从“脾为之卫”理论探析巨噬细胞极化在PCOS慢性低度炎症中的作用

Role of Macrophage Polarization in Chronic Low-grade Inflammation of PCOS Based on Theory of Spleen Being in Charge of Defensive Function

多囊卵巢综合征(PCOS)是一种生殖功能障碍与糖脂代谢异常并存的生殖内分泌紊乱综合征,影响8%~13%的育龄期妇女和3%~11%的青春期女性,其临床特征具有高度异质性,目前治疗主要依赖于症状导向的个体化治疗策略。慢性低度炎症状态是PCOS的核心发病机制之一。巨噬细胞是先天免疫的基础细胞,在调节全身炎症反应中起着不可或缺的作用,巨噬细胞M1/M2极化失衡可通过激活促炎反应、破坏卵巢组织修复、刺激雄激素过度合成、促进胰岛素抵抗(IR)发生等途径参与PCOS慢性低度炎症过程。重塑巨噬细胞表型可能为PCOS的潜在治疗策略。中医学认为“脾虚痰湿”是导致PCOS发病的重要病机,“脾为之卫”功能在PCOS的发生与发展中起着保障脾主运化、卫外防御等生理功能正常运行的关键作用。巨噬细胞极化失衡与中医学“脾为之卫”向“脾失为卫”转化过程相似。因此该文首次从中医“脾为之卫”理论角度,探析巨噬细胞极化与PCOS慢性低度炎症发病机制的深层联系,为PCOS的治疗和药物研究提供理论依据和新的研究方向。

Polycystic ovary syndrome(PCOS)is a reproductive endocrine disorder characterized by coexisting reproductive dysfunction and glucolipid metabolic disturbance,affecting 8%-13%of women of reproductive age and 3%-11%of adolescent females.Due to the highly heterogeneous clinical features,symptom-oriented individualized strategies are commonly adopted for the treatment of PCOS.Chronic low-grade inflammation is one of the core mechanisms for the occurrence of PCOS.Macrophages,as foundational cells of innate immunity,play an indispensable role in modulating systemic inflammatory responses.The imbalance of macrophage M1/M2 polarization is involved in chronic low-grade inflammation in PCOS via pathways such as activating pro-inflammatory responses,disrupting ovarian tissue repair,stimulating excessive synthesis of androgens,and promoting the occurrence of insulin resistance.Reshaping the phenotype of macrophages might serve as a potential therapeutic strategy for PCOS.Traditional Chinese medicine(TCM)holds that spleen deficiency and phlegm dampness is a crucial pathogenesis of PCOS.The spleen,being in charge of defensive function,plays a key role in ensuring normal physiological functions such as transportation and defense against external pathogen during the occurrence and development of PCOS.The imbalance of macrophage polarization resembles the transition from spleen being in charge of defensive function to spleen losing its defensive role in TCM.Therefore,this paper,for the first time,explores the deep connection between macrophage polarization and the pathogenesis of chronic low-grade inflammation in PCOS from the TCM theory of spleen being in charge of defensive function,providing theoretical support and new research directions for the treatment and drug research of PCOS.