关于肥胖的中医药代谢组学研究进展

A review on the metabonomics of traditional Chinese medicine on obesity

目前国内外代谢组学研究发现与肥胖相关的主要代谢通路有脂代谢、氨基酸代谢、糖代谢、磷脂类代谢及肠道菌群代谢等,包括中药内服及外治疗法在内的中医治疗方法在治疗肥胖疾病方面具有其独特的优势,采用磁共振氢谱法、气相色谱-质谱联合法和超高效液相色谱/串联质谱法等代谢组学技术,对血清、血浆、尿液、粪便和器官组织等样本进行相关代谢组学分析,能够更为系统全面地揭示肥胖中痰湿证、脾气虚证、脾虚痰湿证、脾肾阳虚证和脾肾气虚证等5种不同的中医证型中主要的代谢标志物及代谢途径的差异,探究葛根芩连汤、益糖康、贞术调脂方、五苓散、苓桂术甘汤、半夏白术天麻汤和祛湿化瘀汤等7种中药复方以及藿香、苦瓜、苦地丁、茯苓、黄连、黄芪、西洋参和灵芝等8种单味中药或中药提取物和针灸中医外治疗法治疗肥胖的作用通路与起效机制,发现肥胖的中医证型不同,其影响的代谢通路有明显的区别,不论中药内服还是外治等中医治疗方法对于肥胖代谢产物的浓度调节均具有显著疗效,而且中医治疗方法不同作用的通路也有所差异,在通路中起效的代谢标志物也各有千秋。故运用代谢组学技术可为中医诊断不同证型的肥胖及采取有针对性的治疗手段提供合理依据。

At present,domestic and foreign metabolomics studies have found that the main metabolic pathways related to obesity include lipid metabolism,amino acid metabolism,glucose metabolism,phospholipid metabolism and intestinal flora metabolism,etc.TCM treatment methods,including internal and external TCM treatment,have unique advantages in the treatment of obesity.The metabolomics of serum,plasma,urine,feces and organ tissues were analyzed by 1H NMR,GC/MS and UPLC-MS/MS,respectively.It can more systematically and comprehensively reveal the differences of main metabolic markers and metabolic pathways in 5 different TCM syndrome types of obesity,such as phlegm-dampness syndrome,spleen Qi(气)deficiency syndrome,spleen deficiency phlegmdampness syndrome,spleen and kidney Yang(阳)deficiency syndrome and spleen and kidney Qi deficiency syndrome.This paper explores the action pathway and mechanism of acupuncture and moxibustion external treatment of obesity with 7 kinds of traditional Chinese medicine compounds,such as Geren Qinlian decoction(葛根芩连汤),Yitangkang(益糖康),Zhenzhu Tiaozhi decoction(贞术调脂方),Wuling San(五苓散),Linggui Zhugan decoction(苓桂术甘汤),Banxia Baizhu Tianma decoction(半夏白术天麻汤)and Qushi Huayu decoction(祛湿化瘀汤),as well as 8 kinds of single TCM medicine or TCM medicine extracts,such as Huoxiang(patchouli),Kugua(Momordica charantia),Kudiaing(Corydalis bungeana),Fuling(Poria),Huanglian(Coptis chinensis),Huangqi(Astragalus membranaceus),Xiyangshen(American ginseng)and Linzhi(Ganoderma lucidum).It is found that there are significant differences in the metabolic pathways affected by different TCM syndrome types of obesity.Both internal and external TCM treatment methods have significant effects on the concentration regulation of obesity metabolites,and the pathways of different TCM treatment methods are also different,and the effective metabolic markers in the pathways are also different.Therefore,the application of metabonomics technology can provide a reasonable basis for TCM diagnosis of different syndrome types of obesity and targeted treatment.