糖尿病性脑内微小病变与养阴截断疗法

刘笑迎,周 端,王长德

神经病学与神经康复学杂志 ›› 2017, Vol. 13 ›› Issue (4) : 204-212.

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神经病学与神经康复学杂志 ›› 2017, Vol. 13 ›› Issue (4) : 204-212. DOI: 10.12022/jnnr.2017-0062
综述

糖尿病性脑内微小病变与养阴截断疗法

  • 刘笑迎1, 2,周 端1,王长德2
作者信息 +

Small brain lesions related to diabetes mellitus and the method of nourishing Yin and truncating lesion

  • LIU Xiaoying1, 2, ZHOU Duan1, WANG Changde2
Author information +
文章历史 +

摘要

本文综述了糖尿病性脑内微小病变的中西医研究进展,结合中国传统医学的“络病学说”和“截断扭转”等理论,提出“养阴截断”法治疗糖尿病性脑内微小病变以预防脑卒中的假说,旨在进一步完善及明确“养阴截断”学说,完善中医“治未病”理论,为中医预防糖尿病性脑卒中提供参考。

Abstract

This paper reviews the progress in traditional Chinese medicine and western medicine research on the relationship of diabetes mellitus and small brain lesions, and puts forward the hypothesis of nourishing Yin and truncating lesion method for the treatment of small brain lesions related to diabetes mellitus in stroke prevention based on traditional Chinese medicine theory of collaterals disease and torsion and truncation, in order to further improve and clear the traditional Chinese medicine theory of nourishing Yin and truncating lesion and preventive treatment of disease, providing references for preventing stroke related to diabetic mellitus in traditional Chinese medicine.

关键词

脑内微小病变 / 糖尿病 / 血脑屏障 / 养阴截断 / 治未病

Key words

Small brain lesions / Diabetes mellitus / Blood-brain barrier / Nourishing Yin and truncating lesion / Preventive treatment of disease

引用本文

导出引用
刘笑迎,周 端,王长德. 糖尿病性脑内微小病变与养阴截断疗法[J]. 神经病学与神经康复学杂志. 2017, 13(4): 204-212 https://doi.org/10.12022/jnnr.2017-0062
LIU Xiaoying, , ZHOU Duan, WANG Changde. Small brain lesions related to diabetes mellitus and the method of nourishing Yin and truncating lesion[J]. Journal of Neurology and Neurorehabilitation. 2017, 13(4): 204-212 https://doi.org/10.12022/jnnr.2017-0062

参考文献

[1] 澤田徹, 種田二郎, 岡本幸市, ほか. 無症候性脳血管障害の診断基準に関する研究[J]. 脳卒中, 1997, 19(6):489-493.
[2] 藤井進也, 松末英司. ラクナ梗死と血管周囲腔[J]. 画像診断, 2005, 25:1326-1327.
[3] ROUHL RP, VAN OOSTENBRUGGE RJ, KNOTTNERUS IL, et al. Virchow-Robin spaces relate to cerebral small vessel disease severity[J]. J Neurol, 2008, 255(5):692-696.
[4] SELVARAJAH J, SCOTT M, STIVAROS S, et al. Potential surrogate markers of cerebral microvascular angiopathy in asymptomatic subjects at risk of stroke[J]. Eur Radiol, 2009, 19(4):1011-1018.
[5] ZHU YC, TZOURIO C, SOUMARé A, et al. Severity of dilated Virchow-Robin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: a population-based study[J]. Stroke, 2010, 41(11):2483-2490.
[6] XU Y, WANG L, HE J, et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013, 310(9):948-959.
[7] YANG Z, XING X, XIAO J, et al. Prevalence of cardiovascular disease and risk factors in the Chinese population with impaired glucose regulation: the 2007-2008 China national diabetes and metabolic disorders study[J]. Exp Clin Endocrinol Diabetes, 2013, 121(6):372-374.
[8] PINTO A, TUTTOLOMONDO A, DI RAIMONDO D, et al. A case control study between diabetic and non-diabetic subjects with ischemic stroke[J]. Int Angiol, 2007, 26(1):26-32.
[9] 曲 红, 周蔓蔓, 张玉倩, 等. MRI上血管周围间隙与血管性危险因子及脑梗死发病的相关性[J]. 中国医学影像学杂志, 2012, 20(9):641-645.
[10] WINDHAM BG, DEERE B, GRISWOLD ME, et al. Small brain lesions and incident stroke and mortality: a cohort study[J]. Ann Intern Med, 2015, 163(1):22-31.
[11] KNOPMAN DS, GRISWOLD ME, LIRETTE ST, et al. Vascular imaging abnormalities and cognition mediation by cortical volume in nondemented individuals: atherosclerosis risk in communities-neurocognitive study[J]. Stroke, 2015, 46(2):433-440.
[12] 曲 红, 张玉倩, 周蔓蔓, 等. 脑内微小病变不同干预模式的临床疗效比较[J]. 中国中西医结合杂志, 2013, 33(3):332-337.
[13] PUTAALA J, LIEBKIND R, GORDIN D, et al. Diabetes mellitus and ischemic stroke in the young: clinical features and long-term prognosis[J]. Neurology, 2011, 76(21):1831-1837.
[14] ABBOTT NJ, PATABENDIGE AA, DOLMAN DE, et al. Structure and function of the blood-brain barrier[J]. Neurobiol Dis, 2010, 37(1):13-25.
[15] TANNE D, KOREN-MORAG N, GOLDBOURT U. Fasting plasma glucose and risk of incident ischemic stroke or transient ischemic attacks: a prospective cohort study[J]. Stroke, 2004, 35(10):2351-2355.
[16] MARSO SP, KENNEDY KF, HOUSE JA, et al. The effect of intensive glucose control on all-cause and cardiovascular mortality, myocardial infarction and stroke in persons with type 2 diabetes mellitus: a systematic review and meta-analysis[J]. Diab Vasc Dis Res, 2010, 7(2):119-130.
[17] STEVENS RJ, COLEMAN RL, ADLER AI, et al. Risk factors for myocardial infarction case fatality and stroke case fatality in type 2 diabetes: UKPDS 66[J]. Diabetes Care, 2004, 27(1): 201-207.
[18] MYINT PK, SINHA S, WAREHAM NJ, et al. Glycated hemoglobin and risk of stroke in people without known diabetes in the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study: a threshold relationship?[J]. Stroke, 2007, 38(2):271-275.
[19] AMARENCO P, LABREUCHE J, TOUBOUL PJ. High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review[J]. Atherosclerosis, 2008, 196(2):489-496.
[20] Cholesterol Treatment Trialists’ (CTT) Collaborators, KEARNEY PM, BLACKWELL L, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomized trials of statins: a meta-analysis[J]. Lancet, 2008, 371(9607):117-125.
[21] YANG X, KO GT, SO WY, et al. Additive interaction of hyperglycemia and albuminuria on risk of ischemic stroke in type 2 diabetes: Hong Kong Diabetes Registry[J]. Diabetes Care, 2008, 31(12):2294-2300.
[22] KUWASHIRO T, KAMOUCHI M, AGO T, et al. The factors associated with a functional outcome after ischemic stroke in diabetic patients: the Fukuoka Stroke Registry[J]. J Neurol Sci, 2012, 313(1-2):110-114.
[23] URABE T, WATADA H, OKUMA Y, et al. Prevalence of abnormal glucose metabolism and insulin resistance among subtypes of ischemic stroke in Japanese patients[J]. Stroke, 2009, 40(4):1289-1295.
[24] PARDRIDGE WM. Drug transport across the blood-brain barrier[J]. J Cereb Blood Flow Metab, 2012, 32(11):1959-1972.
[25] PEDRAM MZ, SHAMLOO A, ALASTY A, et al. Optimal magnetic field for crossing super-para-magnetic nanoparticles through the brain blood barrier: a computational approach[J/OL]. Biosensors (Basel), 2016, 6(2):25(2016-06-14)[2017-10-18]. http://www.mdpi.com/2079-6374/6/2/25. DOI: 10.3390/bios6020025.
[26] ZEPEDA AB, PESSOA A JR, CASTILLO RL, et al. Cellular and molecular mechanisms in the hypoxic tissue: role of HIF-1 and ROS[J]. Cell Biochem Funct, 2013, 31(6):451-459.
[27] MALIK RA, TESFAYE S, NEWRICK PG, et al. Sural nerve pathology in diabetic patients with minimal but progressive neuropathy[J]. Diabetologia, 2005, 48(3):578-585.
[28] KRISTOVá V, LíSKOVá S, SOTNíKOVá R, et al. Sulodexide improves endothelial dysfunction in streptozotocin-induced diabetes in rats[J]. Physiol Res, 2008, 57(3):491-494.
[29] DANEMAN R. The blood-brain barrier in health and disease[J]. Ann Neurol, 2012, 72(5):648-672.
[30] BOHUSLAVOVA R, KOLAR F, SEDMERA D, et al. Partial deficiency of HIF-1α stimulates pathological cardiac changes in streptozotocin-induced diabetic mice[J/OL]. BMC Endocr Disord, 2014, 14:11(2014-02-06)[2017-10-18]. https://doi.org/10.1186/1472-6823-14-11. DOI: 10.1186/1472-6823-14-11.
[31] ORTEGA A, FERNáNDEZ A, ARENAS MI. Outcome of acute renal injury in diabetic mice with experimental endotoxemia: role of hypoxia-inducible factor-1 α[J/OL]. J Diabetes Res, 2013:254529(2013-07-31)[2017-10-18]. http://dx.doi.org/10.1155/2013/254529. DOI: 10.1155/2013/254529.
[32] NAKAGAWA K, KOHARA T, UEHATA Y, et al. PIAS3 enhances the transcriptional activity of HIF-1α by increasing its protein stability[J]. Biochem Biophys Res Commun, 2016, 469(3):470-476.
[33] NISHIYAMA Y, GODA N, KANAI M, et al. HIF-1α induction suppresses excessive lipid accumulation in alcoholic fatty liver in mice[J]. J Hepatol, 2012, 56(2):441-447.
[34] WANG V, DAVIS DA, HAQUE M, et al. Differential gene up-regulation by hypoxia-inducible factor-1alpha and hypoxia-inducible factor-2alpha in HEK293T celIs[J]. Cancer Res, 2005, 65(8):3299-3306.
[35] NICHOLAS SA, SUMBAYEV VV. The role of redox-dependent mechanisms in the downregulation of ligand-induced Toll-like receptors 7, 8 and 4-mediated HIF-1 alpha proly hydroxylation[J]. Immunol Cell Biol, 2010, 88(2):180-186.
[36] WEN Z, HUANG C, XU Y, et al. a-Solanine inhibits vascular endothelial growth factor expression by down-regulating the ERK1/2-HIF-1α and STAT3 signaling pathways[J]. Eur J Pharmacol, 2016, 771:93-98.
[37] NISHIJIMA K, NG YS, ZHONG L, et al. Vascular endothelial growth factor-A is a survival factor for retinal neurons and a critical neuroprotectant during the adaptive response to ischemic injury[J]. Am J Pathol, 2007, 171(1):53-67.
[38] PARK CW, KIM HW, LIM JH, et al. Vascular endothelial growth factor inhibition by dRK6 causes endothelial apoptosis, fibrosis, and inflammation in the heart via the Akt/eNOS axis in db/db mice[J]. Diabetes, 2009, 58(11):2666-2676.
[39] SIOMEK A. NF-κB signaling pathway and free radical impact[J]. Acta Biochim Pol, 2012, 59(3):323-331.
[40] NAZIR FS, ALEM M, SMALL M, et al. Blunted response to systemic nitric oxide synthase inhibition in the cerebral circulation of patients with Type 2 diabetes[J]. Diabet Med, 2006, 23(4):398-402.
[41] 陈玉华, 苏健民, 武 革,等. 内皮素、降钙素基因相关肽参与糖尿病合并脑梗死发病过程中的作用[J]. 中国临床康复, 2003, 7(15):2141-2143.
[42] JOUTEL A, CORPECHOT C, DUCROS A, et al. Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia[J]. Nature, 1996, 383(6602):707-710.
[43] ANASTASI E, CAMPESE AF, BELLAVIA D, et al. Expression of activated Notch3 in transgenic mice enhances generation of T regulatory cells and protects against experimental autoimmune diabetes[J]. J Immunol, 2003, 171(9):4504-4511.
[44] BORSELLO T, CLARKE PG, HIRT L, et al. A peptide inhibitor of c-Jun N-terminal kinase protects against excitotoxicity and cerebral ischemia[J]. Nat Med, 2003, 9(9):1180-1186.
[45] KANETO H, NAKATANI Y, MIYATSUKA T, et al. Possible novel therapy for diabetes with cell-permeable JNK-inhibitory peptide[J]. Nat Med, 2004, 10(10):1128-1132.
[46] 吴以岭. 络病治疗原则与通络药物[J]. 疑难病杂志, 2005, 4(4):213-215.
[47] 朱良春. 先发制病,早用通利[J]. 中国社区医师, 2003, 18(11):23-24.
[48] 姜春华. 姜春华与“截断扭转”理论[J]. 中国社区医师, 2005, 21(15):34-34.
[49] 赵锡武. 赵锡武医疗经验[M]. 北京:人民卫生出版社, 1950:47.
[50] 姜春华. 扭转截断重祛邪,先证而治勿因循[J]. 中国社区医师, 2003, 18(11):21-23.
[51] 青木茂樹. よくわかる脳MRI[M]. 東京: 株式会社秀潤社, 1998:14-16.
[52] 曲 红, 西丸雄也. 从脑内微小病变探讨中风“治未病”客观依据的研究[J]. 天津中医药, 2008, 25(4):292-295.
[53] 曲 红, 张玉倩, 赵小英, 等. 桂枝茯苓丸加地龙干预脑内微小病变及预防脑梗死发病的临床研究[J]. 上海中医药杂志, 2012, 46(8):15-21.
[54] 周小祝,莫志贤. 桂枝茯苓丸的药理作用研究进展[J]. 医药导报, 2006, 25(2):142-143.
[55] 刘笑迎, 曹 贺, 钟 萍. 益气养阴活血方治疗糖尿病周围神经病变效果观察[J]. 人民军医, 2015, 58(8):914-916.
[56] 刘笑迎, 张云云, 张捷青, 等. 黄芪、丹参、山药及其复方对高糖所致雪旺细胞凋亡的保护作用[J]. 中药药理与临床, 2010, 26(1):41-45.
[57] TOSHIMA Y, SATOH S, IKEGAKI I, et al. A new model of cerebral microthrombosis in rats and the neuroprotective effect of a Rho-kinase inhibitor[J]. Stroke, 2000, 31(9):2245-2250.

基金

上海市科学技术委员会引导类课题(编号:16401931600);上海市卫生和计划生育委员会青年课题(编号:2016LQ010);上海市虹口区卫生和计划生育委员会课题(编号:1604-10)

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