基于“血气成痰”理论探讨中性粒细胞胞外诱捕网在支气管扩张症中的作用机制及证治策略

Based on the Theory of “Blood-Qi Transforming into Phlegm”: Exploring the Mechanism and Therapeutic Strategy of Neutrophil Extracellular Traps in Bronchiectasis

摘要: 支气管扩张症(支扩)是以慢性气道中性粒细胞炎症为特征的疾病，临床缺乏特异性靶向药物，病情呈进行性发展。中医将其归属于“咳嗽”“咯血”“肺痈”等范畴，痰、热、瘀、虚贯穿病程始终。“血气成痰”理论源于《景岳全书》，认为血气失于正化则败浊成痰，与朱丹溪“痰挟瘀血，遂成窠囊”、唐宗海“瘀血积久，亦能化为痰水”一脉相承，揭示了痰瘀同源互化的病机规律。中性粒细胞胞外诱捕网(NETs)是中性粒细胞活化后释放的以DNA为骨架、富含颗粒蛋白的网状结构，近年研究提示其过度形成与清除障碍是支扩气道炎症持续、黏液高分泌、纤毛及上皮屏障损伤和急性加重的重要环节，并与疾病严重程度和预后相关，可视为“血气失正、败浊成痰、痰瘀胶结”的微观体现。基于该理论，本文从清热化痰、化痰祛瘀、扶正防复三方面探讨中医药调控NETs治疗支扩的作用机制与证治策略，以期为支扩的中西医结合防治提供参考。

Abstract: Bronchiectasis is a chronic airway disease characterized by persistent neutrophilic inflammation; specific targeted therapies remain lacking in clinical practice, and the disease tends to progress over time. In traditional Chinese medicine (TCM), bronchiectasis is classified into the categories of “cough”, “hemoptysis”, and “lung abscess”, with phlegm, heat, blood stasis, and deficiency running through its entire course. The theory of “blood-qi transforming into phlegm”, originating from Jing Yue Quan Shu (Complete Works of Zhang Jingyue), holds that when blood and qi lose their proper transformation, they turn into turbid phlegm. This theory is consistent with Zhu Danxi’s notion that “phlegm intermingled with blood stasis forms a nest-like mass” and Tang Zonghai’s statement that “long-standing blood stasis can transform into phlegm-fluid”, together revealing the pathological rule that phlegm and blood stasis share a common origin and can transform into each other. Neutrophil extracellular traps (NETs) are web-like structures released by activated neutrophils, consisting of a DNA backbone embedded with abundant granular proteins. Accumulating evidence in recent years suggests that excessive NET formation and impaired clearance are important contributors to sustained airway inflammation, mucus hypersecretion, ciliary and epithelial barrier injury, and acute exacerbations in bronchiectasis, and are associated with disease severity and prognosis; this may be regarded as a microscopic manifestation of “deranged blood-qi turning into turbid phlegm with intermingled phlegm and stasis”. Based on this theory, this article explores the mechanisms and therapeutic strategies of TCM in regulating NETs for the treatment of bronchiectasis from three aspects—clearing heat and resolving phlegm, resolving phlegm and removing blood stasis, and reinforcing healthy qi to prevent recurrence—with the aim of providing a reference for the integrative prevention and treatment of bronchiectasis.