基于虚实辨证探讨中药干预肝癌炎性微环境的研究进展

Based on Syndrome Differentiation of Excess and Deficiency to Explore Chinese Medicine Intervention on the Inflammatory Microenvironment of Liver Cancer

肝癌的病机错综复杂,起病隐匿,确诊时多为中晚期,是国内外研究的热点与难点。炎性微环境与肝癌的发生、发展、转移息息相关,在促进肿瘤细胞的增殖和新生血管方面有重要作用,且在肝癌中的动态变化与中医“因虚而实”“因实而虚”的病机有共通之处。中药通过补虚通实、攻补兼施等治法,在控制肝癌炎症、延缓病程进展、提高患者生存质量等方面具有独特优势。因此,该文基于虚实辨证理论,从炎性微环境与肝癌的关系、中医药对肝癌炎性微环境的认识及中药干预进行系统总结,提出肝、脾、肾亏虚(虚)为发病之本,气滞、血瘀、痰结、湿聚、热毒等病理变化(实)为发病之标。“虚”“实”互为因果、相互促进,贯穿肝癌发展始终。中医治疗以益气滋阴、疏肝活血、解毒散结为主,可下调炎性因子、促血管生成因子、趋化因子、基质金属蛋白酶等表达,调控机体炎性微环境,提高机体免疫功能,延缓肝癌进展,提高疗效,改善预后,为临床治疗肝癌提供参考。

Liver cancer is affected by a variety of factors,the pathogenesis is complex,and the onset is insidious.Diagnosis of liver cancer has been a hot spot and difficult research area at home and abroad,most patients are in middle and late stages of the disease.The study found that the occurrence,development,and metastasis of liver cancer is closely related to the inflammatory microenvironment,which has an important role in promoting the proliferation of tumor cells and the formation of neovascularization.It was also found that the dynamic changes of inflammatory factors in liver cancer are in common with the dynamic pathogenesis of“healthy energy deficiency and pathogenic excess”and“excess resulted from deficiency”in Chinese medicine.Traditional Chinese medicine(TCM)has played a unique role in controlling inflammation of liver cancer,delaying the progression of the disease,and improving the quality of life of patients through reducing the excessive and replenishing the deficient,reinforcement and elimination in combination.Therefore,based on the syndrome differentiation of excess and deficiency,this paper systematically summarizes the relationship between the inflammatory microenvironment and liver cancer,the understanding and treatment of the inflammatory microenvironment of liver cancer in TCM.It also proposes that liver,spleen,and kidney deficiency(healthy energy deficiency)are the causes of the disease,while qi stagnation and blood stasis,phlegm-damp,heat-toxin and other pathological products(pathogenic excess)are the result of the onset.“Healthy energy deficiency”and“pathogenic excess”may be mutually causal and promote each other in the entire development of liver cancer.TCM has the effects of invigorating qi and nourishing yin,soothing liver and activating blood circulation,detoxification and dispersing accumulation.It regulates the body's inflammatory microenvironment and improves the body's immune function by down-regulating the expressions of inflammatory factors,pro-angiogenic factors,chemokines,and matrix metalloproteinases,thus delaying the progression of liver cancer,improving curative effect and prognosis,and providing reference for clinical treatment.