| 引用本文: |
吴凯,时健,刘倩宏,陈惠媚,汤钰,陈雄,姚小磊.基于线粒体自噬从“虚气留滞”理论角度探讨青光眼的病机与治疗[J].湖南中医药大学学报,2024,45(3):493-498[点击复制] |
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| 基于线粒体自噬从“虚气留滞”理论角度探讨青光眼的病机与治疗 |
| 吴凯,时健,刘倩宏,陈惠媚,汤钰,陈雄,姚小磊 |
| (湖南中医药大学第一附属医院, 湖南 长沙 410007;湖南中医药大学, 湖南 长沙 410208) |
| 摘要: |
| 视网膜神经节细胞（retinal ganglion cells，RGCs）凋亡是青光眼致盲的直接原因，线粒体自噬是RGCs维持线粒体质量的自我保护机制，与青光眼视神经损害密切相关。线粒体自噬对于青光眼具有双面效应，因此，调节线粒体自噬水平在青光眼领域具有重要的意义。“虚气留滞”是指病久损耗机体元气，导致脏腑气血阴阳亏虚，无力推动气、血、水的运行，使得痰饮、瘀血等病理产物内生的过程。以“虚气”之肝脾肾三脏亏虚为本，以“留滞”之血瘀、痰饮为标，是青光眼视神经损伤的关键病机。“虚气留滞”与线粒体自噬存在直接联系，肝脾肾三脏亏虚可增加RGCs的线粒体自噬，增加不完整的线粒体自噬数量，是促进RGCs凋亡的关键因素，而痰瘀有形之邪是导致线粒体自噬无法完整进行的直接原因。立足于“虚气留滞”理论，中医治疗以扶正祛邪为主，治宜益气活血利水，以益气扶正为治本，以活血利水为治标，可将RGCs中的线粒体自噬调整为合适的状态。线粒体自噬与“虚气留滞”理论的结合为中医认识青光眼提供了新的角度，增添了新的观点。 |
| 关键词: 青光眼 虚气留滞 线粒体自噬 视网膜神经节细胞 视神经 病机 |
| DOI：10.3969/j.issn.1674-070X.2024.03.023 |
| 投稿时间：2023-10-08 |
| 基金项目:国家自然科学基金地区基金项目（81860870）；第64批中国博士后科学基金面上资助一等资助项目（2018M640754）；湖南中医药大学“王衡新基金”项目（2023HX007）；湖南省眼科疾病（中医）临床医学研究中心（2023SK4038）。 |
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| Pathogenesis and treatment of glaucoma based on mitophagy from "stagnation of deficient qi" theory |
| WU Kai,SHI Jian,LIU Qianhong,CHEN Huimei,TANG Yu,CHEN Xiong,YAO Xiaolei |
| (The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China;Hunan University of Chinese Medicine, Changsha, Hunan 410208, China) |
| Abstract: |
| Retinal ganglion cells (RGCs) apoptosis is a direct cause of blindness in glaucoma. Mitophagy is a self-protective mechanism of RGCs to maintain mitochondrial quality, and is closely related to optic nerve damage in glaucoma. Since mitophagy has a double-sided effect on glaucoma, regulating mitophagy levels is of great significance in the field of glaucoma. "Stagnation of deficient qi" refers to the process in which prolonged illness depletes the body's vital energy, leading to deficiency of qi, blood, yin, and yang in the zang and fu organs. This weakness results in an inability to promote the circulation of qi, blood, and body fluids, giving rise to pathological products such as phlegm retention and blood stasis. The essential pathogenesis of optic nerve damage in glaucoma is the deficiency of the liver, spleen, and kidney due to "deficient qi", while the manifestation is blood stasis and phlegm retention caused by "stagnation". There is a direct connection between "stagnation of deficient qi" and mitophagy. Deficiency of the three zang organs of liver, spleen, and kidney can increase mitophagy in RGCs, and the increase of incomplete mitophagy is the key factor promoting the apoptosis of RGCs. The direct cause of incomplete mitophagy is the evil of phlegm and blood stasis. Based on the theory of "stagnation of deficient qi", Chinese medicine treats the condition by reinforcing the healthy qi to eliminate pathogenic factors. The treatment principles involve supplementing qi, activating blood circulation, and promoting diuresis. By focusing on supplementing qi to reinforce healthy qi as the root treatment, and activating blood circulation and promoting diuresis as the manifestation treatment, mitochondrial autophagy in RGCs can be adjusted to an appropriate state. The combination of mitophagy and the theory of "stagnation of deficient qi" provides a new perspective and fresh viewpoints for TCM to understand glaucoma. |
| Key words: glaucoma stagnation of deficient qi mitophagy retinal ganglion cells optic nerve pathogenesis |
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