基于血浊理论探讨内皮细胞损伤在糖尿病微血管病变中的作用机制

Explore the mechanism of endothelial cell injury in diabetic microangiopathy based on the theory of“turbid blood”

血浊理论作为现代中医学理论,是指血液在各种因素作用下,失去清纯状态,转变为混乱、浊化、失序的病理现象。血浊作为病理产物的同时,又可以作为诸多疾病的继发性致病因素。微血管病变是糖尿病常见的并发症之一,主要包括肾脏病变及视网膜病变。内皮细胞是血浆与血管壁之间的一层特殊扁平上皮细胞,具有完成血浆与组织液代谢交换、合成和分泌生物活性物质、维持血管张力等功能。糖尿病诱导的内皮细胞损伤与功能障碍是导致微血管病变的关键病理因素,这与血浊的特性高度契合。血浊既是导致内皮细胞损伤的致病因素,内皮细胞持续损伤亦是血浊继而为病的病理基础。本文首先阐释了血浊理论的源流,强调了血浊的中医学属性特点;然后,介绍了血浊与内皮细胞损伤的密切联系,并认为血浊与内皮细胞损伤是导致糖尿病微血管病变的核心病机。最后,基于血浊理论,结合糖尿病微血管病变的疾病特点,归纳出该病阴虚燥热、血浊内生、络脉瘀痹的病机演变特点,并提出以养阴护脉、清化血浊、通瘀畅络为治法,延缓糖尿病微血管病变的进程,从而改善患者的临床症状。

“Turbid blood”theory as a new theory of traditional Chinese medicine(TCM),refers to the pathological phenomenon that blood loses its pure state and becomes chaotic,turbid and dysfunctional under the action of various factors.As a pathological product,turbid blood can also be a secondary pathogenic factor of many diseases.Microangiopathy is one of the common complications of diabetes,along with kidney disease and retinopathy.Endothelial cells are a layer of special flat cells between plasma and the blood vessel wall.They have many functions,such as metabolic exchange between plasma and the tissue fluid,synthesis and secretion of bioactive substances,and maintenance of vascular tension.Endothelial cell injury and dysfunction induced by diabetes are the key pathological factors leading to microangiopathy,which is highly consistent with the characteristics of turbid blood.Turbid blood is the cause of endothelial cell damage,and the sustained injury of endothelial cells is the pathological basis of turbid blood followed by disease.In this article,we explain the origin of the theory of turbid blood,emphasize that turbid blood belongs to the theory of TCM,and introduce the close relationship between turbid blood and endothelial cell injury.This article is based on the belief that turbid blood and endothelial cell injury are the core pathogenesis leading to diabetic microangiopathy.Moreover,based on the theory of turbid blood and combined with the disease characteristics of diabetic microangiopathy,the pathogenic evolution characteristics of the disease are summarized as yin deficiency leading to dryness-heat,endogenous turbid blood,and collateral stasis obstruction,and the proposed treatment is based on nourishing yin and protecting vessels,clearing turbid blood,and dredging blood stasis to delay the process of diabetic microangiopathy,thereby improving the clinical symptoms of patients.