中药防治糖尿病认知功能障碍的实验研究进展

Experimental Research Progress on Prevention and Treatment of Cognitive Dysfunction in Diabetes Mellitusby Traditional Chinese Medicine

糖尿病认知功能障碍是糖尿病的并发症之一,其临床表现为记忆能力减退,学习能力下降,语言表达、理解能力下降,注意力不集中等。现代医学认为其发病机制复杂,与糖代谢异常,脂代谢异常,胰岛素抵抗,Tau蛋白异常磷酸化,炎症反应,氧化应激,胆碱能系统损伤,神经元细胞凋亡等多种因素有关,且是多因素共同作用的结果。虽然二甲双胍、格列苯脲等传统降糖药也具有一定控制糖尿病认知损伤的作用,但目前尚无有针对性的有效药物上市,从而导致该疾病给家庭和社会造成沉重负担。中医认为糖尿病认知功能障碍的基本病机为本虚标实,虚以肾精亏虚、髓海不足、阴虚燥热为主,痰浊阻窍、瘀阻脑络为其标,治疗多以补肾填精、益气养阴、活血化瘀、化痰开窍为治疗大法。近年来,有关中药防治糖尿病认知功能障碍的研究成果大量涌现,中医学者针对该病做了大量的基础和临床研究,发现中药可通过降血糖、促进细胞内胆固醇排出、改善胰岛素抵抗、抑制Tau蛋白过度磷酸化、抑制炎症反应、抗氧化应激、改善胆碱能神经功能、抑制神经元细胞凋亡等多个作用机制改善认知功能障碍,延缓其发展。文章从中药有效成分及其提取物、中药方剂防治糖尿病认知功能障碍的实验研究进行综述,揭示中药的作用靶点和机制,以期为临床上防治该病提供充分的科学依据。

Cognitive dysfunction of diabetes mellitus is one of the complications of diabetes mellitus. Its clinical manifestations include decreased memory ability,learning ability,language expression and comprehension ability,and inattention. The pathogenesis is complex,which is related to various factors such as abnormal glucose metabolism,abnormal lipid metabolism,insulin resistance,abnormal phosphorylation of Tau protein,inflammatory reaction,oxidative stress, cholinergic system injury, neuronal cell apoptosis, et al. Although traditional hypoglycemic drugs such as metformin and glibenclamide have a little effect in controlling diabetic cognitive impairment,but there has no effective drugs for this disease which causes a heavy burden on families and society.The concepts of holism and preventing disease of traditional Chinese medicine( TCM) have obvious advantages in delaying the occurrence and development the complications. TCM believes that the basic pathogenesis of diabetic cognitive dysfunction is based on deficiency complicated with excess. The therapeutic principles includes tonifying the kidney essence,reinforcing Qi and nourishing Yin,dissipating phlegm for resuscitation,and promoting blood circulation to remove blood stasis. In recent years,there have been a lot of research achievements on the prevention and treatment of cognitive dysfunction in diabetes mellitus with TCM. Researchers of TCM do abundant researches,and find that TCM can improve cognitive dysfunction by lowering blood glucose,promoting intracellular cholesterol excretion,improving insulin resistance,lowering p-Tau,anti-oxidative stress,inhibiting inflammatory reactions,improving the function of cholinergic nerve,inhibiting neuronal apoptosis. The article reviews the experimental research on the prevention and treatment of cognitive dysfunction of diabetes mellitus by TCM and its extracts and reveals the target and mechanism,in order to provide sufficient scientific basis for TCM to prevent cognitive dysfunction of diabetes mellitus.