基于中西医结合的血管性痴呆发病机制及治疗的研究进展

Pathogenesis and Treatment of Vascular Dementia Based on Integrated Traditional Chinese and Western Medicine:A Review

血管性痴呆(VaD)是影响老年人健康的常见疾病,由于社会人口老龄化逐渐加重,VaD的发病率也在逐年上升,而对于此疾病一直没有官方批准的治疗药物,主要是因为其发病机制复杂、有效药物治疗的作用机制尚未明确阻碍了治疗VaD的药物研究。因此,文章通过查阅与VaD相关的国内外文献,从中医学和西医学2个层面梳理VaD的发病机制,总结得出中医学均围绕脾肾亏虚为虚,痰瘀互结为实这一体系,而西医学认为VaD的发病机制主要为炎症反应、氧化应激、相关蛋白的异常表达和信号通路的功能障碍等。在此基础上,文章也总结了近年来常用单味中药及中药复方、西药及中西药联合治疗VaD的作用机制研究,常用的单味中药银杏叶及中药复方地黄饮子等具有多成分、多靶点及不良反应少的治疗优势,常用西药多奈哌齐、美金刚等具有靶点明确、见效快的特点,中西药联合效果更佳。文章通过对VaD发病机制及治疗的研究梳理和总结,旨在将VaD发病机制与有效药物治疗的作用机制联系起来,为今后治疗VaD的药物研发提供重要参考。

Vascular dementia(VaD)is a common disease that affects the health of the elderly.Due to the aging of the social population,the incidence of VaD is increasing year by year.There have been no officially approved treatments for this disease,mainly because its pathogenesis is complex,and the mechanism of action of effective drugs is not yet clear,which hinders drug research for the treatment of VaD.Therefore,by reviewing the available literature related to VaD,this study sorted out the pathogenesis of VaD from traditional Chinese medicine(TCM)and western medicine,and concluded that in TCM,VaD was characterized by the deficiency of the spleen and kidney(deficiency)and combination of phlegm and blood stasis(excess),while in western medicine,the pathogenesis of VaD is mainly inflammatory response,oxidative stress,abnormal expression of related proteins,and dysfunction of signaling pathways.On this basis,this study also summarized the research on the mechanism of action of commonly used single Chinese herbal medicine and Chinese herbal medicine compound,western medicine,and the combination of Chinese herbal medicine and western medicine in the treatment of VaD in recent years.The commonly used single Chinese herbal medicine Ginkgo Folium and Chinese herbal medicine compound Dihuang Yinzi have the multi-component and multi-target characteristics and few adverse reactions in the treatment of VaD,while the commonly used western medicines such as donepezil and memantine have the characteristics of the clear target and quick onset.The combination of Chinese herbal medicine and western medicines can achieve a better effect.This study summarized the research on the pathogenesis and treatment of VaD,aiming to link the pathogenesis of VaD with the mechanism of effective drug therapy,and provide an important reference for future drug development for the treatment of VaD.