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中国中医科学院 西苑医院 国家中医心血管病临床医学研究中心,北京 100091
Received:29 June 2023,
Published Online:07 August 2023,
Published:05 March 2024
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王子钰,王文婷,徐仕晗等.“异病同治”视角下从血瘀论治糖尿病视网膜病变与冠心病的现代机制探析[J].中国实验方剂学杂志,2024,30(05):197-205.
WANG Ziyu,WANG Wenting,XU Shihan,et al.Exploring Modern Mechanism of Treating Diabetic Retinopathy and Coronary Heart Disease from Perspective of Blood Stasis Under Viewpoint of Treating Different Diseases with the Same Method[J].Chinese Journal of Experimental Traditional Medical Formulae,2024,30(05):197-205.
王子钰,王文婷,徐仕晗等.“异病同治”视角下从血瘀论治糖尿病视网膜病变与冠心病的现代机制探析[J].中国实验方剂学杂志,2024,30(05):197-205. DOI: 10.13422/j.cnki.syfjx.20231347.
WANG Ziyu,WANG Wenting,XU Shihan,et al.Exploring Modern Mechanism of Treating Diabetic Retinopathy and Coronary Heart Disease from Perspective of Blood Stasis Under Viewpoint of Treating Different Diseases with the Same Method[J].Chinese Journal of Experimental Traditional Medical Formulae,2024,30(05):197-205. DOI: 10.13422/j.cnki.syfjx.20231347.
糖尿病视网膜病变(DR)与冠心病(CHD)均属于重大慢性血管并发症,严重危害人群健康,临床常相伴出现,积极探索二者在疾病发展过程中的关联及中西医结合防治方法具有重要的临床价值。中医学认为,心与目生理上以气、血、脉为桥梁相互沟通,“瘀血阻络”是DR与CHD的共同中医病机,其机制涉及炎症、氧化应激和内皮功能障碍等。活血化瘀在异病同治及共病防治中扮演着重要角色,可能通过抑制白细胞介素-1
β
(IL-1
β
)、内皮素-1(ET-1)和缺氧诱导因子-1
α
/血管内皮生长因子(HIF-1
α
/VEGF)的表达,调节磷脂酰肌醇3-激酶/蛋白激酶B/哺乳动物雷帕霉素靶蛋白(PI3K/Akt/mTOR)信号通路,启动腺苷酸活化蛋白激酶/沉默信息调节因子1(AMPK/SIRT1)和核转录因子E
2
相关因子2/血红素氧合酶1(Nrf2/HO-1)信号通路,抑制河马/Yes相关蛋白(Hippo/YAP)信号通路,抑制线粒体通透性过渡孔和抗血小板凝集等多途径治疗DR及CHD,从生物学角度为中医药防治DR及CHD提供了多成分、多通路、多靶点的选择策略及思路。后续研究应着重构建临床相关的共病模型、开展多中心前瞻性研究,充分利用人工智能技术深入解析DR与CHD的关联性,将活血化瘀防治泛血管疾病的机制阐释清楚。
Diabetic retinopathy(DR) and coronary heart disease(CHD) are both major chronic vascular complications that seriously jeopardize the health of the population and often occur together in clinical practice, it is of great clinical value to actively explore the association between the two in the process of disease development and methods of prevention and treatment of modern medicine and traditional Chinese medicine(TCM). According to TCM, the heart and eyes physiologically communicate with each other by taking Qi, blood and veins as bridges, blood stasis obstructing collaterals is the common TCM etiology of DR and CHD, whose mechanism involves inflammation, oxidative stress and endothelial dysfunction. Promoting blood circulation and removing blood stasis plays an important role in the same treatment for different diseases and prevention and treatment of comorbidities, possibly by inhibiting the expression of interleukin-1
β
(IL-1
β
)
,
endothelin-1(ET-1) and hypoxia inducible factor-1
α
/vascular endothelial growth factor(HIF-1
α
/VEGF), regulating phosphatidylinositol 3-kinases/protein kinase B/mammalian target of rapamycin(PI3K/Akt/mTOR) pathway, initiating adenosine monophosphate(AMP)-activated protein kinase/silent information regulator 1(AMPK/SIRT1) and nuclear transcription factor erythroid 2-related factor 2/heme oxygenase-1(Nrf2/HO-1) signaling pathways, inhibiting Hippo/Yes-associated protein(Hippo/YAP) signaling pathway, inhibiting mitochondrial permeability transition pore and anti-platelet agglutination for treating DR and CHD, which provides a multi-component, multi-pathway and multi-target selection strategies and ideas for the prevention and treatment of DR and CHD by TCM from a biological perspective. Based on this, subsequent studies should focus on constructing clinically relevant comorbidity models, conducting multicenter prospective studies, and fully utilizing artificial intelligence technology to gain a deeper understanding of the relationship between the two diseases, so as to elucidate the mechanism of promoting blood circulation and removing blood stasis in preventing and treating panvascular diseases.
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