基于单胺类神经递质的COPD抑郁障碍与“肺主悲忧”理论的关联机制研究

The concept that "lung governing anxiety"is derived from "yellow Emperor's InnerCanon", It is a main point in the theory of visceral outward manifestation,andIt's plays an important role in the pathogenesis of lung diseases. However, thecurrent lack of research in this field has restricted its clinicalapplication.Depressive disorder has become a common complication of COPD,modernresearch confirms that it has closely relationship with monoamine neurotransmittermetabolism. Our preliminary study has found that many COPD patients are alsosuffering from depressive disorder. Furthermore, the severity of lung qideficiency and depressive disorder have a positive correlation.The Yiqi HuatanQuyu prescription has good curative effects.Therefore, we put forward thehypothesis that"lung qi deficiency, phlegm and blood stasis obstructinglung,essential qi can not disseminate and deep grief can induce monoamineneurotransmitter metabolic disorder, resulting in the occurrence of COPDdepression". Guided by the theory of visceral outward manifestation, this studyselects the COPD depression model rats, prescribes them with the Yiqi Huatan Quyuprescription to regulate qi-blood circulation and body fluid operation, in orderto regulate the monoamine neurotransmitter to intervene COPD depression disorder.This study interprets the relevance between the oretical connotation of"lunggoverning anxiety",the monoamine neurotransmitters and COPD depression,preliminarysets forth the guidance of the theory"lung governing anxiety"on the prevention andtreatment of COPD depression.

《黄帝内经》之“肺主悲忧”说是肺藏象学的主要内容。而肺与悲忧的关系目前国内外研究均相对较少，限制了该理论在临床中的应用。临床观察表明，抑郁障碍已成为慢性阻塞性肺疾病（COPD）的常见合并症。现代研究证实，其与患者单胺类神经递质代谢失常关系密切。我们前期研究发现，COPD患者随着病程进展，肺气亏虚程度逐步加重，并伴有痰瘀阻肺的表现，此时患者多合并抑郁障碍，应用补肺气、化痰瘀方药治疗，临床疗效确切。据此我们提出“COPD肺气亏虚、痰瘀阻肺，精气不化，悲忧过激，致单胺类神经递质代谢失常，从而导致COPD抑郁的发生”之假说。本研究以中医藏象理论为指导，选择COPD抑郁障碍模型大鼠，给予补肺气、化痰瘀方药，调节气血水液运行，调控单胺类神经递质干预COPD抑郁障碍，以期阐释“肺主悲忧”的理论内涵与单胺类神经递质及COPD抑郁障碍的关联机制，初步明确“肺主悲忧”理论对COPD抑郁障碍防治的指导作用。

课题组探讨了益气化痰祛瘀方——芪白平肺胶囊对COPD合并抑郁大鼠神经递质影响的观察。主要研究内容与研究结果如下：.1）通过理论研究，初步明确“肺主悲忧”理论的关键内涵。“肺主悲忧”是对肺的生理功能在情绪方面的高度概括，治节功能是通过肺主气而行使的，肺气虚则肺失治节，顺次发生的“气虚痰凝血瘀”是多种肺系疾病如肺胀等的关键病理环节和重要发病机理。.2）动物实验建立COPD合并抑郁障碍模型大鼠，通过芪白平肺胶囊有效干预，确证芪白平肺胶囊能有效改善COPD抑郁大鼠一般状况及抑郁状态，上调肺功能参数值，改善肺通气和炎症反应从而有效改善肺功能。.3）课题通过系列研究，明确了“肺主悲忧”的理论内涵及对COPD合并抑郁障碍的防治指导作用，阐明“肺主悲忧”与单胺类神经递质及COPD抑郁障碍的关联性，为中医药防治COPD合并抑郁提供理论和实验依据。