“脾-肠-肌”的中医模式探讨肠道微生态延缓COPD肌少症的新机制

"Spleen-gut-muscle"Model of Chinese Medicine to Explore Effect of Gut Microbiota on COPD with Sarcopenia

慢性阻塞性肺疾病(COPD)易受多种全身合并症影响,其中,肌少症是COPD患者呼吸肌疲劳、跌倒或骨折、降低生活质量的独立危险因素。肌少症发生机制涉及线粒体功能障碍、胰岛素抵抗、骨骼肌纤维类型转变及蛋白质合成和分解失衡等多个方面,常规营养支持和运动康复治疗疗效有限。因此,极力寻找延缓COPD肌少症的方法十分迫切。近年来,研究发现COPD患者肠道微生态深受肺部微生物菌群紊乱的影响。而肠道微生态及其代谢产物具有调节炎症和免疫、糖脂代谢和线粒体功能等多种作用也逐渐被证实。基于中医藏象理论,中医脾、肠与肌肉之间联系密切,肠道微生态可能是改善“脾主肌肉”功能,并增强肌肉质量和力量的重要环节。该文重在阐明肠道微生态延缓COPD肌少症的作用机制,为未来研究和临床提供新的思路与见解。

Chronic obstructive pulmonary disease(COPD)is susceptible to systemic complications.Especially,sarcopenia is an independent risk factor for COPD patients that can exacerbate respiratory muscle fatigue,lead to a higher risk of falls and fractures,and lower the quality of life.The pathogenesis of sarcopenia involves such aspects as mitochondrial dysfunction,insulin resistance,changes in skeletal muscle fiber types,and an imbalance in protein synthesis and breakdown.As nutrition support and exercise rehabilitation therapy frequently have limited effectiveness,it is urgent to find a way to slow the progression of COPD with sarcopenia.Numerous studies conducted in recent years have discovered a potential link between pulmonary microbiome disorders and the gut microbiota of COPD patients.Furthermore,a wide range of functions of gut microbiota and its metabolites have been demonstrated,such as regulating inflammation and immunity,glucose and lipid metabolism,and mitochondrial function.According to the Zangxiang theory in Chinese medicine,there are intimate connections between the spleen,intestine,and muscle,and gut microbiota may be the most essential part of ameliorating"spleen governing muscle"and increasing muscle mass and strength.This study aims to expound on the effect mechanism of gut microbiota in slowing the progression of COPD with sarcopenia,thereby furnishing novel perspectives and recommendations for forthcoming investigations and therapeutic applications.