基于脾主运化理论探讨肠道菌群失调与心力衰竭的相关性

The correlation between intestinal flora imbalance and heart failure based on spleen governing transportation and transformation theory

中医学中的脾并不是单纯的现代解剖学中的脾脏,而是附加了消化和免疫等多种人体生理功能的脏器。中医理论认为脾有运化、统血、升清功能,脾主运化是其核心,是整个饮食物代谢以及营养吸收过程的中心环节,其生理功能与机体消化吸收、能量供应、水液代谢等过程密切相关,包含小肠泌别清浊和大肠传导的功能;现代解剖学脾脏是人体最大的淋巴器官,有储血、造血、清除衰老红细胞和免疫应答的功能,两者具有相关联的部分。在人体的胃肠道里共存着数量庞大的微生物群,这些微生物群中绝大部分参与了脾、胃、大肠、小肠等的生理活动。文章从中西医结合的角度阐述了脾主运化、肠道菌群与心力衰竭三者的关系,脾失健运会引起肠道微生物组群的改变,是引起心力衰竭发生的重要因素。西医多靶点的治疗方式与中医辨证论治的特点不谋而合,依据心力衰竭证型辨证施治,用中西医结合的方式,发挥中医药多靶点、辨证论治及未病先防的优势。脾主运化的正常与否和肠道菌群微生物稳态有着密切的关系。近些年来随着学界对肠道菌群研究的不断深入,研究发现肠道菌群失调会引起心力衰竭患者体内代谢物的变化,以肠道微生物稳态作为治疗心力衰竭的新切入点是医学研究的热点。

The spleen in traditional Chinese medicine is not simply the spleen in modern anatomy,but an organ with multiple physiological functions such as digestion and immunity.TCM theory holds that the spleen has the functions of transportation,blood distribution and ascending,and the spleen is the central link of the whole diet metabolism and nutrition absorption.Its physiological function is closely related to the processes of digestion and absorption,energy supply,water and liquid metabolism,including the functions of small intestine clearing and large intestine conduction.According to modern anatomy,the spleen is the largest lymphatic organ in the human body,which has the functions of blood storage,hematopoiesis,removal of aging red blood cells and immune response,the two are correlated.A large number of microbiomes coexist in the gastrointestinal tract of human body,and most of these microbiomes participate in the physiological activities of the spleen,stomach,large intestine,small intestine and so on.The paper expounds the relationship between spleen governing transportation and transformation,intestinal flora and heart failure from the perspective of the integrative medicine.The loss of spleen governing transportation and transformation will affect other viscera and tissue lesions and lead to the occurrence of chronic heart failure.The multi-target treatment of Western medicine coincides with the characteristics of syndrome differentiation and treatment of traditional Chinese medicine.According to the syndrome differentiation and treatment of heart failure,the combination of TCM and Western medicine gives full play to the advantages of multi-target,syndrome differentiation and prevention before disease.The normal functioning of spleen governing transportation and transformation is closely related to the homeostasis of intestinal flora.In recent years,in-depth studies on intestinal flora have found that the imbalance of intestinal flora can cause changes in metabolites in patients with heart failure.Taking intestinal microbial homeostasis as a new entry point for the treatment of heart failure has become a hot topic in medical research.