下丘脑神经内分泌调控网络失衡引发女性生殖内分泌紊乱中西医结合辨析

Imbalance of Hypothalamic Neuroendocrine Regulatory Network Leading to Female Reproductive Endocrine Disorders:Integrative Analysis of Traditional Chinese and Western Medicine

女性生命周期中各时段的生殖内分泌变化均体现着中枢与外周间微观分子协同作用共达平衡状态的动态演化特征。位于下丘脑的神经-生殖内分泌调控网络,对性激素诱导的特定核区兴奋/抑制性神经递质合成分泌失衡,造成促性腺激素释放激素分泌失常,是引发女性早期生殖衰老或多囊卵巢综合征(PCOS)黄体生成素超常分泌,继而引起生育力下降的关键;该过程涉及多因素调控的不同分子功能失常,与中医学“阴阳消长失衡”的观点契合。以生殖衰老和PCOS为典型代表的女性生殖内分泌紊乱,中医辨证为脾肾亏虚,现代研究发现可能与下丘脑特定区域表观遗传学调控作用的酶类合成变化、组蛋白乙酰化降低、基因表达失常,肠道菌群呈现多态性改变有关。运用中西医结合观辨析女性生殖内分泌紊乱的微观分子变化规律,将为现代中医药精准干预女性相关疾病,提供新的方向和防治靶标。

Reproductive endocrine changes in different stages of female life cycle reflect the characteristic dynamic interaction between central and systemic micro-molecules.Alterations of hypothalamic gonadotropin releasing-hormone(GnRH)neuronal network,especially the unbalanced excitatory and inhibitory neurotransmitters release responded to steroid hormone positive/negative feedbacks,are the key mechanisms of early female reproductive aging or excessive secretion of luteinizing hormone in polycystic ovarian syndrome.This process involves different molecular dysfunction regulated by multiple factors.This complicated process coincides with the theory of traditional Chinese medicine"misbalancing interaction between yin and yang"and"insufficiency of Pi and Shen",which were positively consistent with changes of epigenetic-related enzymes,decreased histone acetylation,gene expression disorder in specific area of hypothalamus,and polymorphism changes of intestinal flora.The application of integrated traditional Chinese and Western medicine to analyze the micromolecular changes of female reproductive endocrine disorders will provide a new direction and prevention target for the precise intervention of modern Chinese medicine in female reproductive endocrine disorders.