中药治疗糖尿病微血管病变的研究进展

Chinese Medicine Treats Diabetic Microangiopathy:A Review

糖尿病及其并发症病是全世界关注的重大公共卫生问题。糖尿病微血管病变是糖尿病虚损夹血瘀形成的血管并发症,以微循环障碍并伴有透明样物质沉积为基本病理改变特征,糖尿病肾病、糖尿病视网膜病变和糖尿病神经病变最为常见。糖尿病微血管病变可追溯到糖尿病前期,随着糖尿病发生发展动态演进不断加重,需及早干预。临床在降糖、降脂、降压的基础治疗上,多选择抗氧化应激、抗炎、改善微循环和抗血管新生的药物治疗糖尿病微血管并发症。糖尿病微血管病变属于中医“络病”的概念,中药治疗糖尿病微血管病变的核心是在降糖的基础上保护“孙络-微血管”,组方多为补气滋阴、清热活血药味配伍而成。该文基于糖尿病微血管病变的中西医认识及治疗原则,简要概述针对不同证型治疗糖尿病微血管病变的常用方剂,如白虎加人参汤、玉液汤、四妙勇安汤、葛根芩连汤、六味地黄丸及一些现代制剂,同时概述方剂常用药味,如人参、黄芪、地黄、枸杞子、三七、丹参、金银花、葛根的研究进展,以期为中药治疗糖尿病微血管病变提供临床依据和理论指导。

Diabetes and its complications are major public health issues of worldwide concern.Diabetic microangiopathy is a vascular complication of diabetes caused by blood stasis and deficiency,characterized by impaired microcirculation with hyaline deposits.Diabetic nephropathy,diabetic retinopathy,and diabetic neuropathy are the most common types of diabetic microangiopathy,which can be traced back to the prediabetes period and is aggravated by the dynamic evolution of diabetes.Therefore,early intervention is required.Anti-oxidative,anti-inflammatory,and microcirculation-improving drugs should be chosen to treat diabetic microangiopathy based on hypoglycemic,lipid-lowering,and hypotensive treatment in clinical practice.Diabetic microangiopathy belongs to the theoretical concept of"collateral disease"in traditional Chinese medicine(TCM).The core of the treatment of diabetic microangiopathy with Chinese medicine is to protect"tertiary collateral vessels-microvascular",and Chinese medicines with Qi-replenishing,Yin-nourishing,heatclearing,and blood-activating effect are used for compatibility in Chinese medicine prescriptions.Based on the understanding and treatment principles of TCM and western medicine for diabetic microangiopathy,this review briefly summarized the research progress of commonly used prescriptions such as Renshen Baihutang,Yuye Tang,Simiao Yongantang,Gegen Qiliantang,Liuwei Dihuangwan,and modern Chinese medicine preparations for the treatment of diabetic microangiopathy.Moreover,the research progress of Chinese medicines including Ginseng Radix et Rhizoma,Astragali Radix,Rehmannia Radix,Lycii Fructus,Notoginseng Radix et Rhizoma,Salviea Miltiorrhizae Radix et Rhizoma,Lonicera Japonica Flos,and Puerariae Lobatae Radix were outlined.This review is expected to provide the clinical basis and theoretical guidance for the treatment of diabetic microangiopathy with Chinese medicine.