[1]黄熠,许小岑,程沁钰,等.基于“肾脑相济”探讨HPA轴失调在干燥综合征合并抑郁症中的作用机制[J].陕西中医,2026,(1):66-71.[doi:DOI:10.3969/j.issn.1000-7369.2026.01.011]
 HUANG Yi,XU Xiaoceng,CHENG Qinyu,et al.Based on the kidney-brain interaction theory investigating the pathological mechanisms of HPA axis dysfunction in Sjogren’s Syndrome complicated with depression[J].,2026,(1):66-71.[doi:DOI:10.3969/j.issn.1000-7369.2026.01.011]
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基于“肾脑相济”探讨HPA轴失调在干燥综合征合并抑郁症中的作用机制

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2026年1期
页码:
66-71
栏目:
学术探讨
出版日期:
2026-01-05

文章信息/Info

Title:
Based on the kidney-brain interaction theory investigating the pathological mechanisms of HPA axis dysfunction in Sjogren’s Syndrome complicated with depression
作者:
黄熠1许小岑1程沁钰1陆燕1SO Xin Ru2(马来西亚)
(1.南京中医药大学附属医院,南京 210029;2.南京中医药大学,南京 210023)
Author(s):
HUANG Yi 1XU Xiaoceng1CHENG Qinyu1LU Yan1SO Xin Ru2
(1.Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China;2.Nanjing University of Traditional Chinese Medicine,Nanjing 210023,China)
关键词:
干燥综合征抑郁症肾脑相济下丘脑-垂体-肾上腺轴发病机制辨治思路
Keywords:
Sjogren’s syndromeDepressionKidney-brain coordinationHypothalamic-pituitary-adrenal axisTheoretical implicationsTreatment strategies
分类号:
R 749.41
DOI:
DOI:10.3969/j.issn.1000-7369.2026.01.011
文献标志码:
A
摘要:
干燥综合征(SS)是一种慢性自身免疫性疾病,常累及多脏器与系统,抑郁为常见合并症。SS与抑郁共病,患者常面临更严重的身心负担与不良预后。下丘脑-垂体-肾上腺(HPA)轴可能通过影响激素水平、脑结构、神经递质、促炎因子等途径介导SS合并抑郁症的发生发展。目前现代医学治疗手段存在一定局限性,亟需探索更有效的干预策略。中医“肾脑相济”理论深刻阐释了肾与脑的生理病理联系,在神志疾病治疗中具有独特优势。SS合并抑郁症属中医“燥郁共病”范畴,其核心病机为“肾脑失济”,以肾精亏虚、髓海失养为发病之始基,气郁血瘀、络脉阻滞为病进之标象。运用补肾填精益髓、行气化瘀通络的治则可有效改善患者临床症状,调节HPA轴功能紊乱,丰富并发展“肾脑相济”的中西医理论内涵,以期为临床治疗SS合并抑郁症提供新的理论支持和治疗思路。
Abstract:
Sjogren’s syndrome (SS) is a chronic autoimmune disease that often affects multiple organs and systems,with depression being a common comorbidity.The coexistence of SS and depression often imposes a more severe physical and mental burden on patients and leads to a poor prognosis.The hypothalamic-pituitary-adrenal (HPA) axis may mediate the occurrence and development of SS with depression through influencing hormone levels,brain structure,neurotransmitters,pro-inflammatory factors,etc.Modern medical treatment methods have certain limitations,and there is an urgent need to explore more effective intervention strategies.The theory of kidney-brain mutual assistance in traditional Chinese medicine profoundly explains the physiological and pathological connections between the kidney and the brain,and has unique advantages in the treatment of mental disorders.The condition of SS complicated by depression falls into the category of “co-morbidity of dryness and depression” in traditional chinese medicine.Its core pathogenesis is “the disconnection between the kidney and the brain”.The onset of the disease is based on the deficiency of kidney essence and the lack of nourishment for the sea of marrow,while Qi stagnation,blood stasis,and collateral obstruction are the manifestations of disease progression.The therapeutic principle of tonifying the kidney,enriching essence and marrow,regulating Qi,resolving blood stasis and unblocking meridians can effectively improve the clinical symptoms of patients,regulate the dysfunction of the HPA axis,enrich and develop the theoretical connotations of kidney-brain mutual assistance in both traditional Chinese and Western medicine,and provide new theoretical support and treatment ideas for the clinical treatment of SS combined with depression.

参考文献/References:

[1]姜泉,周新尧,唐晓颇,等.干燥综合征病证结合诊疗指南[J].中医杂志,2024,65(4):434-444.
[2]CUI Y,LI L,YIN R,et al.Depression in primary Sjogren’s syndrome:A systematic review and meta-analysis[J].Psychol Health Med,2018,23(2):198-209.
[3]KOTSIS K,VOULGARI P V,TSIFETAKI N,et al.Illness perceptions and psychological distress associated with physical health-related quality of life in primary Sjogren’s syndrome compared to systemic lupus erythematosus and rheumatoid arthritis[J].Rheumatol Int,2014,34(12):1671-1681.
[4]戴敏,刘婷,许潆月,等.原发性干燥综合征抑郁的研究进展[J].安徽医药,2024,28(3):436-440.
[5]ANDRE F,BOCKLE B C.Sjogren’s syndrome[J].J Dtsch Dermatol Ges,2022,20(7):980-1002.
[6]崔嘉桐,任路.基于“肾脑相济”理论探讨耳穴通过HPO轴治疗围绝经期失眠的机制[J].辽宁中医药大学学报,2025,27(1):152-155.
[7]孙元芳,赖嘉敏,王永宽,等.基于“肾脑相济”理论探讨安神补脑液防治阿尔茨海默病[J].中草药,2024,55(16):5692-5703.
[8]陈蕊,任路.基于“肾脑相济”理论探析不孕导致情志异常的因机证治[J].辽宁中医药大学学报,2024,26(4):207-210.
[9]郭延林,张树泉,王小亮.基于肾脑相关理论探讨补肾法在中风病治疗中的应用[J].中国中医基础医学杂志,2021,27(12):1912-1915,1942.
[10]于志谋,李响,崔冉,等.朱良春教授培补肾阳汤“阴阳并补”治疗干燥综合征经验介绍[J].世界中西医结合杂志,2019,14(3):340-343.
[11]马雯璐,杜晓林.从“胆气春升”探析卒中后抑郁[J].山东中医药大学学报,2025,49(1):26-30.
[12]李灿梅,黄竞瑶,程开远,等.名中医陈国忠基于“阳气怫郁”论治脾胃病并焦虑抑郁经验[J].陕西中医,2024,45(12):1683-1685,1690.
[13]罗静,吴子华,陶庆文.从燥湿同病探析原发性干燥综合征的病因病机[J].中华中医药杂志,2023,38(7):3154-3157.
[14]张文,陈竹,厉小梅,等.原发性干燥综合征诊疗规范[J].中华内科杂志,2023,62(9):1059-1067.
[15]MCCARRON R M,SHAPIRO B,RAWLES J,et al.Depression[J].Ann Intern Med,2021,174(5):65-80.
[16]JOHNSON E O,VLACHOYIANNOPOULOS P G,SKOPOULI F N,et al.Hypofunction of the stress axis in Sjogren’s syndrome[J].J Rheumatol,1998,25(8):1508-1514.
[17]SKOPOULI F N,KATSIOUGIANNIS S.How stress contributes to autoimmunity-lessons from Sjogren’s syndrome[J].FEBS Lett,2018,592(1):5-14.
[18]KINLEIN S A,PHILLIPS D J,KELLER C R,et al.Role of corticosterone in altered neurobehavioral responses to acute stress in a model of compromised hypothalamic-pituitary-adrenal axis function[J].Psychoneuroendocrinology,2019,102:248-255.
[19]褚配鑫,许超,杨亚旭,等.原发性干燥综合征合并抑郁症发病相关机制研究进展[J].中外医学研究,2024,22(14):171-176.
[20]BATSUKH S,OH S,RHEU K,et al.Rice germ ameliorated chronic unpredictable mild stress-induced depressive-like behavior by reducing neuroinflammation[J].Nutrients,2022,14(24):5382.
[21]张婷,张珂霖,周仁来.经前期综合征女性的HPA轴功能失调:一项基于皮质醇水平的元分析[J].心理科学进展,2023,31(6):988-1002.
[22]钟静玫,张虹,武绍远,等.干燥综合征并发抑郁的神经内分泌病因分析[J].中国全科医学,2018,21(20):2448-2451.
[23]MA H,LI C,WANG J,et al.Amygdala-hippocampal innervation modulates stress-induced depressive-like behaviors through AMPA receptors[J].Proc Natl Acad Sci USA,2021,118(6):1-10.
[24]PENG G J,TIAN J S,GAO X X,et al.Research on the pathological mechanism and drug treatment mechanism of depression[J].Curr Neuropharmacol,2015,13(4):514-523.
[25]LUO Y,HE H,ZHANG M,et al.Altered serum levels of TNF-α,IL-6 and IL-18 in manic,depressive,mixed state of bipolar disorder patients[J].Psychiatry Res,2016,244:19-23.
[26]ANJUM S,QUSAR M M,SHAHRIAR M,et al.Altered serum interleukin-7 and interleukin-10 are associated with drug-free major depressive disorder[J].Ther Adv Psychopharmacol,2020,10:1-11.
[27]LI S,FANG Y,ZHANG Y,et al.Microglial NLRP3 inflammasome activates neurotoxic astrocytes in depression-like mice[J].Cell Rep,2022,41(4):1-10.
[28]刘燕,彭梦薇,张文娴,等.脑内星形胶质细胞-神经元相互作用参与抑郁症发病研究进展[J].中国比较医学杂志,2023,33(3):124-129.
[29]TROUBAT R,BARONE P,LEMAN S,et al.Neuroinflammation and depression:A review[J].Eur J Neurosci,2021,53(1):151-171.
[30]SARNO E,MOESER A J,ROBISON A J.Neuroimmunology of depression[J].Adv Pharmacol,2021,91:259-292.
[31]沈自尹.肾阳虚证的定位研究[J].中国中西医结合杂志,1997,17(1):50-52.
[32]周玲,王平,彭圆.中医“肾脑系统”的构建及其现代生物学基础[J].中华中医药杂志,2018,33(2):422-425.
[33]卞琴,刘书芬,黄建华,等.3种补肾中药有效成分对去卵巢骨质疏松大鼠骨髓间充质干细胞的调控作用[J].中华中医药杂志,2011,26(5):889-893.
[34]阮玲娟,崔戈,顾旭东,等.虎杖苷诱导人脐带间充质干细胞向神经元样细胞分化过程中Notch信号通路的表达改变[J].中华中医药学刊,2014,32(8):1848-1851.
[35]招远祺,乔利军,袁龙健,等.从神经干细胞角度探索中医药介入中枢神经再生的研究策略[J].中国中医基础医学杂志,2015,21(7):915-918.
[36]TONG X,YANG Y,GONG S,et al.Data mining and network pharmacology analysis of kidney-tonifying herbs on the treatment of renal osteodystrophy based on the theory of “kidney governing bones” in traditional Chinese medicine[J].Evid Based Complement Alternat Med,2022,2022:1-13.
[37]YAO R,ZHANG L,LI X,et al.Effects of epimedium flavonoids on proliferation and differentiation of neural stem cells in vitro[J].Neurol Res,2010,32(7):736-742.
[38]王水华,陈帮明,刘永芳,等.养阴益肾颗粒对糖皮质激素致肾阴虚证大鼠HPA轴的影响[J].中国实验方剂学杂志,2016,22(11):142-147.
[39]秦臻,任艳玲,史馨钰.左、右归丸及其拆方对去卵巢大鼠下丘脑及肾上腺TGF-β1、PKA蛋白表达的影响[J].中华中医药杂志,2019,34(2):569-573.
[40]孙卫,赵珩茜,陈月月.归元饮对干燥综合征合并抑郁症疗效研究[J].陕西中医,2025,46(3):330-334.
[41]张堃,周楠,王立娜.补泻针灸疗法联合疏肝解郁汤治疗原发性干燥综合征伴焦虑抑郁临床研究[J].陕西中医,2022,43(4):515-518.
[42]胡丹,刘元月,盛蕾.柴胡疏肝散对卒中后抑郁模型大鼠BDNF/TrkB信号通路和炎症指标的影响[J].江苏中医药,2020,52(8):78-81.
[43]黄丽蓉,何乾超,庞东林,等.四逆散抗抑郁机制研究进展[J].亚太传统医药,2022,18(6):230-234.
[44]杨孝兵,龙小琴,蔡慧.解毒祛瘀滋阴方对原发性干燥综合征伴抑郁患者高凝血状态及临床疗效的影响[J].浙江中西医结合杂志,2022,32(6):530-533.
[45]赵雪莹,何世宇.赤芍总苷药理作用研究进展[J].辽宁中医药大学学报,2024,26(7):4-9.
[46]QUAN W,LIU F,ZHANG Y,et al.Antidepressant-like effects of magnesium lithospermate B in a rat model of chronic unpredictable stress[J].Pharm Biol,2015,53(8):1168-1175.
[47]赖克道,李冬梅,韦桂宁,等.基于CREB/BDNF通路探讨鸡血藤总黄酮对抑郁大鼠海马神经可塑性的影响[J].中国实验方剂学杂志,2022,28(5):55-61.
[48]刘若楠,古力巴克然木·阿布拉,沈小琴,等.雷公藤甲素通过上调miR-137调控小胶质细胞极化改善大鼠抑郁样行为[J].现代药物与临床,2023,38(5):1021-1027.

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备注/Memo

备注/Memo:
国家自然科学基金资助面上项目(81774104);江苏省卫生健康委员会中医药科技发展专项课题(2020ZX09);江苏省教育厅研究生实践创新计划项目(SJCX24-0989);江苏省中医院科主任学术提升专项课题(Y2022ZR01)
更新日期/Last Update: 2026-01-08