中医药通过自噬防治糖尿病周围神经病变作用机制研究进展

Research Progress on Mechanism of Autophagy in Prevention and Treatment of Diabetic Peripheral Neuropathy by Traditional Chinese Medicine

糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)病程长且预后差,以轴突变性坏死、神经纤维节段性脱髓鞘、雪旺细胞凋亡等神经细胞损伤为主要病理特点。自噬是神经细胞的清洁机制,通过清除多余的代谢物来消除细胞压力源造成的伤害,从而维持细胞内稳态平衡。持续的高糖环境改变了机体自噬水平,自噬被抑制或过度激活均会造成神经细胞不可逆损伤,加速DPN进展,恢复自噬平衡,从而减轻神经损伤对于DPN的治疗尤为关键。DPN的治疗目前尚无满意方案,中医药在防治DPN的进程中以多靶点、多效应、多成分等独特优势取得了较好的临床效果,大量中医药治疗DPN的动物及临床研究均显示自噬是中医药治疗DPN的重要靶点,恢复自噬平衡可以减轻神经损伤、延缓神经细胞死亡进程,起到防治DPN的作用。但其具体机制不明,基于此,对自噬的调控及其在DPN发病过程中的作用机制,以及单味中药或复方有效成分对自噬干预作用进行总结,进一步探讨DPN发病机制及中医药干预自噬的潜在治疗靶点,为进一步提升中医治疗DPN的疗效提供参考。

Diabetic peripheral neuropathy(DPN)has a long course and poor prognosis,with axonal degeneration and necrosis,segmental demyelination of nerve fibers,apoptosis of Schwann cells nd other nerve cell injuries as the main pathological features.Autophagy is the cleaning mechanism of nerve cells,which eliminates damage caused by cellular stressors by clearing excess metabolites,thereby maintaining intracellular homeostasis.The sustained high glucose environment alters the level of autophagy in the body.Inhibition or excessive activation of autophagy can cause irreversible damage to nerve cells,accelerate the progression of DPN,restore autophagy balance,and thus reducing nerve damage.This is particularly crucial for the treatment of DPN.At present,there is no satisfactory treatment for DPN.In the process of prevention and treatment of DPN,traditional Chinese medicine has achieved good clinical effects with its unique advantages of multiple targets,multiple effects and multiple components.A large number of animal and clinical studies on the treatment of DPN by traditional Chinese medicine have shown that autophagy is an important target for the treatment of DPN by traditional Chinese medicine.Restoring autophagy balance can reduce nerve injury,delay the process of nerve cell death and play a role in the prevention and treatment of DPN.However,its specific mechanism is unknown.Based on this,this paper focused on the regulation of autophagy and its mechanism of action in the pathogenesis of DPN,as well as the intervention effect of single traditional Chinese medicine or compound effective ingredients on autophagy.It further explored the pathogenesis of DPN and potential therapeutic targets of traditional Chinese medicine intervention in autophagy,providing reference for further improving the efficacy of traditional Chinese medicine in treating DPN.