从瘀论治脂质代谢紊乱的药理作用机制研究进展

Research Progress on Pharmacological Mechanisms of Treating Lipid Metabolism Disorders Based on Blood Stasis Theory

瘀血贯穿于脂质代谢紊乱发展全过程,是其发生发展的促进因素。瘀血阻滞是脂质代谢紊乱重要病机。从瘀论治能有效治疗脂质代谢紊乱,其潜在药理作用机制包括抑制肠道脂质消化吸收、增加脂质排泄;限制肝脏和脂肪组织脂质合成,促进脂质氧化利用和白色脂肪棕色化,减轻脂质沉积;调控肝脏、巨噬细胞、脂肪细胞等脂质转运和血脂运输,减少细胞脂质含量。此外,从瘀论治还能通过以下途径改善包括肝脏、脂肪组织在内的脂质代谢:调节肠道微生物,改善肠道渗透性和恢复肠壁完整性;通过抑制核因子E2相关因子2(Nuclear erythroid 2-related factor 2,Nrf2)-血红素加氧酶-1(Heme oxygenase 1,HO-1)等途径而抗氧化;调节免疫细胞、抑制炎症细胞趋化和极化、控制核因子κB(Nuclear facto-κB,NF-κB)信号通路和NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)炎症小体活化而改善炎症反应;通过改善自噬而影响氧化应激和炎症反应等病理生理过程。探讨有关从瘀论治脂质代谢紊乱的药理作用机制,这将有助于为临床推广应用从瘀论治脂质代谢紊乱提供新策略和科学依据。

Blood stasis exists in the entire process of lipid dysmetabolism development,and is a promoting factor of its occurrence and development.Blood stasis is an important pathogenesis of lipid dysmetabolism.The treatment by promoting blood circulation and removing blood stasis effectively ameliorates lipid dysmetabolism,and the potential pharmacological mechanisms involve inhibition of lipid digestion and absorption as well as increases in lipid excretion in intestine,restriction of liposynthesis in liver and fatty tissue,promotion of lipid oxidation utilization and browning of white fat as well as a reduction in lipid deposition,regulation of lipid transport in liver,macrophages,adipocytes and blood lipid transport and cell lipid decrease.Additionally,the treatment by promoting blood circulation and removing blood stasis still improves the lipid metabolism of the tissues including liver and fatty tissue through the following pathways:regulation of gut microbiota,improvement of gut permeability and restoration of intestinal wall integrity,antioxidant functions through inhibition of the pathways such as nuclear erythroid 2-related factor 2(Nrf2)-heme oxygenase 1(HO-1)pathway,amelioration of inflammation via regulating immune cells,inhibiting chemotaxis and polarization of inflammatory cells and controlling nuclear facto-κB(NF-κB)signaling pathway and the activation of NOD-like receptor thermal protein domain associated protein 3(NLRP3)inflammasome,and tje improvement of pathophysiological processes such as oxidative stress and inflammatory reactions through ameliorating autophagy.The paper aimed to explore the pharmacological action mechanism involving the treatment of lipid dysmetabolism through promoting blood circulation and removing blood stasis,providing a new strategy and scientific evidence for clinical application of treatment of lipid dysmetabolism through promoting blood circulation and removing blood stasis.