福建中医药大学附属康复医院;福建中医药大学;
从胶质淋巴系统与血管性认知障碍(VCI)核心病机水湿、痰浊、瘀血的内在关系出发,探讨VCI的临床辨治思路。“肾主水”功能异常引起的水湿、痰浊、瘀血是VCI发生、发展的关键病机。胶质淋巴系统参与了中枢神经系统的脑脊液循环,其功能障碍可导致大脑内可溶性代谢产物的清除率下降,而这些代谢废物是VCI发生进展的重要原因。认为“肾主水”与胶质淋巴系统功能相关,脑络与胶质淋巴系统结构相关,应用补肾化痰、活血通络法以清除互结之水湿、痰浊、瘀血,常用具有祛湿化浊、化痰开窍、益智健脑功效的开心散加减,并且推测其可能通过调控胶质淋巴系统功能以达到改善VCI预后的目的,为中医药防治VCI提供思路。
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下载次数 | 被引频次 | 阅读次数 |
[1]RUNDEK T,TOLEA M,ARIKO T,et al. Vascular cognitive impairment(VCI)[J]. Neurotherapeutics,2022,19(1):68-88.
[2]CHANG WONG E,CHANG CHUI H. Vascular cognitive impairment and dementia[J]. Continuum(Minneap Minn),2022,28(3):750-780.
[3]刁美玲,孙梦珠,许贝贝,等.中医治疗非痴呆型血管性认知功能障碍研究概况[J].中医药临床杂志,2017,29(11):1797-1800.
[4]祁帅党,马巧琳,胡斌,等.针药并用从“肾主水”论治五液失常病症[J].世界中医药,2024,19(4):533-536.
[5]黎明全,艾春玲,赵建军,等.中国血管性认知功能障碍中医证候分布频率的Meta分析[J].北京中医药,2016,35(7):628-633.
[6]ANG PS,ZHANG DM,AZIZI SA,et al. The glymphatic system and cerebral small vessel disease[J]. J Stroke Cerebrovasc Dis,2024,33(3):107557.
[7]宋颢.血管性认知障碍中的类淋巴功能改变及机制研究[D].武汉:武汉大学,2023.
[8]TIAN Y,CAI X,ZHOU Y, et al. Impaired glymphatic system as evidenced by low diffusivity along perivascular spaces is associated with cerebral small vessel disease:a population-based study[J]. Stroke Vasc Neurol,2023,8(5):413-423.
[9]成西,马淑然,张和韡,等.肾主水季节性变化规律的理论探讨[J].中医药导报,2017,23(16):6-9.
[10]袁玉娇,时晶,田金洲.田金洲分期治疗痴呆经验[J].北京中医药,2019,38(8):770-773.
[11]陈昱彤,喻嵘,谭艳,等.血管性认知障碍的中医证型、证素分布及用药规律[J].湖南中医药大学学报,2021,41(6):869-874.
[12]沈志强,张闻东.中医药治疗血管性认知障碍研究进展[J].老年医学研究,2024,5(4):31-33.
[13]HABLITZ LM,PLáV,GIANNETTO M,et al. Circadian control of brain glymphatic and lymphatic fluid flow[J].Nat Commun,2020,11(1):4411.
[14]JIANG-XIE LF,DRIEU A,BHASIIN K,et al. Neuronal dynamics direct cerebrospinal fluid perfusion and brain clearance[J]. Nature,2024,627(8002):157-164.
[15]ILIFF JJ,WANG M,LIAO Y,et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitialsolutes, including amyloidβ[J]. Sci Transl Med,2012,4(147):147ra111. doi:10. 1126/scitranslmed. 3003748.
[16]JESSEN NA,MUNK AS,LUNDGAARD I,et al. The glymphatic system:a Beginner's guide[J]. Neurochem Res,2015,40(12):2583-2599.
[17]NYCZ B,MANDERA M. The features of the glymphatic system[J]. Auton Neurosci,2021,232:102774. doi:10. 1016/j. autneu. 2021. 102774.
[18]LI C,ZHANG L,LI X,et al. Sulforaphane suppresses Aβaccumulation and tau hyperphosphorylation in vascular cognitive impairment(VCI)[J]. J Nutr Biochem,2025,136:109803. doi:10. 1016/j. jnutbio. 2024. 109803.
[19]TIAN Y,ZHAO M,CHEN Y,et al. The underlying role of the glymphatic system and meningeal lymphatic vessels in cerebral small vessel disease[J]. Biomolecules,2022,12(6):748.
[20]HOSOKI S,HANSRA GK,JAYASENA T,et al. Molecular biomarkers for vascular cognitive impairment and dementia[J]. Nat Rev Neurol,2023,19(12):737-753.
[21]SONG H,RUAN Z,GAO L,et al. Structural network efficiency mediates the association between glymphatic function and cognition in mild VCI:a DTI-ALPS study[J].Front Aging Neurosci,2022,14:974114. doi:10. 3389/fnagi. 2022. 974114.
[22]LIANG T,CHANG F,HUANG Z,et al. Evaluation of glymphatic system activity by diffusion tensor image analysis along the perivascular space(DTI-ALPS)in dementia patients[J]. Br J Radiol,2023,96(1146):20220315.
[23]LOGIN FH,NEJSUM LN. Aquaporin water channels:roles beyond renal water handling[J]. Nat Rev Nephrol,2023,19(9):604-618.
[24]MESTRE H,HABLITZ LM,XAVIER ALR,et al.Aquaporin-4-dependent glymphatic solute transport in the rodent brain[J]. Elife,2018,7:e40070. doi:10. 7554/eLife. 40070.
[25]DU T,RAGHUNANDAN A,MESTRE H,et al. Restoration of cervical lymphatic vessel function in aging rescues cerebrospinal fluid drainage[J]. Nat Aging,2024,4(10):1418-1431.
[26]金硕果,刘福友,杨东东,等.基于胶质淋巴系统探讨“毒损脑络”[J].中国实验方剂学杂志,2020,26(10):186-191.
[27]XIONG Y,YU Q,ZHI H,et al. Advances in the study of the glymphatic system and aging[J]. CNS Neurosci Ther,2024,30(6):e14803.
[28]苏芮,韩振蕴,范吉平,等.“毒损脑络”理论在阿尔茨海默病中医研究领域中的意义[J].中医杂志,2011,52(16):1370-1371.
[29]申伟,曾子修,金香兰,等.中药治疗卒中后认知障碍疗效和安全性的系统评价[J].中国实验方剂学杂志,2020,26(11):185-193.
[30]孔繁鑫.基于临床状态医学理论研究脑髓康治疗卒中后非痴呆型认知障碍的临床疗效[D].广州:广州中医药大学,2021.
[31]黄润记,杨文明.益肾通络方治疗缺血性脑小血管病伴非痴呆型血管性认知功能障碍的临床疗效观察[J].中西医结合心脑血管病杂志,2020,18(8):1204-1207.
[32]DEARDORFF WJ,GROSSBERG GT. Behavioral and psychological symptoms in Alzheimer's dementia and vascular dementia[J]. Handb Clin Neurol,2019,165:5-32.doi:10. 1016/B978-0-444-64012-3. 00002-2.
[33]董晓静.丹参调节AQPs表达诠释“活血利水”之亚法本质的研究[D].西安:第四军医大学,2014.
[34]周慧敏,向楠,胡旭,等.基于“肾主水”探讨“肉桂-陈皮”调控肥胖大鼠AQP7、AQP9的作用机制[J].湖北中医杂志,2020,42(11):3-6.
[35]李佳欣.远志散“益气化痰开窍”促进中枢淋巴系统引流清除AD脑内Aβ的机制研究[D].成都:成都中医药大学,2024.
基本信息:
DOI:10.13288/j.11-2166/r.2025.11.006
中图分类号:R277.7
引用信息:
[1]陈森林,陈雨,邹愉龙等.从“肾主水”和胶质淋巴系统的关系探讨血管性认知障碍的辨治[J].中医杂志,2025,66(11):1114-1118.DOI:10.13288/j.11-2166/r.2025.11.006.
基金信息:
福建省认知功能康复重点实验室开放课题(XKF2023006); 福建省自然科学基金(2024J01142,2021J01954); 福建省卫健委医学创新课题(2021CXA040)