周波波,尚 芳,孟丽红,张彦博

慢性阻塞性肺疾病（COPD，慢阻肺）属中医“肺胀”“喘证”范畴，核心病理为气道慢性炎症与进行性气流受限，发病与肺脾肾三脏亏虚、痰瘀毒互结密切相关。现代医学证实，miRNA介导的基因调控网络在慢阻肺进展中起关键作用，其中miR-218-5p/LIN28B轴通过调控气道上皮细胞凋亡、自噬及炎症反应，与慢阻肺气道炎症加剧、肺功能下降密切相关。本文结合中医“本虚标实”病机特点，综述miR-218-5p/LIN28B轴调控慢阻肺气道炎症的分子机制，系统梳理中西医基于该轴及相关信号通路的干预研究进展，为中西医结合防治慢阻肺提供新的理论依据与临床思路。

慢性阻塞性肺疾病；miR-218-5p/LIN28B轴；细胞凋亡

[1] 中国慢性阻塞性肺疾病诊治指南(2021年修订版)写作组.中国慢性阻塞性肺疾病诊治指南(2021年修订版)[J].中华结核和呼吸杂志,2021,44(3):170-205. [2] Booton R,Lindsay M A.Emerging role of microRNAs and long noncoding RNAs in respiratory disease[J].Chest,2014,146(1):193-204. [3] Conickx G,Mestdagh P,Avila Cobos F,et al.MicroRNA Profiling Reveals a Role for MicroRNA-218-5p in the Pathogenesis of Chronic Obstructive Pulmonary Disease[J].Am J Respir Crit Care Med,2017,195(1):43-56. [4] 林琳,殷明刚,张念志.慢性阻塞性肺疾病中医病机及辨证论治研究进展[J].中医药临床杂志,2022,34(7):1339-1343. [5] 焦伟,李艳,张庆莲.miRNA在呼吸系统疾病中的研究进展[J].中国老年学杂志,2020,40(24):5360-5364. [6] Pietrusińska M,Pajak A,Górski P,et al.Differences in microRNA expression in asthma and chronic obstructive pulmonary disease[J]. Postepy Dermatol Alergol,2016,33(4):276-280. [7] 李想,王辰.非编码RNA在肺发育与肺部疾病中的作用[J].中华结核和呼吸杂志,2018,41(6):479-483. [8] Dang X,Qu X,Wang W,et al.Bioinformatic analysis of microRNA and mRNA regulation in peripheral blood mononuclear cells of patients with chronic obstructive pulmonary disease[J].Respir Res,2017,18(1):4. [9] Campbell J D,McDonough J E,Zeskind J E,et al.A gene expression signature of emphysema-related lung destruction and its reversal by the tripeptide GHK[J].Genome Med,2012,4(8):67. [10] Xu H,Sun Q,Lu L,et al.MicroRNA-218 acts by repressing TNFR1-mediated activation of NF-κB,which is involved in MUC5AC hyper-production and inflammation in smoking-induced bronchiolitis of COPD[J].Toxicol Lett,2017,280:171-180. [11] 任敏,李琳,梁向清.miR-218-5p通过靶向LIN28B调控COPD气道上皮细胞凋亡和炎症反应[J].西部医学,2021,33(1):27-32. [12] 白亚虎,董延春,宁康.常见信号通路在慢性阻塞性肺疾病发病机制中的研究进展[J].中国医药,2023,18(1):127-130. [13] 钟南山,王辰,冉丕鑫.慢性阻塞性肺疾病学[M].北京:人民卫生出版社,2020:89-96. [14] 张雪,谭庆晶,窦维华.自噬调控在慢性阻塞性肺疾病中的作用及中医药干预研究进展[J].中国中药杂志,2023,48(12):3198-3205. [15] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组｡慢性阻塞性肺疾病急性加重期抗感染治疗专家共识(2023年版)[J].中华结核和呼吸杂志,2023,46(5):401-410. [16] Zhang Y,Li X,Wang H,et al.MiR-486-5p enhances TLR1-induced inflammation in COPD by targeting HAT4[J].J Cell Mol Med, 2022,26(19):5566-5578. [17] 梅永添,向薇,赵涛,等.慢性阻塞性肺疾病患者血清miR-218､miR-29b水平变化及对急性加重期的预测价值[J].中国医刊,2024, 59(12):1308-1311. [18] Nadi E,Geramirad G,Kahramfar Z,et al.Peripheral blood expressions of MicroRNA-146a and MicroRNA-218 in chronic obstructive pulmonary disease with/without cigarette smoke exposure[J].Iran J Allergy Asthma Immunol,2022,21(4):399-406. [19] 王梦迪,丁浩.头孢他啶通过miR-218-5p调控Nrf2/HO-1信号通路对LPS诱导的慢性支气管炎大鼠模型气道炎症和阻塞的改善作用[J].免疫学杂志,2024,40(8):655-662. [20] 周仲瑛.中医内科学[M].北京:中国中医药出版社,2021:78-85. [21] 吴思骐,刘建博.慢性阻塞性肺疾病差异基因与中药预测的生物信息学分析[J].世界中医药,2021,16(14):2189-2195. [22] Zhang H,Liu B,Jiang S,et al.Baicalin ameliorates cigarette smoke-induced airway inflammation in rats by modulating HDAC2/NF-κB/PAI-1 signalling[J].Pulm Pharmacol Ther,2021,71:102061. [23] 杨晓敏,张蓓,张鹏飞.等.基于p38MAPK通路探讨银杏叶提取物对慢性阻塞性肺疾病大鼠气道黏液高分泌及血管重塑的影响[J].现代生物医学进展,2023,23(9):1624-1630+1641. [24] Zhou B,Yu W,Zhang C,et al.Tiao-bu-shen formula promotes downregulation of the caveolin 1-p38 mapk signaling pathway in COPD-associated tracheobronchomalacia cell model[J].J Ethnopharmacol,2022,293:115256. [25] 张高,黄楚栓,褚庆民,等.肺康颗粒对COPD大鼠miRNA21､TGF-β/Wnt5a信号通路的影响及机制[J].广东医学,2022,43(5):529-533.

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