基于“脾–卫–痹”模型探讨肠道菌群在类风湿性关节炎中的作用及中医药干预策略

The “Spleen-Wei-Bi” Axis: Exploring the Role of Gut Microbiome in Rheumatoid Arthritis and TCM Intervention Strategies

摘要: 类风湿性关节炎(Rheumatoid Arthritis, RA)是一种以滑膜炎症和渐进性关节损伤为特征的慢性自身免疫性疾病，其发生发展已被证实与肠道微生态失衡密切相关。文章基于中医学“脾为之卫”理论，构建“脾–卫–痹”动态失衡模型，该模型将RA病理演变划分为三个递进阶段：“脾虚失卫–邪乘虚入–痰瘀互结”。脾虚可致肠道菌群紊乱、肠屏障受损，是疾病发生的始动环节；卫气失固致使外邪乘隙侵入，激活免疫炎症级联反应，成为病情进展枢纽；痰瘀互结终致关节结构破坏、骨组织侵蚀，形成最终病理结局。研究通过临床研究、动物实验、网状Meta分析及孟德尔随机化研究从多维度为该理论模型提供了翔实证据，并以“脾–卫–痹”模型为指导，系统整合RA发病机制与中医药干预策略，为临床诊疗提供整体性思路。

Abstract: Rheumatoid arthritis (RA) is a chronic autoimmune disease driven by synovial inflammation and progressive joint damage, a process increasingly linked to gut microbiota dysbiosis. Drawing on the traditional Chinese medicine (TCM) principle that “the spleen governs defensive Qi (Wei-Qi)”, this article proposes a dynamic “Spleen-Wei-Bi” imbalance model. This model conceptualizes the pathological evolution of RA (Bi syndrome) through three sequential stages: “spleen deficiency with compromised defense, pathogen invasion due to vulnerability, intermingled phlegm and blood stasis”. Spleen deficiency, characterized by gut microbiota dysbiosis and impaired intestinal barrier function, serving as the initiating factor; failure of defensive Qi (Wei-Qi), which permits pathogen invasion and triggers a maladaptive immune-inflammatory cascade, representing the critical juncture in disease progression; intermingled phlegm and blood stasis, culminating in irreversible joint structural damage and bone erosion as the final pathological outcome. We substantiate this conceptual framework by integrating multi-dimensional evidence from clinical studies, animal experiments, network meta-analyses, and Mendelian randomization studies. By framing RA pathogenesis within the “Spleen-Wei-Bi” model, this review systematically aligns disease mechanisms with TCM intervention strategies, offering a holistic perspective for clinical management and future research.