溃疡性结肠炎病因病机述评
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摘要
西医认为溃疡性结肠炎与免疫、肠道菌群、遗传、感染、环境以及精神心理等因素有关。环境因素作用于遗传易感者,在肠道菌群的参与下,精神心理因素与感染参与其中,启动了难以停止的、发作与缓解交替的肠道天然免疫及获得性免疫反应,导致肠道的屏障功能受到损害、增加肠道的通透性,与此同时,肠腔内的促炎症物质如抗原、内毒素等进入肠黏膜固有层,诱发机体的免疫应答。中医认为溃疡性结肠炎与脾胃虚弱、外感六淫、饮食不节、情志失调、禀赋不足等因素有关。其病因病机是素体脾胃虚弱,加之外感和内伤,导致湿热壅滞肠道,气机阻滞,损伤肠络。临床上辨证分为大肠湿热证、热毒炽盛证、脾虚湿蕴证、寒热错杂证、肝郁脾虚证、脾肾阳虚证、阴血亏虚证等证型。
According to Western medicine,ulcerative colitis is related to immunity,intestinal flora,heredity,infection,environment and mental and psychological factors. Environmental factors act on genetic susceptible persons. With the participation of intestinal flora,psycho-psychological factors and infections participate in the process. They initiate the innate and acquired immune responses of the intestine which are difficult to stop,and lead to impairment of intestinal barrier function which attacks and relieves alternately,and increase intestinal permeability. At the same time,pro-inflammatory substances such as antigens and endotoxins enter the intestinal mucosa,and induce the immune response of the body. According to TCM,ulcerative colitis is related to deficiency of the spleen and stomach,exogenous six excesses,improper diet,emotional disorders,insufficient endowment and other factors. Its etiology and pathogenesis are weakness of the spleen and stomach,external sensation and internal injury,resulting in damp-heat obstruction of the intestinal tract,blockade of qi,injury of the intestines and collaterals. Clinical syndrome differentiation can be divided into damp-heat syndrome of large intestine,excessive heat toxicity syndrome,spleen deficiency and dampness accumulation syndrome,miscellaneous cold-heat syndrome,liver depression and spleen deficiency syndrome,spleen-kidney yang deficiency syndrome,yin-blood deficiency syndrome,etc.
According to Western medicine,ulcerative colitis is related to immunity,intestinal flora,heredity,infection,environment and mental and psychological factors. Environmental factors act on genetic susceptible persons. With the participation of intestinal flora,psycho-psychological factors and infections participate in the process. They initiate the innate and acquired immune responses of the intestine which are difficult to stop,and lead to impairment of intestinal barrier function which attacks and relieves alternately,and increase intestinal permeability. At the same time,pro-inflammatory substances such as antigens and endotoxins enter the intestinal mucosa,and induce the immune response of the body. According to TCM,ulcerative colitis is related to deficiency of the spleen and stomach,exogenous six excesses,improper diet,emotional disorders,insufficient endowment and other factors. Its etiology and pathogenesis are weakness of the spleen and stomach,external sensation and internal injury,resulting in damp-heat obstruction of the intestinal tract,blockade of qi,injury of the intestines and collaterals. Clinical syndrome differentiation can be divided into damp-heat syndrome of large intestine,excessive heat toxicity syndrome,spleen deficiency and dampness accumulation syndrome,miscellaneous cold-heat syndrome,liver depression and spleen deficiency syndrome,spleen-kidney yang deficiency syndrome,yin-blood deficiency syndrome,etc.
引文
[1]屈冬冬,金世禄.溃疡性结肠炎发病机制研究进展[J].实用临床医药杂志,2016,20(3):184-187.
[2]中华中医药学会脾胃病分会,张声生,沈洪.溃疡性结肠炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(8):3585-3589.
[3]张新,刘冬梅,曹志群,等.溃疡性结肠炎伴抑郁、焦虑的中西医诊疗研究进展[J].山西中医,2015,31(10):60-62.
[4]郑帆,蔡丽,邱承智,等.中医药治疗溃疡性结肠炎临床研究进展[J].亚太传统医药,2018,14(6):91-93.
[5]朱立,王新月.溃疡性结肠炎病因病机理论探讨[J].吉林中医药,2010,30(1):10-11.
[6]刘启鸿,黄文彬,骆云丰,等.溃疡性结肠炎当重湿热[J].陕西中医药大学学报,2018,41(6):13-16.
[7]张丽芬.溃疡性结肠炎中医病名及发病机制探讨[J].国医论坛,2009,24(3):9-10.
[8]董俊刚,崔国宁,刘喜平,等.溃疡性结肠炎的中医病因病机研究进展[J].中国民族民间医药,2016,25(23):52-54.
[9]刘力,张欢.肠道菌群失调与溃疡性结肠炎[J].现代中医药,2010,30(2):45-47.
[10]黄艳,窦传字,刘慧荣,等.表观遗传修饰与溃疡性结肠炎[J].中国组织工程研究,2015,19(7):1099-1103.
[11]潘国宗.溃疡性结肠炎的病因和发病机制[J].现代消化及介入诊疗,2008,13(2):103-105.
[12]柯红燕,冯义朝.精神心理因素与溃疡性结肠炎关系的研究现状[J].医学综述,2014,20(16):2965-2967.
[13]孙鑫,王承党.吸烟对溃疡性结肠炎发病和免疫功能的影响[J].胃肠病学,2015,20(1):49-51.
[14]韩现红,翟晓萍,戴新娟.溃疡性结肠炎相关饮食影响及管理研究现状[J].中华护理杂志,2014,49(2):216-220.
[15]王艳芬,张建民.溃疡性结肠炎的危险因素[J].医学研究与教育,2010,27(3):57-60.
[16]格日勒,苏秉忠.溃疡性结肠炎危险因素研究进展[J].世界最新医学信息文摘,2016,16(100):65-66.
[17]姜杰新.溃疡性结肠炎病因及发病机制的研究进展[J].中国医师进修杂志,2004,27(23):51-52.
[2]中华中医药学会脾胃病分会,张声生,沈洪.溃疡性结肠炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(8):3585-3589.
[3]张新,刘冬梅,曹志群,等.溃疡性结肠炎伴抑郁、焦虑的中西医诊疗研究进展[J].山西中医,2015,31(10):60-62.
[4]郑帆,蔡丽,邱承智,等.中医药治疗溃疡性结肠炎临床研究进展[J].亚太传统医药,2018,14(6):91-93.
[5]朱立,王新月.溃疡性结肠炎病因病机理论探讨[J].吉林中医药,2010,30(1):10-11.
[6]刘启鸿,黄文彬,骆云丰,等.溃疡性结肠炎当重湿热[J].陕西中医药大学学报,2018,41(6):13-16.
[7]张丽芬.溃疡性结肠炎中医病名及发病机制探讨[J].国医论坛,2009,24(3):9-10.
[8]董俊刚,崔国宁,刘喜平,等.溃疡性结肠炎的中医病因病机研究进展[J].中国民族民间医药,2016,25(23):52-54.
[9]刘力,张欢.肠道菌群失调与溃疡性结肠炎[J].现代中医药,2010,30(2):45-47.
[10]黄艳,窦传字,刘慧荣,等.表观遗传修饰与溃疡性结肠炎[J].中国组织工程研究,2015,19(7):1099-1103.
[11]潘国宗.溃疡性结肠炎的病因和发病机制[J].现代消化及介入诊疗,2008,13(2):103-105.
[12]柯红燕,冯义朝.精神心理因素与溃疡性结肠炎关系的研究现状[J].医学综述,2014,20(16):2965-2967.
[13]孙鑫,王承党.吸烟对溃疡性结肠炎发病和免疫功能的影响[J].胃肠病学,2015,20(1):49-51.
[14]韩现红,翟晓萍,戴新娟.溃疡性结肠炎相关饮食影响及管理研究现状[J].中华护理杂志,2014,49(2):216-220.
[15]王艳芬,张建民.溃疡性结肠炎的危险因素[J].医学研究与教育,2010,27(3):57-60.
[16]格日勒,苏秉忠.溃疡性结肠炎危险因素研究进展[J].世界最新医学信息文摘,2016,16(100):65-66.
[17]姜杰新.溃疡性结肠炎病因及发病机制的研究进展[J].中国医师进修杂志,2004,27(23):51-52.
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