从氧化低密度脂蛋白论动脉粥样硬化与类风湿关节炎的异病同证(1)
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摘 要：动脉粥样硬化(AS)按其临床表现属于中医“瘀血”、“痰浊”的范畴，类风湿关节炎(RA)属中医学“痹证”范畴，二者中西医临床诊断虽均为不同的疾病，但从中医发病机制来看，均与“因瘀致痰，日久痰瘀互结”密切相关，因此我们认为二者虽为“异病”，但同有“瘀血痰浊”之证。AS与免疫炎症反应密切相关，氧化低密度脂蛋白(ox-LDL)、ox-LDL抗体及低密度脂蛋白免疫复合物 (LDL-IC) 在AS的发病中起重要作用。AS的快速发展致RA心血管事件高发生率。RA患者尤其是合并有心血管疾病的患者，其血脂和脂蛋白表现出致As性，有血浆Ox-LDL水平升高；血MDA-LDL、LDL-IC水平明显增加；LDL抗氧化能力下降。“氧化低密度脂蛋白”可以作为AS与RA“异病同证”的现代医学的研究指标之一，对与其相关的指标如ox-LDL、ox-LDL抗体及LDL-IC等进行密切的监测和药物干预，将有助于更好的全面的评估和治疗RA。
关键词：动脉粥样硬化；类风湿关节炎；氧化低密度脂蛋白
中图分类号：R285.5 文献标识码：A 文章编号：1673-7717(2011)04-0908-03
Atherosclerosis and Rheumatoid Arthritis are “Different Diseases
Tongzheng” to Follow Oxidized Low Density Lipoprotein
YAO Ru-Bing， CAI Hui
(Department of Integrated Traditional Chinese and Western Medicine,Nanjing General
Hospital of Nanjing Military Command,PLA,Nanjing 210002,Jiangsu，China)
Abstract:Atherosclerosis (AS)belongs to “stagnant blood”or“phlegm” according to clinical manifestation, and rheumatoid arthritis (RA)belongs to “arthralgia zheng”. They are “Different Diseases” according to diagnosis of traditional chinese medicine and west medicine. According to pathogenesis of traditional chinese medicine, they are relevant to“stagnant blood cause phlegm，stagnant blood and phlegm interties gradually”, and they have “Tongzheng” such as “stagnant blood and phlegm interties ”. AS is close relevant to immune inflammatory reaction. Oxidized low density lipoprotein(ox-LDL)，ox-LDL antibody and low density lipoprotein- immune complexes(LDL-IC) all play important roles in AS. More and more cadiovascular events of RA are relevant to AS rapid expansion. Lipids profile of RA are causing AS above all combined cadiovascular diseases, such as high levels Ox-LDL , MDA-LDL and LDL-IC , and LDL is more susceptible to oxidative. Ox-LDL could be as one of "Different Diseases Tongzheng" index about AS and RA. To monitor ox-LDL , ox-LDL antibody and LDL-IC are helpful to better evaluate and treat RA.
Key words:atherosclerosis；rheumatoid arthritis；oxidized low density lipoprotein
动脉粥样硬化(atherosclerosis， AS)是众多心脑血管疾病共同的病理基础。据报道，在 AS特征病变出现之前，人类从很小的年龄开始动脉就会出现弥散性内膜增厚， AS的发生发展包括脂质入侵、血小板活化、血栓形成、 内膜损伤、炎性反应、氧化应激、血管平滑肌细胞(VS MC)激活、 选择性基质代谢及血管重建等。中医古典医籍中没有动脉粥样硬化(atherosclerosis， AS)之名，按其临床表现属于中医“瘀血”、“痰浊”的范畴，“血瘀”、“痰凝”是其主要病理改变。张仲景在《金匮要略·惊悸吐衄下血胸满瘀血病脉证治第十六》中就“瘀血”言“血不利则为水” ......
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