基于“浊”与氧化三甲胺相关性探讨动脉粥样硬化之病机

Discussion on pathogenesis of atherosclerosis based on the correlation between‘turbidity’and trimethylamine N-oxide

动脉粥样硬化(AS)作为脂质驱动的慢性炎症反应,其发病与人们饮食模式的改变有关。浊邪是现代中医病因病机学的一次创新,具有隐匿性、暗耗性、杂合性、易阻性、多变性、缠绵性,切合AS的病理特点。目前从“正虚浊伏”入手,治疗AS取得有效进展,但对浊邪的认识还相对抽象,未落实到具象靶位。近年来,肠道菌群代谢产物氧化三甲胺(TMAO)的探讨,深化了“正虚浊伏”和AS的具象联系,发现TMAO处在水谷精微代谢途径,TMAO致病特点与浊邪具有一定的相关性,中医药“给浊邪以出路”和“扶正助其驱浊”的治浊方式对TMAO诱导的AS起着抑制作用。以TMAO为靶点,可能为从浊论治AS提供新的视角。

Atherosclerosis(AS) is a chronic lipid-driven inflammatory response associated with changes in people’s dietary patterns. Turbidity is an innovation of modern etiology and pathogenesis of traditional Chinese medicine(TCM), having the characteristics of concealment, undermining, hybridity, retardation, variability and entanglement, which also consist with AS. Though effective progresses have been made in the treatment of AS from ‘vital qi deficiency with insidious turbidity’, the understanding on its connotation remains abstract. Recently, trimethylamine N-oxide(TMAO), a metabolite of intestinal flora, deepened this concrete relationship. TMAO was found in the pathway of cereal essence’s metabolism, and the pathogenic characteristics of TMAO had a certain correlation with turbidity. The turbidity control methods of ‘give turbidity a way out’ and ‘nourish vitality to drive turbidity away’ play an inhibition role in the AS with elevated TMAO. TMAO as a target might provide a new perspective for the treatment of AS from controlling turbidity.