基于调节肠道菌群探讨清热类方治疗糖尿病的研究进展

Research Progress on Heat-clearing Chinese Herbal Compounds Against Diabetes Based on Regulating Intestinal Flora

糖尿病已成为全球增长最快的公共卫生问题之一,其病理机制复杂,受多重因素影响。人体肠道内有数百万亿的微生物,大致分为益生菌、中性菌、致病菌三类,处于动态平衡,构成复杂的肠道微生态系统,肠道微生态系统的平衡和稳态对维持机体内环境稳定、维系人体健康至关重要。随着高通量测序技术的快速发展,肠道菌群分布不平衡已被证实是促进胰岛素抵抗(IR)进展的重要原因,增加糖尿病的发生风险。近年来,对肠道菌群的调控成为防治糖尿病及其并发症的新途径、新靶点。中医药对糖尿病、肥胖症等代谢性疾病的治疗由来已久,独具特色与优势,但其尚不明确的作用机制限制了中药的现代化、产业化。肠道菌群与宿主之间的和谐共生与中医理论"人与自然和谐统一"相一致,中医药对肠道微生物群的影响逐渐成为当今医学研究的热门领域。有研究认为糖尿病起源于"肠道内热",目前已有一些相关的实验研究和临床研究的文献表明部分清热类方对失衡的肠道菌群具有一定调节作用,为此探讨肠道菌群与糖尿病的关联性,分析清热类方(大柴胡汤、葛根芩连汤、黄连解毒汤、乌梅丸)通过调节肠道菌群防治糖尿病热证的作用机制,以期为治疗糖尿病药物的进一步开发提供新的理论依据和研究线索。

Diabetes has become one of the fastest growing public health issues in the world. Its pathological mechanism is complex and affected by multiple factors. There are trillions of microbes in the human intestine,which are roughly divided into three types:probiotics,neutral bacteria,and pathogenic bacteria. They are in a dynamic balance and constitute a complex intestinal micro-ecosystem. The balance and homeostasis of the intestinal micro-ecosystem are essential to maintain the stability of the body’s environment and human health.With the rapid development of high-throughput sequencing technology,imbalanced intestinal flora distribution has been proven to be an important factor in promoting the development of insulin resistance(IR),thus increasing the risk of diabetes. In recent years,the regulation of intestinal flora has become a new approach and new target for the prevention and treatment of diabetes and its complications. The application of traditional Chinese medicine(TCM)in treatment of metabolic diseases such as diabetes and obesity has a long history.TCM has its unique characteristics and advantages,however,the unclear mechanism of action has limited its modernization and industrialization. The harmonious symbiosis between the intestinal flora and the host is consistent with the TCM theory of "harmony between human and nature". The effect of TCM on the intestinal microflora has gradually become a hot topic in medical research today. One study believes that diabetes originates from "intestinal fever". At present,some relevant experimental researches and clinical research literatures have shown that some heat-clearing Chinese herbal compounds have a certain regulating effect on imbalanced intestinal flora. Therefore, the relationship between intestinal flora and diabetes was explored, and the mechanism of heat-clearing Chinese herbal compounds(Da Chaihutang, Gegen Qinliantang, Huanglian Jiedutang,and Wumeiwan)in preventing and treating heat syndrome of diabetes through regulation of intestinal flora was analyzed,in order to provide new theoretical basis and research clues for the further development of drugs for treating diabetes.