基于“内皮损伤学说”探讨动脉粥样硬化的中医药防治策略

傅馨莹 孙正骥 张伟

摘要 基于“动脉粥样硬化内皮损伤学说”，探讨在动脉粥样硬化（AS）疾病发生发展过程中，血管内皮功能障碍与血管内皮损伤的联系及区别。阐述血管内皮功能障碍与血管内皮损伤的概念，从血管内皮细胞分泌的一氧化氮/内皮素（NO/ET）稳态，诱发的炎症反应及氧化应激的角度和激活的VECF、MAKP、JAK/STAT、PI3K-AKT通路出发，探讨动脉粥样硬化疾病进程中二者的联系与区别。通过检索Genecards数据库，筛选血管内皮功能障碍、血管内皮损伤及AS的相关靶点，从分子角度进一步论证。阐明中药对血管内皮功能障碍及血管内皮损伤的保护及修复作用。

关键词 血管内皮功能障碍;血管内皮损伤;动脉粥样硬化;Genecards数据库;中医药;炎症反应;氧化应激;内皮细胞

Abstract Based on the theory of atherosclerotic endothelial injury，this paper discusses the relationship and difference between vascular endothelial dysfunction and vascular endothelial injury in the course of occurrence and development of atherosclerotic diseases.This paper firstly describes the concepts of vascular endothelial dysfunction and vascular endothelial injury，and explores the relationship and difference between the two in the process of atherosclerotic disease from the point of view of NO/ET homeostasis secreted by vascular endothelial cells，inflammatory response and oxidative stress induced by vascular endothelial cells and activated VECF，MAKP，JAK/STAT，PI3K-AKT signaling pathway.Then the Genecards database were searched to screen the related targets of vascular endothelial dysfunction，vascular endothelial injury and AS，which were further demonstrated from the molecular point of view.Finally，the protective and repair effects of traditional Chinese medicine on vascular endothelial dysfunction and vascular endothelial injury were described.

Keywords Vascular endothelial dysfunction; Vascular endothelial injury; Atherosclerosis; Genecards database; Traditional Chinese medicine; Inflammatory response; Oxidative stress; Vascular endothelial cells

中圖分类号：R242;R256文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.11.024

Ross[1]提出“动脉粥样硬化（Atherosclerosis，AS）内皮损伤反应学说”，认为血管内皮功能障碍发生在AS致血管内皮损伤前，并对血管内皮造成持续性的病理损伤，使功能障碍渐进性加重，从而致相关血管壁发生炎症反应及过度的慢性增生，进一步造成血管内皮损伤的病理性改变。自这一学说的提出后，血管内皮细胞（Vascular Endothelial Cells，VECs）成为一个新的研究方向及热点问题，多以血管细胞内皮功能障碍与AS的关系作为主要的切入点，但血管内皮功能障碍和血管内皮细胞损伤的联系及区别的研究较少。我们基于AS探讨血管内皮功能障碍及血管内皮损伤联系及区别，并探讨其可能的作用机制及中医药干预作用。

1 血管内皮功能……