| 引用本文: |
刘均瑜, 鲍秋羽, 冯瑞瑶, 黄秋锦, 席建元.基于“血热伤阴”理论探讨银屑病坏死性凋亡的病机与治疗策略[J].湖南中医药大学学报,2026,46(6):1213-1220[点击复制] |
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| 基于“血热伤阴”理论探讨银屑病坏死性凋亡的病机与治疗策略 |
| 刘均瑜,鲍秋羽,冯瑞瑶,黄秋锦,席建元 |
| (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: |
| 银屑病是一种以免疫失衡为核心机制的慢性炎症性皮肤病，临床常表现为皮损反复发作、治疗困难，并可伴发多系统并发症。细胞坏死性凋亡通过受体相互作用蛋白质激酶1（RIPK1）/RIPK3混合谱系激酶结构域样蛋白质（MLKL）信号通路介导角质形成细胞膜破裂与损伤相关分子模式释放，参与银屑病炎症放大与屏障损伤。银屑病归属于中医学“白疕”“白疠”范畴，核心病机为血热伤阴、热毒壅盛、灼伤阴液，致使血热内扰、肌肤失养、燥瘀互结。在系统梳理银屑病发病机制的基础上，从血热炽盛、灼伤阴液、瘀阻络脉三个阶段反映银屑病的临床演变规律，剖析“血热伤阴”理论与坏死性凋亡病机的一致性，明确坏死性凋亡在银屑病进展与迁延中的分子病理作用，为银屑病辨证论治与靶向干预提供理论基础与实践路径。 |
| 关键词: 银屑病 血热伤阴 坏死性凋亡 RIPK1/RIPK3/MLKL信号通路 银屑平丸 |
| DOI：10.3969/j.issn.1674-070X.2026.06.017 |
| 投稿时间：2025-12-21 |
| 基金项目:湖南省教育厅重点项目（23A0276）；湖南中医药大学校院联合基金一般项目（2025XYLH025）。 |
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| Pathogenesis and therapeutic strategies of necroptosis in psoriasis based on the theory of “blood heat injuring yin” |
| LIU Junyu, BAO Qiuyu, FENG Ruiyao, HUANG Qiujin, XI Jianyuan |
| (The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China;Hunan University of Chinese Medicine, Changsha, Hunan 410208, China) |
| Abstract: |
| Psoriasis is a chronic inflammatory skin disease with immune imbalance as its core mechanism. Clinically, it is characterized by recurrent skin lesions, refractory to treatment, and is often associated with multisystem complications. Necroptosis, mediated by the receptor-interacting protein kinase 1 (RIPK1)/RIPK3/mixed lineage kinase domain-like protein (MLKL) signaling axis, induces keratinocyte membrane rupture and the release of damage-associated molecular patterns (DAMPs), thereby participating in the amplification of inflammation and impairment of the skin barrier in psoriasis. Psoriasis falls within the categories of "white scaling skin" and "white lichen" in TCM. Its core pathogenesis involves blood heat injuring yin, with exuberant heat toxin scorching yin fluids, leading to internal disturbance of blood heat, malnutrition of the skin, and intermingling of dryness and blood stasis. Based on a systematic review of the pathogenesis of psoriasis, this paper delineates the clinical evolution pattern through three stages—exuberance of blood heat, depletion of yin fluids, and obstruction of the collaterals by blood stasis—to reflect the progressive changes in psoriasis. Furthermore, it analyzes the consistency between the theory of "blood heat injuring yin" and the pathogenesis of necroptosis, and clarifies the molecular pathological role of necroptosis in the progression and persistence of psoriasis. Building on this understanding, this paper proposes a TCM intervention strategy centered on clearing heat and cooling blood, nourishing yin and moistening dryness, and circulating blood and eliminating stasis. It further elaborates on the modern mechanisms by which representative formulas such as Xijiao Dihuang Decoction, Qingying Decoction, and Yinxieping Pill improve psoriasis through the regulation of inflammatory pathways and cell death patterns, thereby providing a theoretical basis and practical pathway for the pattern differentiation and targeted intervention of psoriasis. |
| Key words: psoriasis blood heat injuring yin necroptosis RIPK1/RIPK3/MLKL signaling pathway Yinxieping Pill |
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