1.天津市第一中心医院,天津市南开区康复路24号,300190
2.天津中医药大学
3.天津中医药大学第一附属医院
tjzhtcm@163.com
收稿:2021-10-14,
修回:2022-04-09,
纸质出版:2022-08-17
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陈馨浓,葛其卉,赵一璇等.从“脉中积”认识动脉粥样硬化[J].中医杂志,2022,63(16):1532-1537.
CHEN Xinnong,GE Qihui,ZHAO Yixuan,et al.Understanding Atherosclerosis from “Accumulation in Vessel”[J].Journal of Traditional Chinese Medicine,2022,63(16):1532-1537.
陈馨浓,葛其卉,赵一璇等.从“脉中积”认识动脉粥样硬化[J].中医杂志,2022,63(16):1532-1537. DOI: 10.13288/j.11-2166/r.2022.16.007.
CHEN Xinnong,GE Qihui,ZHAO Yixuan,et al.Understanding Atherosclerosis from “Accumulation in Vessel”[J].Journal of Traditional Chinese Medicine,2022,63(16):1532-1537. DOI: 10.13288/j.11-2166/r.2022.16.007.
动脉粥样硬化与中医积病在病理形态和发生机制上具有一定的相似性,“脉中积”即痰浊、瘀血和毒邪等有形之物凝滞脉中。从斑块微环境角度阐释“脉中积”的生物学内涵和病理演变规律。认为AS发病初期为脾肾亏虚、血浊脉弱,中期为脉道失柔、脉络绌急,后期为脉络骤闭、脏腑受损。以缺血性心脏病为例,根据其不同阶段病机特点,斑块形成早期治以化痰降浊、养血护脉,斑块易损期治以活血解毒、畅脉稳斑,心脏恢复期治以温经通络、保脉育心。
Atherosclerosis (AS) is similar to the traditional Chinese medicine (TCM) accumulation disease in pathological form and mechanism. The “accumulation in vessel” refers to the congealing and constraint of the tangibles such as phlegm-turbid, blood stasis, and pathogenic toxin in the vessels. This paper explained the biological connotation and pathological evolution law of “accumulation in vessel” from the perspective of plaque microenvironment, and discussed the pathogenesis at different stages of AS. It is believed that at the early stage of AS, the pathogenesis is mainly spleen-kidney depletion, internal generation of phlegm-turbidity, and insufficiency of vessel
qi
, which can be treated by dissolving phlegm and direct turbidity downward, regulate
qi
and harmonize blood. At the middle stage, it is mainly manifested as binding of phlegm and stasis, unsoftened vessels, and urgent vessel collaterals, and the method of invigorating blood and resolving toxins, unblocking vessels and stabilizing plagues is advised. At the late stage, it is characterized by obstruction of stasis and toxins, sudden blocking of vessel collaterals, and damaged
zang
-
fu
(脏腑) organs, and the treatment method is warming channels and unblocking collaterals, protecting vessels and caring the heart.
LIBBY P , RIDKER PM , HANSSON GK . Progress and challenges in translating the biology of atherosclerosis [J]. Nature , 2011 , 473 ( 7347 ): 317 - 325 .
ZHOU M , WANG H , ZENG X , et al . Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the global burden of di-sease study 2017 [J]. Lancet , 2019 , 394 ( 10204 ): 1145 - 1158 .
方子寒 , 张琴 , 谢盈彧 , 等 . 阮士怡从“脉中积”理论治疗冠心病冠状动脉粥样硬化经验 [J]. 中医杂志 , 2018 , 59 ( 21 ): 1812 - 1814,1823 .
李丽恩 . 益气养血、破瘀消积治疗胸痹心痛的临床研究 [D]. 济南 : 山东中医药大学 , 2012 .
周欢 , 张军平 , 王晓景 , 等 . 基于血管稳态的动脉粥样硬化病-证-时分期防治思路 [J]. 中医杂志 , 2018 , 59 ( 15 ): 1284 - 1287 .
陈燕 , 符宇 , 韩景辉 , 等 . 基于“积聚”“癥瘕”视角探讨糖尿病大血管病变中医防治策略 [J]. 光明中医 , 2017 , 32 ( 9 ): 1221 - 1223 .
高铸烨 , 徐浩 . 从痰瘀毒辨析冠心病 [C]//中华中医药学会,中华中医药学会血栓病分会成立大会暨首届血栓病学术研讨会论文集. 北京 : 中华中医药学会 , 2007 : 165 - 169 .
杨怡玲 , 杨志蓉 , 杨爱国 , 等 . 动脉粥样硬化与痰证之相关性研究 [J]. 中医药导报 , 2007 , 13 ( 3 ): 15 - 17 .
ROSS R , HARKER L . Hyperlipidemia and atherosclerosis [J]. Science , 1976 , 193 ( 4258 ): 1094 - 1100 .
YASUNARI K , KOHNO M , KANO H , et al . Mechanisms of action of troglitazone in the prevention of high glucose-induced migration and proliferation of cultured coronary smooth muscle cells [J]. Circ Res , 1997 , 81 ( 6 ): 953 - 962 .
LORENZI M , CAGLIERO E , TOLEDO S . Glucose toxicity for human endothelial cells in culture. Delayed replication, disturbed cell cycle, and accelerated death [J]. Diabetes , 1985 , 34 ( 7 ): 621 - 627 .
姜明 , 雷燕 , 修成奎 , 等 . 从中医虚、浊、瘀角度认识血管老化 [J]. 环球中医药 , 2017 , 10 ( 5 ): 596 - 599 .
王新陆 , 王栋先 . 血浊的生化基础以及与其他病理因素的关系 [J]. 天津中医药 , 2021 , 38 ( 1 ): 1 - 6 .
MCCULLY KS . Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis [J]. Am J Pathol , 1969 , 56 ( 1 ): 111 - 128 .
ZHAO J , CHEN H , LIU N , et al . Role of hyperhomocysteinemia and hyperuricemia in pathogenesis of atherosclerosis [J]. J Stroke Cerebrovasc Dis , 2017 , 26 ( 12 ): 2695 - 2699 .
MUTLUAY R , DEGER SM , BAHADIR E , et al . Uric acid is an important predictor for hypertensive early atherosclerosis [J]. Adv Ther , 2012 , 29 ( 3 ): 276 - 286 .
贾连群 , 张妮 , 宋囡 , 等 . 从“脉道不利”探讨冠心病“痰浊血瘀”的现代生物学基础 [J]. 遵义医学院学报 , 2015 , 38 ( 4 ): 337 - 340 .
COENEN DM , MASTENBROEK TG , COSEMANS JMEM . Platelet interaction with activated endothelium: mechanistic insights from microfluidics [J]. Blood , 2017 , 130 ( 26 ): 2819 - 2828 .
付玉娜 . 冠状动脉粥样硬化性心脏病瘀毒理论探讨 [J]. 中医临床研究 , 2020 , 12 ( 25 ): 48 - 50 .
王小玲 , 张军平 , 许颖智 . 论毒邪理论在心系疾病中的运用 [J]. 中华中医药杂志 , 2012 , 27 ( 8 ): 2090 - 2093 .
雷雅伦 , 杨化冰 , 刘洪涛 . 动脉粥样硬化内生热毒病机及清热解毒法运用探讨 [J]. 湖北中医药大学学报 , 2020 , 22 ( 4 ): 48 - 51 .
张风 , 郑刚 , 齐婧 , 等 . 动脉粥样硬化相关的炎性信号通路的研究进展 [J]. 实用临床医药杂志 , 2022 , 26 ( 10 ): 144 - 148 .
LIBBY P , LOSCALZO J , RIDKER PM , et al . Inflammation, immunity, and infection in atherothrombosis: JACC review topic of the week [J]. J Am Coll Cardiol , 2018 , 72 ( 17 ): 2071 - 2081 .
NAGHAVI M , WYDE P , LITOVSKY S , et al . Influenza infection exerts prominent inflammatory and thrombotic effects on the atherosclerotic plaques of apolipoprotein E-deficient mice [J]. Circulation , 2003 , 107 ( 5 ): 762 - 768 .
ANDERSON JL , MUHLESTEIN JB , CARLQUIST J , et al . Randomized secondary prevention trial of azithromycin in patients with coronary artery disease and serological evidence for Chlamydia pneumoniae infection: The Azithromycin in Coronary Artery Disease: Elimination of Myocardial Infection with Chlamydia (ACADEMIC) study [J]. Circulation , 1999 , 99 ( 12 ): 1540 - 1547 .
POST WS , BUDOFF M , KINGSLEY L , et al . Associations between HIV infection and subclinical coronary atherosclerosis [J]. Ann Intern Med , 2014 , 160 ( 7 ): 458 - 467 .
ROHATGI A , KHERA A , BERRY JD , et al . HDL cholesterol efflux capacity and incident cardiovascular events [J]. N Engl J Med , 2014 , 371 ( 25 ): 2383 - 2393 .
RAJAVASHISTH TB , ANDALIBI A , TERRITO MC , et al . Induction of endothelial cell expression of granulocyte and macrophage colony-stimulating factors by modified low-density lipoproteins [J]. Nature , 1990 , 344 ( 6263 ): 254 - 257 .
GOLDFINE AB , BECKMAN JA , BETENSKY RA , et al . Family history of diabetes is a major determinant of endothelial function [J]. J Am Coll Cardiol , 2006 , 47 ( 12 ): 2456 - 2461 .
LIBBY P , BURING JE , BADIMON L , et al . Atherosclerosis [J]. Nat Rev Dis Primers , 2019 , 5 ( 1 ): 56 .
BACK M , YURDAGUL JR A , TABAS I , et al . Inflammation and its resolution in atherosclerosis: mediators and therapeutic opportunities [J]. Nat Rev Cardiol , 2019 , 16 ( 7 ): 389 - 406 .
BELL L , MADRI JA . Effect of platelet factors on migration of cultured bovine aortic endothelial and smooth muscle cells [J]. Circ Res , 1989 , 65 ( 4 ): 1057 - 1065 .
PAN J , CAI Y , LIU M , et al . Role of vascular smooth muscle cell phenotypic switching in plaque progression: a hybrid modeling study [J]. J Theor Biol , 2021 , 526 : 110794 . doi: 10.1016/j.jtbi.2021.110794 http://dx.doi.org/10.1016/j.jtbi.2021.110794 .
KOELWYN GJ , CORR EM , ERBAY E , et al . Regulation of macrophage immunometabolism in atherosclerosis [J]. Nat Immunol , 2018 , 19 ( 6 ): 526 - 537 .
FONG GH . Potential contributions of intimal and plaque hypoxia to atherosclerosis [J]. Curr Atheroscler Rep , 2015 , 17 ( 6 ): 510 .
THONDAPU V , BOURANTAS CV , FOIN N , et al . Biomechanical stress in coronary atherosclerosis: emerging insights from computational modelling [J]. Eur Heart J , 2017 , 38 ( 2 ): 81 - 92 .
GALIS ZS , MUSZYNSKI M , SUKHOVA GK , et al . Enhanced expression of vascular matrix metalloproteina-ses induced in vitro by cytokines and in regions of human atherosclerotic lesions [J]. Ann N Y Acad Sci , 1995 , 748 : 501 - 507 . doi: 10.1111/j.1749-6632.1994.tb17348.x http://dx.doi.org/10.1111/j.1749-6632.1994.tb17348.x .
BUTOI E , GAN AM , TUCUREANU MM , et al . Cross-talk between macrophages and smooth muscle cells impairs collagen and metalloprotease synthesis and promotes angiogenesis [J]. Biochim Biophys Acta , 2016 , 1863 ( 7 Pt A ): 1568 - 1578 .
MARTINOD K , WAGNER DD . Thrombosis: tangled up in NETs [J]. Blood , 2014 , 123 ( 18 ): 2768 - 2776 .
HATAKEYAMA K , ASADA Y , MARUTSUKA K , et al . Localization and activity of tissue factor in human aortic atherosclerotic lesions [J]. Atherosclerosis , 1997 , 133 ( 2 ): 213 - 219 .
杨颖溪 , 刘琪 , 周欢 , 等 . 斑块微环境与中医阴阳学说的关系 [J]. 中医杂志 , 2020 , 61 ( 10 ): 862 - 865 .
王生万 , 胡镜清 , 江丽杰 , 等 . 痰瘀互结形成的可能相关分子生物学机制探究 [J]. 世界科学技术-中医药现代化 , 2016 , 18 ( 5 ): 805 - 812 .
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