摘要
减少血糖波动是目前干预糖尿病和预防并发症的重点,也是中医药在糖尿病治疗中的优势所在。越来越多的研究表明,胰岛微循环障碍是胰岛功能下降进而引发血糖波动的关键病理环节,而胰岛微循环局部肾素-血管紧张素系统(renin-angiotensin system,RAS)的过度激活作为胰岛功能失代偿的使动环节,与胰岛内分泌细胞功能密切相关,是研究胰岛功能的关键靶点。中医学认为糖尿病血糖波动与"脾气散精"障碍密切相关,脾不散"精"(血糖),精滞为浊,浊邪壅塞,是血糖稳态失衡的使动环节,亦为糖尿病全病程的关键病机。通过补益"脾"气以促进"胰"中精微物质的布散能够恢复糖调节激素间的平衡,从而减少血糖波动。目前,"脾气散精"对血糖波动的调节机制尚不明确。作者基于以往的临床和科研工作基础,提出"脾气散精"环节通过促进机体胰岛微循环从而发挥其改善胰岛功能、调节血糖稳态的作用,其机制可能与抑制胰岛微循环局部RAS的激活状态相关。RAS系统在胰岛微循环中各信号通路的相互拮抗关系,与中医理论中脾气散精与固精作用的对立制约关系相类似。因此"脾气散精"环节对血糖波动的调节机制有必要从胰岛微循环RAS整体调控的角度进行深入探索,以此揭示中医药调节机体内环境稳态,减少糖尿病患者血糖波动的科学内涵。
Reducing glycemic excursion is of great importance to the successful practice for diabetes intervention and complication prevention. This is also an advantage of traditional Chinese medicine( TCM) in the treatment of diabetes. More and more studies have shown that the dysfunction of islet microcirculation is the key pathological link for glycemic excursion caused by decrease of islet function. The over-activation of local reninangiotensin system( RAS) in islet microcirculation is a key ring to the islet decompensation,intimately related to the functionality of islet endocrine cells,and has gradually become the focus in the study of islet functionality. In TCM,it is believed that glycemic excursion in diabetes mellitus is closely related to the incapability of "spleen Qi to dispersing essence". If spleen fails to disperse essence,the essence will be accumulated in the body and become harmful stuffs. The stuffs further break the blood glucose homeostasis,acting as the key pathogenesis of diabetes.By supplementing the "spleen"Qi and promoting the dispersion of nutrient substance( hormone) in "pancreas",the balance between sugar-regulated hormones can be restored and therefore glycemic excursion can be reduced.However,the regulation mechanism of "spleen Qi to dispersing essence"on glycemic excursion remains unclear at present. Based on the previous clinical and scientific work,the following ideas were proposed by the authors: the effects of "spleen Qi to dispersing essence"on the improvement of islet function and the regulation of glycemic excursion may be achieved by promoting islet microcirculation,and its mechanism may be related to inhibiting the activation status of local RAS in islet microcirculation. It is important to note that the mutual antagonistic relationship between the signal pathways of RAS in islet microcirculation is similar to the antagonistic relationship between "spleen Qi to dispersing essence "and spermatozoa in TCM. Thus,the mechanism of "spleen Qi to dispersing essence"on the regulation mechanism of blood glucose fluctuations needs to be further explored from the perspective of the overall regulation of RAS in islet microcirculation,so as to reveal the scientific connotation of TCM on regulating the body's environmental homeostasis and reducing glycemic excursion in diabetic patients.
作者
富晓旭
高泓
刘桠
周秀娟
周明阳
谢春光
FU Xiao-xu;GAO Hong;LIU Ya;ZHOU Xiu-juan;ZHOU Ming-yang;XIE Chun-guang(School of Clinical Medicine/Affiliated Hospital,Teaching Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2019年第2期214-219,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金青年科学基金项目(81703953,81503566)
四川省中医药管理局中医药科技专项(2018LC016)
关键词
糖尿病
血糖波动
脾气散精
胰岛微循环
diabetes mellitus
glycemic excursion
spleen Qi to dispersing essence
islet microcirculation
作者简介
第一作者:富晓旭,博士,讲师,从事中医药防治内分泌及代谢性疾病的实验研究,E-mail:fxxtcm@foxmail.com;通信作者:谢春光,博士,教授,从事中医药防治内分泌及代谢性疾病的临床与基础研究,Tel:028-87783242,E-mail:xcg718@aliyun.com.
