基于巨噬细胞极化探讨寒热并用法治疗溃疡性结肠炎的作用机制

Study on the Mechanism of Combination of Cold and Heat Method in the Treatment of Ulcerative Colitis Based on Macrophage Polarization

巨噬细胞作为机体重要的免疫细胞在溃疡性结肠炎中发挥关键作用。巨噬细胞极化是其根据周围环境转变不同表型的动态过程,一般分为两个表型:经典激活的M1型巨噬细胞和替代激活的M2型巨噬细胞。当巨噬细胞极化为M1型时,炎症反应启动,介导组织损伤;当巨噬细胞极化为M2型时,发挥抗炎、修复组织损伤作用。在一定条件下,二者状态可以相互转化,因此巨噬细胞不同的极化表型是炎症发展与转归的"风向标",而调节巨噬细胞极化状态无疑是治疗溃疡性结肠炎的重中之重。本虚标实、寒热错杂乃溃疡性结肠炎基本病机,故治疗上,当寒热同用、疏理气机、调和阴阳,代表方半夏泻心汤、乌梅丸。半夏泻心汤可能通过抑制巨噬细胞向M1型极化,从而减轻炎症反应;乌梅丸不仅可以减少M1型促炎巨噬细胞,同时增加M2型抗炎巨噬细胞的表达,恢复促炎/抗炎轴的平衡。通过中医寒热并用法调节巨噬细胞极化的动态平衡是治疗溃疡性结肠炎的一条可行之径。

As an important immune cell,macrophages play a key role in ulcerative colitis(UC).Macrophage polarization is a dynamic process of changing different phenotypes according to the surrounding environment.It can be divided into two phenotypes:classical activated M1 macrophage and alternative activated M2 macrophage.When macrophages polarize to M1 type,inflammation starts and mediates tissue damage;when macrophages polarize to M2 type,they play the role of anti-inflammatory and repair tissue damage.Under certain conditions,the two states can transform each other,so the different polarization phenotypes of macrophages are the"wind vane"of the development and outcome of inflammation,and regulating the polarization state of macrophages is undoubtedly the top priority in the treatment of UC.The basic pathogenesis of UC is deficiency in origin and excess in superficiality,mixed cold and heat.Therefore,in the treatment of UC,it is necessary to treat cold and heat together,regulate qi and regulate yin and yang,and Banxia Xiexin Decoction and Wumei Pill can be used.Banxia Xiexin Decoction may reduce the inflammatory reaction by inhibiting macrophage polarization to M1 type;Wumei Pill can not only reduce M1 pro-inflammatory macrophages,but also increase the expression of M2 anti-inflammatory macrophages,and restore the balance of pro-inflammatory/anti-inflammatory axis.It is a feasible way to treat UC by regulating the dynamic balance of macrophage polarization through the combination of cold and heat method in Chinese medicine.