中药干预皮瓣血管再生相关信号通路研究进展

Chinese Medicine in Intervention in Signaling Pathways Related to Flap Revascularization:A Review

皮瓣是创伤外科和整形修复外科用于修复开放性大面积损伤的重要手段,然而皮瓣坏死屡见不鲜。良好的血液循环提供营养是皮瓣生存的必要条件,皮瓣移植术后尽快促进血管再生、建立血液循环、恢复血液灌注是皮瓣成活的关键。同时,皮瓣修复后,血管再生/血液再灌注可引起皮瓣缺血再灌注损伤(FIRI),若是未能及时、正确地处理FIRI,最终可能会造成皮瓣坏死,导致移植手术失败。既往研究显示,与细胞增殖凋亡的Notch信号通路、丝裂原活化蛋白激酶(MAPK)信号通路、磷脂酰肌醇3-激酶/蛋白激酶B(PI3K/Akt)信号通路和与炎症相关核因子E2相关因子2(Nrf2)信号通路、核转录因子-κB(NF-κB)信号通路均能够促进血管再生,改善局部血运,抑制炎症介质产生及表达,减少氧化应激和细胞凋亡,减轻缺血再灌注损伤(IRI),促进皮瓣修复后快速愈合。通过查阅大量现代医学研究文献发现,无论是中药单体还是中药复方均可通过调控上述相关信号通路的关键蛋白分子表达,达到促进血管再生、恢复血液灌注、加速皮瓣修复后愈合的作用。该文通过对国内外研究现状进行总结,旨在为中药促进皮瓣修复后愈合的深入研究及临床应用提供参考依据。

Flap surgery is an important method to repair large open wounds in trauma and plastic surgery.However,flap necrosis is a common issue.Good blood circulation that provides nutrition is a necessary condition for the survival of the flap.Promoting revascularization,establishing blood circulation,and restoring blood perfusion as soon as possible after flap transplantation is crucial for flap survival.However,revascularization/blood reperfusion can cause flap ischemia-reperfusion injury(FIRI) after flap repair.If FIRI is not treated correctly and timely,it can cause flap necrosis and graft failure eventually.Previous studies have shown that the signaling pathways related to cell proliferation and apoptosis,such as the Notch signaling pathway,mitogen-activated protein kinase(MAPK) signaling pathway,and phosphatidylinositol 3-kinase/protein kinase B(PI3K/Akt) signaling pathway,and inflammation-related pathways,such as nuclear factor E2-related factor 2(Nrf2) signaling pathway,and nuclear factor-κB(NF-κB) signaling pathway can promote angiogenesis,improve local blood supply,inhibit the production and expression of inflammatory mediators,reduce oxidative stress and apoptosis,relieve ischemia-reperfusion injury(IRI),and promote rapid healing after flap repair.By consulting a large number of modern medical research literature,this study reveals that both Chinese medicine monomers and Chinese medicine compounds can promote revascularization,restore blood perfusion,and accelerate healing after flap repair by regulating the expression of key protein molecules in the above-mentioned signaling pathways.This study summarized the research status in China and abroad,aiming to provide references for the in-depth study and clinical application of Chinese medicine to promote the healing of skin flaps after repair.