基于“虚气留滞”探讨中医药调控细胞铁死亡对低氧性肺动脉高压的影响*

作者：张敏捷1，曲妮妮2，张全英3，秦一冰1，尹 举4，王冶涵5

单位：1.辽宁中医药大学，辽宁 沈阳 110033； 2.辽宁中医药大学附属医院，辽宁 沈阳 110032； 3.山东中医药大学第一临床学院，山东 济南 250014； 4.辽宁中医药大学附属第二医院，辽宁 沈阳 110034； 5.沈阳航天医院，辽宁 沈阳 110044

引用：引用：张敏捷，曲妮妮，张全英，秦一冰，尹举，王冶涵.基于“虚气留滞”探讨中医药调控细胞铁死亡对低氧性肺动脉高压的影响[J].中医药导报,2025,31(12):196-202,210.

DOI：10.13862/j.cn43-1446/r.2025.12.032

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摘要：低氧性肺动脉高压（HPH）是一种由慢性缺氧引发的肺血管重构性疾病，其病理机制与细胞铁死亡密切相关。细胞铁死亡特征是细胞内脂质过氧化物的积累和铁代谢异常，导致细胞膜完整性破坏和细胞死亡，是一种铁依赖性的程序性细胞死亡方式。本文基于中医“虚气留滞”理论，系统探讨中医药调控细胞铁死亡在HPH中的作用。“虚气留滞”是HPH细胞铁死亡的病机概括，“虚气”（元气亏虚）为本，“留滞”（气滞血瘀，痰热阻肺）为标，二者互相影响，推动疾病发展。通过整合现代分子生物学机制与中医病机理论，提出HPH细胞铁死亡中“元气亏虚（线粒体功能障碍）-气滞血瘀（脂质过氧化）-痰热阻滞（炎症反应）”的中西医结合病理模型。基于“虚气留滞”病机，提出“益气培元、行滞化痰”的中医药治疗原则：早期以补肺汤、参附注射液等中药补益肺脾肾元气，上调GPX4/SLC7A11通路抑制铁死亡；中、后期联合血府逐瘀汤、芪白平肺胶囊等中药行滞化痰，调控TLR4/NF-κB与PI3K/Akt/Nrf2信号轴，改善氧化应激与炎症微环境，抑制铁死亡。

关键词：低氧性肺动脉高压；细胞铁死亡；虚气留滞；中医药；HPH

Abstract：

Hypoxic pulmonary hypertension (HPH) is a pulmonary vascular remodeling disease caused by chronic hypoxia, and its pathological mechanism is closely related to cellular ferroptosis. Characterized by the accumulation of intracellular lipid peroxides and abnormal iron metabolism, ferroptosis leads to the destruction of cell membrane integrity and cell death, which is an iron-dependent form of programmed cell death. Based on the traditional Chinese medicine (TCM) theory of "stagnation of deficient Qi", this paper systematically discusses the role of TCM in regulating cellular ferroptosis in HPH. "Stagnation of deficient Qi" summarizes the pathogenesis of cellular ferroptosis in HPH, where "deficient Qi" (primordial Qi deficiency) is the root cause and "stagnation" (Qi stagnation and blood stasis, phlegm-heat obstructing the lung) is the superficial manifestation. These two factors interact with each other and drive the progression of the disease. By integrating modern molecular biological mechanisms with TCM pathogenesis theory, this paper proposes an integrated Chinese and western medicine pathological model of "primordial Qi deficiency (mitochondrial dysfunction) - Qi stagnation and blood stasis (lipid peroxidation) - phlegm-heat obstruction (inflammatory response)" in cellular ferroptosis of HPH. Based on the pathogenesis of "stagnation of deficient Qi", the TCM treatment principles of "replenishing Qi and cultivating primordial Qi, promoting Qi movement and resolving phlegm" are put forward: in the early stage, Chinese medicinals such as Bufei Decoction (补肺汤) and Shenfu Injection (参附注射液) are used to tonify the primordial Qi of the lung, spleen and kidney, and up-regulate the GPX4/SLC7A11 pathway to inhibit ferroptosis; in the middle and late stages, Chinese medicinals such as Xuefu Zhuyu Decoction (血府逐瘀汤) and Qibai Pingfei Capsule (芪白平肺胶囊) are combined to promote Qi movement and resolve phlegm, regulate the TLR4/NF-κB and PI3K/Akt/Nrf2 signaling axes, improve oxidative stress and inflammatory microenvironment, and inhibit ferroptosis.

Key words：hypoxic pulmonary hypertension; cellular ferroptosis; stagnation of deficient Qi; traditional Chinese medicine; HPH

发布时间：2025-12-31

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