中风发病机制的肝源说
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摘要
我国脑卒中的发病率已经超过心肌梗死和肿瘤,成为居民第一大死亡原因。近20年来虽然投入巨资,但是其发病率不降反升。究其原因,中风发病的源头因素仍值得探索,治疗缺乏整体框架。针对脑卒中的核心病理变化——动脉粥样硬化的成因,中医认为卒中与心、肝、肾三脏之络的平衡失调关系密切,肝失濡养,殃及心脑,因而笔者推导出中风发病机制的肝源说。据此,可以引出心脑血管病治疗和预防的新策略,从源头上狙击中风的高发势头,具有一定的理论价值和潜在的临床应用前景。
Surpassing myocardial infarction and cancer, stroke has been the leading cause of death in China. In the past 20 years, the incidence of stroke did not fall in spite of huge amounts of money invested. The reasons are the unclear pathogenesis of stroke and the lack of overall framework of treatment. According to the core pathological changes of atherosclerosis, that is, abnormal blood lipids and bilirubin abnormality, traditional Chinese medicine holds that stroke is closely related with the balance disorders among the heart, liver and kidney. Therefore, we proposed that the onset of stroke may be caused by the liver losing nutrition leading to the injury of the brain. Based on the hypothesis of liver dysfunctioncaused stroke, we made a new strategy for the prevention and treatment of stroke—controlling stroke from the source. The hypothesis has certain theoretical value and prospect of clinical application.
Surpassing myocardial infarction and cancer, stroke has been the leading cause of death in China. In the past 20 years, the incidence of stroke did not fall in spite of huge amounts of money invested. The reasons are the unclear pathogenesis of stroke and the lack of overall framework of treatment. According to the core pathological changes of atherosclerosis, that is, abnormal blood lipids and bilirubin abnormality, traditional Chinese medicine holds that stroke is closely related with the balance disorders among the heart, liver and kidney. Therefore, we proposed that the onset of stroke may be caused by the liver losing nutrition leading to the injury of the brain. Based on the hypothesis of liver dysfunctioncaused stroke, we made a new strategy for the prevention and treatment of stroke—controlling stroke from the source. The hypothesis has certain theoretical value and prospect of clinical application.
引文
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[2]王伊龙,王春雪,王拥军.颅内动脉粥样硬化性狭窄的流行病学[J].国外医学:脑血管疾病分册,2005,13(6):418-422.
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[4]李伟,刘鸣,王丽春,等.脑卒中患者急性期血脂水平与病情严重程度的关系[J].临床神经病学杂志,2007,20(3):222-223.
[5]阮晓兰,刘春英.急性脑卒中与脂代谢紊乱的相关性分析[J].脑与神经疾病杂志,2012,20(3):228-230.
[6]张伟,高珊.高甘油三酯血症与动脉粥样硬化疾病关系的研究进展[J].宁夏医学杂志,2002,24(5):318-319.
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[8]皇甫建林,马向华,卢姗,等.影响颈动脉内膜中层厚度的代谢因素分析[J].江苏医药,2012,38(20):2413-2415.
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[11]权媛,钱民章.胆固醇通过NADPH氧化酶诱导ROS升高,NF-κB活化进而导致内皮细胞损伤[J].中国病理生理杂志,2010,26(8):1521-1526.
[12]卢志顺,余晓,唐俊利,等.胆固醇对血管内皮细胞的损伤[J].第三军医大学学报,2006,28(16):1679-1681.
[13]Schwertner HA,Jackson WG,Tolan G.Association of low serum concentration of bilirubin with increased risk of coronary artery disease[J].Clin Chem,1994,40(1):18-23.
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[15]李静,张继东,刘同涛.血清胆红素与冠脉病变程度、血脂及冠心病中医证型关系[J].南京中医药大学学报,2006,22(2):77-79.
[16]何昕,唐艳芳,刘景艳,等.血清胆红素水平与冠心病的相关性[J].中华实用诊断与治疗杂志,2012,26(9):929-931.
[17]王清峰.急性脑梗死患者血清胆红素浓度的变化[J].黑龙江医药,2012,25(4):621-622.
[18]马彦,樊继军,吕良德.血清胆红素水平与颈动脉粥样硬化斑块关系研究[J].陕西医学杂志,2012,41(12):1652-1653.
[19]渠建军.高脂血症患者血清总胆红素水平的临床探讨[J].中国医药导报,2012,9(8):154-155.
[20]林青,许少锋,孙凤皋.血清胆红素浓度低下与动脉粥样硬化的关系[J].福建医科大学学报,2000,34(3):259-261.
[21]曾永龙,唐任光,周晖登,等.血清总胆红素及血脂水平与冠心病的关系[J].右江民族医学院学报,2007,29(1):32-33.
[22]李家邦.中医学[M].北京:人民卫生出版社,2003:1-426.
[23]陈育文.健康管理干预对血脂异常人群体重指数、血压和血脂的改善情况分析[J].实用预防医学,2012,19(10):1758-1759.
[24]国立东,杨丽杰,霍贵成.乳酸菌降胆固醇机制的研究进展[J].食品与发酵工业,2013,39(2):117-120.
[2]王伊龙,王春雪,王拥军.颅内动脉粥样硬化性狭窄的流行病学[J].国外医学:脑血管疾病分册,2005,13(6):418-422.
[3]高旭光.脂代谢异常与脑卒中[J].中华老年心脑血管病杂志,2007,9(10):653-655.
[4]李伟,刘鸣,王丽春,等.脑卒中患者急性期血脂水平与病情严重程度的关系[J].临床神经病学杂志,2007,20(3):222-223.
[5]阮晓兰,刘春英.急性脑卒中与脂代谢紊乱的相关性分析[J].脑与神经疾病杂志,2012,20(3):228-230.
[6]张伟,高珊.高甘油三酯血症与动脉粥样硬化疾病关系的研究进展[J].宁夏医学杂志,2002,24(5):318-319.
[7]宋迎.老年脑干梗死的相关危险因素[J].中国老年学杂志,2013,33(6):1283-1284.
[8]皇甫建林,马向华,卢姗,等.影响颈动脉内膜中层厚度的代谢因素分析[J].江苏医药,2012,38(20):2413-2415.
[9]肖利杰,龚爱平,魏秀娥.脑梗死与血脂、血尿酸水平的相关分析[J].医学理论与实践,2012,25(24):3077-3078.
[10]汪慧星,杨一峻,钱民章.胆固醇致人血管内皮细胞DNA损伤[J].中国生物化学与分子生物学报,2012,28(5):442-448.
[11]权媛,钱民章.胆固醇通过NADPH氧化酶诱导ROS升高,NF-κB活化进而导致内皮细胞损伤[J].中国病理生理杂志,2010,26(8):1521-1526.
[12]卢志顺,余晓,唐俊利,等.胆固醇对血管内皮细胞的损伤[J].第三军医大学学报,2006,28(16):1679-1681.
[13]Schwertner HA,Jackson WG,Tolan G.Association of low serum concentration of bilirubin with increased risk of coronary artery disease[J].Clin Chem,1994,40(1):18-23.
[14]孙凤皋,林青,许少锋.血清胆红素与冠心病的关系[J].临床检验杂志,1999,17(4):228.
[15]李静,张继东,刘同涛.血清胆红素与冠脉病变程度、血脂及冠心病中医证型关系[J].南京中医药大学学报,2006,22(2):77-79.
[16]何昕,唐艳芳,刘景艳,等.血清胆红素水平与冠心病的相关性[J].中华实用诊断与治疗杂志,2012,26(9):929-931.
[17]王清峰.急性脑梗死患者血清胆红素浓度的变化[J].黑龙江医药,2012,25(4):621-622.
[18]马彦,樊继军,吕良德.血清胆红素水平与颈动脉粥样硬化斑块关系研究[J].陕西医学杂志,2012,41(12):1652-1653.
[19]渠建军.高脂血症患者血清总胆红素水平的临床探讨[J].中国医药导报,2012,9(8):154-155.
[20]林青,许少锋,孙凤皋.血清胆红素浓度低下与动脉粥样硬化的关系[J].福建医科大学学报,2000,34(3):259-261.
[21]曾永龙,唐任光,周晖登,等.血清总胆红素及血脂水平与冠心病的关系[J].右江民族医学院学报,2007,29(1):32-33.
[22]李家邦.中医学[M].北京:人民卫生出版社,2003:1-426.
[23]陈育文.健康管理干预对血脂异常人群体重指数、血压和血脂的改善情况分析[J].实用预防医学,2012,19(10):1758-1759.
[24]国立东,杨丽杰,霍贵成.乳酸菌降胆固醇机制的研究进展[J].食品与发酵工业,2013,39(2):117-120.