs and meridians,and promotes the progression of colorectal cancer.To treat colorectal cancer from the perspective of Spleen,Spleen Qi should be benefited,Spleen Yang should be warmed and Spleen Yin should be nourished to relieve Spleen deficiency,Spleen Dampness should be transported and removed,Spleen Qi should be regulated,and Heat and Toxin should be eliminated to remove Spleen excess,and the energy metabolism of the body should be reprogrammed so as to treat the root of the lesions.

关 键 词：大肠癌 脾虚瘀毒 肿瘤相关巨噬细胞 代谢重编程 

分 类 号：R273[医药卫生—中西医结合]