正、反Warburg效应与肿瘤活血化瘀治疗

Removing blood stasis with the obverse and reverse Warburg effects in cancer

血瘀证是肿瘤主要病机之一,贯穿肿瘤发生、发展整个过程,活血化瘀用于肿瘤治疗也有2000多年的历史,然而,肿瘤活血化瘀的分子机理并没有明确,活血化瘀药是否会引起肿瘤转移也一直存在争议。过去根深蒂固的观念认为,肿瘤活血化瘀治疗主要是改善肿瘤高凝状态,进而减少转移发生。其实,这种观点并不能完全诠释肿瘤血瘀证与肿瘤发生、发展的本质关系,也不能解释活血化瘀治疗肿瘤的各种问题,诸如活血化瘀是抑制血管增生还是促进血管增生、某些活血化瘀药物是否会引起肿瘤转移等等。本文综述国内外关于肿瘤血瘀证和活血化瘀治疗的各种文献,从肿瘤细胞的核心代谢特征—正、反Warburg效应出发,分析肿瘤血瘀证产生的原因、可能涉及的信号传导通路,探讨肿瘤活血化瘀治疗的可能机制、分子基础,并提出合适的肿瘤活血化瘀治疗时间窗、肿瘤活血化瘀治疗主要原则和可行的疗效评价指标。本文有助于深化对肿瘤活血化瘀治疗的认识,也有助于厘清肿瘤活血化瘀治疗的各种争论。

Blood-stasis syndrome(BSS)was the main pathogenesis of cancer which runs through the whole process of carcinogenesis.Blood-activating and stasis-resolving(BASR)for cancer had a history of more than 2000 years;however,the molecular mechanism of BASR for cancer was still not clear,especially whether BASR can cause cancer metastasis was controversial.For a long time,it was deeply rooted in the idea that BASR was mainly to improve the high coagulation state,thus reducing the occurrence of metastasis.Actually,this view could not fully explain the intrinsic relationship between BSS and carcinogenesis,also could not clarify the controversies on BASR for cancer,such as BASR inhibiting or promoting blood vessels growth,BASR drugs causing or inhibiting cancer metastasis,and so on.This article reviewed literature on BSS and BASR in cancer patients,with beginning from the core of cancer cells metabolism characteristics-obverse and reverse Warburg effect,and analyzed the causes and the main signaling pathways of BSS,explored the possible mechanism of BASR.At the meanwhile,we also put forward the appropriate treatment time of BASR,the main principles and feasible evaluation index for cancer.This article would help to improve the understanding of the treatment of BASR for cancer,and also help clarify whether BASR can cause cancer metastasis.