斑块微环境血管新生-炎症网络及中医药的调控作用

动脉粥样硬化斑块破裂是急性心血管事件发生的主要原因。斑块微环境中多种细胞、细胞因子和通路交互作用形成血管新生-炎症网络,该复杂网络的多种因素共同作用易致斑块破裂。中医学认为动脉粥样硬化斑块微环境的主要病理因素有瘀血、痰浊、毒邪,现有研究证实益气、活血、祛痰、解毒方药可调节血管新生-炎症网络从而稳定斑块、抗动脉粥样硬化。文中以血管新生-炎症网络为切入点探讨斑块不稳定的机制,探求中医药改善斑块微环境的防治思路,以期为动脉粥样硬化性心血管疾病的防治提供新策略。

斑块微环境与中医阴阳学说的关系

动脉粥样硬化斑块的形成、发展与机体和局部的内环境密切相关。斑块微环境既包括组成斑块本身的细胞成分及其分泌的因子,也包括存在于微环境中的促进斑块形成的各种病理因素。中医学认为,阴阳平衡是维持人体正常生命活动的基础,而斑块的形成是其微环境阴阳消长失衡的结果;当微环境中各种阴阳属性的因子过度转化时,则进一步加剧失衡状态,最终走向阴阳格拒,导致斑块破裂。中医药因其多靶点的调节作用,在维持机体阴阳平衡中具有显著的效果,而恢复疾病状态下的阴阳动态平衡是治疗动脉粥样硬化斑块的基本准则。

从“痰瘀-热毒”论冠脉临界病变斑块微环境中医药调控机制

冠脉临界病变是冠状动脉粥样硬化性心脏病发展过程中的特殊阶段,此阶段中斑块微环境内的多种生物成分相互作用,形成一个复杂的生态系统。冠脉临界病变“痰瘀-热毒”的证候演变与炎症反应、内皮损伤、血管新生及脂质代谢等现代病理机制相应。故临证治疗应采用“消、清、通”法调控冠脉临界病变斑块微环境,即:消痰瘀——改善内皮损伤与脂质沉积;清热毒——抑制炎症反应;通脉络——抑制斑块内血管新生。如此则可发挥抗炎、改善内皮与血脂代谢、抑制斑块内血管新生的作用,共同构建冠脉临界病变“痰瘀-热毒”的病证结合全周期动态干预模式。

从“脉中积”认识动脉粥样硬化

动脉粥样硬化与中医积病在病理形态和发生机制上具有一定的相似性,“脉中积”即痰浊、瘀血和毒邪等有形之物凝滞脉中。从斑块微环境角度阐释“脉中积”的生物学内涵和病理演变规律。认为AS发病初期为脾肾亏虚、血浊脉弱,中期为脉道失柔、脉络绌急,后期为脉络骤闭、脏腑受损。以缺血性心脏病为例,根据其不同阶段病机特点,斑块形成早期治以化痰降浊、养血护脉,斑块易损期治以活血解毒、畅脉稳斑,心脏恢复期治以温经通络、保脉育心。

Role of Salix reinii patches in spatio-temporal patterns of cohabitants on a Japanese volcano

Shrub patches often support the colonizers particularly under stressful and/or disturbed environments.The intensities of stresses and disturbances on mountains are often related to an elevation gradient and are decreased by shrub patches(canopy and litter).We aim to clarify these relationships by using shrub patches at different elevations on a volcano.We monitored all shoots in plots established inside and outside of patches of Salix reinii(Salicaceae)and their related environments,such as temperature,light,moisture and chemistry,at three elevations on Mount Koma(1131 m a.s.l.),northern Japan,from early spring in 2005 to summer in 2006.The patch structures were evaluated by area,branch density and litter thickness.The structures of shrub patches did not differ among the elevations.The patches increased the diversity of rare species,by an overall increase in plant species richness.The moisture,nitrogen and phosphate contents in the patches were higher than outside of patches.The effects of shrub patches on the cohabitants were overall positive,although the effects were negative on seedling abundance,shoot survival and flowering.These results suggest that the growth patterns of shrub patches determine the plant community structures and facilitate plant diversity.