多脏器纤维化的络病机制探讨

Research on Multiorganic Fibrosis Based on the Mechanism of Meridian-Collateral Disease

中医络病的病理机制中血行不畅、络脉失养、气血瘀滞、津凝痰结、络毒蕴结等病理变化涉及了血管活性物质调控异常、血管内皮细胞、血管平滑肌细胞的损伤机制、细胞外基质 (ECM)代谢异常、细胞因子及信号传导通路调控异常等生物学内容。津凝标志着正常分布的ECM的积聚增多 ,痰结则代表了ECM的异常分布。细胞、组织形态学的不可逆转的变化是络毒蕴结积聚的结果 ,也是络病发展的晚期阶段。因此 ,纤维化的发展在中医中应属络病的范畴。若发生肺纤维化 ,则属肺络病 ;肝纤维化 ,则属肝络病 ;肾脏纤维化 ,则属肾络病。从“络病”角度进一步寻求中医药防治多脏器纤维化的特异性规律 ,对指导基础研究与临床治疗有重要意义。

The pathologic changes related to the pathogenesis of TCM meridian-collateral disease, such as obstructed blood circulation, malnourished meridian-collaterals, qi and blood stagnation, aggregation of body fluid (TCM) and retention of phlegm (TCM), and toxin accumulation in meridian-collaterals, involve many biological facts, for example, abnormal regulation and control of vasoactive substances, mechanisms for injuries of vasoendothelial cells and vascular smooth muscle cells, ECM malmetabolism, and abnormal regulation and control of cytokines and signal transduction pathway. Aggregation of body fluid denotes an increase in normally-distributed ECM, and retention of phlegm denotes the abnormal distribution of ECM. The irreversible cytomorphological and histomorphological changes are the results of toxin accumulation in meridian-collaterals, which manifest at the late stage of meridian-collateral disease. Therefore, the development of visceral fibrosis can be related with meridian-collateral disease. For example, pulmonary fibrosis can be related with pulmonary meridian-collateral disease; hepatic fibrosis, hepatic meridian-collateral disease; renal fibrosis, renal meridian-collateral disease. The diagnosis and treatment of meridian-collateral diseases can be based on to find a way for preventing and treating multiorganic fibrosis by TCM.