基于肠道微生态系统探讨以脾论治冠心病
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摘要
冠心病是临床中常见的心血管疾病,其较高的病死率极大地威胁人类的生命健康。然而,现代生活节奏快,加之不健康的饮食偏好及其他不良的生活习惯导致冠心病的发病率增加并出现年轻化趋势。冠心病可归属于中医"胸痹心痛"范畴,虽然病位在心,但与脾胃有着十分紧密的联系。该文基于肠道微生态系统,结合中医心脾理论,探讨以脾论治冠心病的科学内涵,以期完善中医辨证论治的理论依据。
Coronary Heart Disease(CHD)is a common cardiovascular disease in clinical with a high mortality,and it has a great threat for human health. However,the morbidity of CHD has increased by the rapid pace of modern life,unhealthy diet and other bad habits,leading to a younger oriented tendency. CHD defined to chest stuffiness and pains in the traditional Chinese medicine. Athough the pathological changes of CHD locatated in the heart,it has a close relationship with spleen and stomach. Based on intestinal microecosystem and combined the theory of heart and spleen of TCM,this article discusses scientific basis of treatments of CHD with spleen,to improve theoretical foundation of syndrome differentiation and treatment of traditional Chinese medicine.
Coronary Heart Disease(CHD)is a common cardiovascular disease in clinical with a high mortality,and it has a great threat for human health. However,the morbidity of CHD has increased by the rapid pace of modern life,unhealthy diet and other bad habits,leading to a younger oriented tendency. CHD defined to chest stuffiness and pains in the traditional Chinese medicine. Athough the pathological changes of CHD locatated in the heart,it has a close relationship with spleen and stomach. Based on intestinal microecosystem and combined the theory of heart and spleen of TCM,this article discusses scientific basis of treatments of CHD with spleen,to improve theoretical foundation of syndrome differentiation and treatment of traditional Chinese medicine.
引文
[1]赵冬,吴兆苏,王薇,等.北京地区1984-1997年急性冠心病事件发病率变化趋势(中国monica方案的研究)[J].中华心血管病杂志,2000(28):14-17.
[2]李艳.国医大师李济仁辨治痹与痿学术思想与经验[J].中国中医基础医学杂志,2012,18(2):1309-1310.
[3]李京,张明雪,金跟海.胸痹心痛中医学证机概要[J].中华中医药杂志,2014(8):2430-2432.
[4]倪菲,李德新,于睿.李德新从脾论治冠心病经验集萃[J].世界中医药,2014,9(1):67-68.
[5]张会永,崔家鹏,杨关林.从《内经》脾病“脉道不利”探讨“从脾论治”冠心病[J].中国中医基础医学杂志,2013,19(11):1256-1258.
[6]Gill SR,Pop M,Deboy RT,et al. Metagenomic analysis of thehuman distal gut microbiome[J].Science,2006,312(5778):1355-1359.
[7]Hooper LV,Wong MH,Thelin A,et al. Molecular analysis of commensal host-microbial relationships in the intestine[J].Science,2001,291(5505):881-884.
[8]Human Microbiome Project Consortium. Structure,function and diversity of the healthy human microbiome[J].Nature,2012,486(7402):207-214.
[9]李兰娟.感染微生态研究进展—肠道菌群对机体代谢影响[J].中国微生态学杂志,2009(2):1-3.
[10]Zhu W,Gregory JC,Org E,et al. Gut microbial metabolite TMAO enhances platelet hyperreactivity and thrombosis risk[J].Cell,2016,165(1):111-124.
[11]Gagliani N,Hu B,Huber S,et al The fire within:microbes inflame tumors[J].Cell,2014,157(4):776-783.
[12]Olszak T,An D,Zeissig S,et al. Microbial exposure during early life has persistent effects on natural killer T cell function[J].Science,2012,336(6080):489-493.
[13]OCHOA-REPARAZ J,MIELCARZ DW,DITRIO LE,et al. Central nervous system demyelinating disease protection by the human commensal Bacteroides fragilis depends on polysaccharide A expression[J]. J Immunol,2010,185(7):4101-4108.
[14]吴国琳,余国友,卢雯雯.肠道微生态的中医本质探讨[J].中华中医药学刊,2015(11):2586-2588.
[15]JENSEN AB,AJSLEV TA,BRUNAK S,et al. Long-term risk of cardiovascular and cerebrovascular disease after removal of the colonic microbiota by colectomy:a cohort study based on the Danish National Patient Register from 1996 to 2014[J]. BMJ Open,2015,5(12):e8702.
[16]T Yang,MM Santisteban,V Rodriguez,et al. Gut dysbiosis is linked to hypertension[J].Hypertension,2015,65(6):1331-1340.
[17]Z Wang,E Klipfell,BJ Bennett,et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease[J].Nature,2011,472(7341):57-63.
[18]MM Santisteban,Y Qi,J Zubcevic,et al. Hypertension-linked pathophysiological alterations in the gut[J].Circulation Res,2016,120(2):312.
[19]SH Karbach,S Tanja,B Ines,et al. Gut microbiota promote angiotensinII-induced arterial hypertension and vascular dysfunction[J]. J Am Heart Assoc,2016,5(9):e003698.
[20]JL Pluznick,RJ Protzko,H Gevorgyan,et al. Olfactory receptor responding to gut microbiota-derived signals plays a role in renin secretion and blood pressure regulation[J]. Proc Natl Acad Sci USA,2013,110(11):4410.
[21]P Jennifer. A novel SCFA receptor,the microbiota,and blood pressure regulation[J].Gut Microbes,2013,5(2):202-207.
[22]S Rohrmann,J Linseisen,M Allenspach,et al. Plasma concentrations of trimethylamine-N-oxide are directly associated with dairy food consumption and low-grade inflammation in a german adult population[J].Journal of Nutrition,2016,146(2):283-289.
[23]Koeth RA,Wang Z,Levison BS,et al. Intestinal microbiota metabolism of L-carnitine,a nutrient in red meat,promotes atherosclerosis[J].Nature Medicine,2013,19(5):576-585.
[24]JK Dibaise,H Zhang,MD Crowell,et al. Gut microbiota and its possible relationship with obesity[J].Mayo Clin Proc,2008,83(4):450-469.
[25]FEI N,ZHAO L. An opportunistic pathogen isolated from the gut of an obese human causes obesity in germfree mice[J]. ISME J,2013,7(4):880-884.
[26]B?ckhed F,Ding H,Wang T,et al. The gut microbiota as an environmental factor that regulates fat storage[J].Proc Natl Acad Sci USA,2004,101(44):15718-15723.
[27]Cani PD,Bibiloni R,Knauf C,et al. Changes in gut microbiota control metabolic endotoxemiainduced inflammation in high-fat diet-induced obe.sity and diabetes in mice[J].Diabetes,2008,57(6):1470-1481.
[28]Chassaing B,Ley RE,Gewirtz AT. Intestinal epithelial cell tolllike receptor 5 regulates the intestinal microbiota to prevent low-grade inflammation and metabolic syndrome in mice[J].Gastroenterology,2014,147(6):1363-1377.
[29]Delzenne NM,Cani PD,Everard A,et al. Gut microorganisms as promising targets for the management of type 2 diabetes[J].Diabetologia,2015,58(10):2206-2217.
[30]V Senthong,Z Wang,XS Li,et al. Intestinal microbiotagenerated metabolite trimethylamine-N-oxide and 5-year mortality risk in stable coronary artery disease:The contributory role of intestinal mierobiota in a COURAGE—like patient cohort[J]. JAHA,2016,5(6):e002816.
[31]WH Tang,Z Wang,BS Levison,et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk[J].N Engl J Med,2013,368(17):1575-1584.
[32]Organ CL,Otsuka H,Bhushan S,et al. Choline diet and its gut microbe.derived metabolite.trimethylamine N-oxide.Exacerbate pressure overload—induced heart failure[J].Circ Heart Fail,2016,9(1):e002314.
[33]Tmseid M,Ueland T'Hov JR. Microbiota-dependent metabolite trimethylamine-N-oxide is associated with disease severity and survival of patients with chronic heart failure[J]. J Intem Med,2015,277(6):717-726.
[2]李艳.国医大师李济仁辨治痹与痿学术思想与经验[J].中国中医基础医学杂志,2012,18(2):1309-1310.
[3]李京,张明雪,金跟海.胸痹心痛中医学证机概要[J].中华中医药杂志,2014(8):2430-2432.
[4]倪菲,李德新,于睿.李德新从脾论治冠心病经验集萃[J].世界中医药,2014,9(1):67-68.
[5]张会永,崔家鹏,杨关林.从《内经》脾病“脉道不利”探讨“从脾论治”冠心病[J].中国中医基础医学杂志,2013,19(11):1256-1258.
[6]Gill SR,Pop M,Deboy RT,et al. Metagenomic analysis of thehuman distal gut microbiome[J].Science,2006,312(5778):1355-1359.
[7]Hooper LV,Wong MH,Thelin A,et al. Molecular analysis of commensal host-microbial relationships in the intestine[J].Science,2001,291(5505):881-884.
[8]Human Microbiome Project Consortium. Structure,function and diversity of the healthy human microbiome[J].Nature,2012,486(7402):207-214.
[9]李兰娟.感染微生态研究进展—肠道菌群对机体代谢影响[J].中国微生态学杂志,2009(2):1-3.
[10]Zhu W,Gregory JC,Org E,et al. Gut microbial metabolite TMAO enhances platelet hyperreactivity and thrombosis risk[J].Cell,2016,165(1):111-124.
[11]Gagliani N,Hu B,Huber S,et al The fire within:microbes inflame tumors[J].Cell,2014,157(4):776-783.
[12]Olszak T,An D,Zeissig S,et al. Microbial exposure during early life has persistent effects on natural killer T cell function[J].Science,2012,336(6080):489-493.
[13]OCHOA-REPARAZ J,MIELCARZ DW,DITRIO LE,et al. Central nervous system demyelinating disease protection by the human commensal Bacteroides fragilis depends on polysaccharide A expression[J]. J Immunol,2010,185(7):4101-4108.
[14]吴国琳,余国友,卢雯雯.肠道微生态的中医本质探讨[J].中华中医药学刊,2015(11):2586-2588.
[15]JENSEN AB,AJSLEV TA,BRUNAK S,et al. Long-term risk of cardiovascular and cerebrovascular disease after removal of the colonic microbiota by colectomy:a cohort study based on the Danish National Patient Register from 1996 to 2014[J]. BMJ Open,2015,5(12):e8702.
[16]T Yang,MM Santisteban,V Rodriguez,et al. Gut dysbiosis is linked to hypertension[J].Hypertension,2015,65(6):1331-1340.
[17]Z Wang,E Klipfell,BJ Bennett,et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease[J].Nature,2011,472(7341):57-63.
[18]MM Santisteban,Y Qi,J Zubcevic,et al. Hypertension-linked pathophysiological alterations in the gut[J].Circulation Res,2016,120(2):312.
[19]SH Karbach,S Tanja,B Ines,et al. Gut microbiota promote angiotensinII-induced arterial hypertension and vascular dysfunction[J]. J Am Heart Assoc,2016,5(9):e003698.
[20]JL Pluznick,RJ Protzko,H Gevorgyan,et al. Olfactory receptor responding to gut microbiota-derived signals plays a role in renin secretion and blood pressure regulation[J]. Proc Natl Acad Sci USA,2013,110(11):4410.
[21]P Jennifer. A novel SCFA receptor,the microbiota,and blood pressure regulation[J].Gut Microbes,2013,5(2):202-207.
[22]S Rohrmann,J Linseisen,M Allenspach,et al. Plasma concentrations of trimethylamine-N-oxide are directly associated with dairy food consumption and low-grade inflammation in a german adult population[J].Journal of Nutrition,2016,146(2):283-289.
[23]Koeth RA,Wang Z,Levison BS,et al. Intestinal microbiota metabolism of L-carnitine,a nutrient in red meat,promotes atherosclerosis[J].Nature Medicine,2013,19(5):576-585.
[24]JK Dibaise,H Zhang,MD Crowell,et al. Gut microbiota and its possible relationship with obesity[J].Mayo Clin Proc,2008,83(4):450-469.
[25]FEI N,ZHAO L. An opportunistic pathogen isolated from the gut of an obese human causes obesity in germfree mice[J]. ISME J,2013,7(4):880-884.
[26]B?ckhed F,Ding H,Wang T,et al. The gut microbiota as an environmental factor that regulates fat storage[J].Proc Natl Acad Sci USA,2004,101(44):15718-15723.
[27]Cani PD,Bibiloni R,Knauf C,et al. Changes in gut microbiota control metabolic endotoxemiainduced inflammation in high-fat diet-induced obe.sity and diabetes in mice[J].Diabetes,2008,57(6):1470-1481.
[28]Chassaing B,Ley RE,Gewirtz AT. Intestinal epithelial cell tolllike receptor 5 regulates the intestinal microbiota to prevent low-grade inflammation and metabolic syndrome in mice[J].Gastroenterology,2014,147(6):1363-1377.
[29]Delzenne NM,Cani PD,Everard A,et al. Gut microorganisms as promising targets for the management of type 2 diabetes[J].Diabetologia,2015,58(10):2206-2217.
[30]V Senthong,Z Wang,XS Li,et al. Intestinal microbiotagenerated metabolite trimethylamine-N-oxide and 5-year mortality risk in stable coronary artery disease:The contributory role of intestinal mierobiota in a COURAGE—like patient cohort[J]. JAHA,2016,5(6):e002816.
[31]WH Tang,Z Wang,BS Levison,et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk[J].N Engl J Med,2013,368(17):1575-1584.
[32]Organ CL,Otsuka H,Bhushan S,et al. Choline diet and its gut microbe.derived metabolite.trimethylamine N-oxide.Exacerbate pressure overload—induced heart failure[J].Circ Heart Fail,2016,9(1):e002314.
[33]Tmseid M,Ueland T'Hov JR. Microbiota-dependent metabolite trimethylamine-N-oxide is associated with disease severity and survival of patients with chronic heart failure[J]. J Intem Med,2015,277(6):717-726.