以失功能高密度脂蛋白为指导探讨健脾化痰祛瘀法治疗冠心病的科学内涵

Discussion on the Scientific Connotation of Fortifying Spleen,Resolving Phlegm and Dispelling Stasis in the Treatment of Coronary Heart Disease under the Guidance of Dysfunctional High-Density Lipoprotein

冠心病的关键病机为脾虚痰瘀,失功能高密度脂蛋白(dys-HDL)可能为脾虚痰瘀导致冠心病发病的生物学基础。结合高密度脂蛋白(HDL)的生物学特性及作用,认为脾虚状态下HDL的结构和组分发生异常,导致dys-HDL的产生;而dys-HDL通过介导内皮细胞功能障碍和介导巨噬细胞、平滑肌细胞泡沫化两大途径促使动脉粥样硬化斑块形成,从而引发冠心病。同时认为dys-HDL是脾虚的微观体现,即脾虚状态的病理产物,脾虚状态为dys-HDL的产生提供条件;dys-HDL亦是冠心病痰瘀互结的重要生物学基础。提出健脾化痰祛瘀法作为中医药治疗冠心病的重要法则,能够通过影响dys-HDL结构和组分的改变而达到治疗目的,从而揭示健脾化痰祛瘀法治疗冠心病的科学内涵,以期为冠心病的中医诊疗提供思路。

The key pathogenesis of coronary heart disease(CHD)is spleen deficiency and phlegm stasis,and dysfunctional high-density lipoprotein(dys-HDL)may be the biological basis for the occurrence of CHD due to spleen deficiency and phlegm stasis.Considering the biological properties and effects of high-density lipoprotein(HDL),it is believed that the structure and components of HDL are abnormal in the state of spleen deficiency which led to dys-HDL;and dys-HDL contributes to the formation of atherosclerotic plaques through two major pathways,namely,mediating the dysfunction of endothelial cells and mediating the foaminess of macrophages and smooth muscle cells,thus triggering the development of CHD.It is also believed that dys-HDL is a microcosmic manifestation and a pathological product of spleen deficiency,and spleen deficiency makes foundation for the production of dys-HDL;dys-HDL is also an important biological basis for the phlegm-stasis interactions in CHD.The method of fortifying spleen,resolving phlegm,and dispelling stasis,is proposed as an important principle in the treatment of CHD by traditional Chinese medicine,which can achieve the therapeutic purpose by affecting the changes in the structure and components of dys-HDL,thus revealing the scientific connotation of this method,and providing ideas for the diagnosis and treatment of CHD by traditional Chinese medicine.