基于"肾虚血瘀"理论探讨血管紧张素转换酶2调控缺血性脑卒中研究进展OA

The pathogenesis of ischemic stroke(IS)is closely associated with dysregulation of the renin-angiotensin system(RAS).Angiotensin-converting enzyme 2(ACE2)as a key regulator of the RAS,when dysfunctional,leads to oxidative stress,inflammatory re-sponses,and disruption of the blood-brain barrier,thereby exacerbating cerebral ischemic injury.The TCM theory of"kidney deficiency and blood stasis"proposes that deficiency of kidney essence results in qi and blood stagnation obstructing the cerebral collaterals,which closely parallels the RAS dysregulation induced by downregulation of ACE2 expression in modern medicine.However,cross-disciplinary research in this field still faces the following challenges:(1)Superficial correlation between TCM syndrome and mechanistic targets:There is a lack of a direct and specific molecular bridge linking the macroscopic syndrome of"kidney deficiency and blood stasis"to the downregulation of ACE2 expression/function;(2)Absence of quantitative biological evidence for TCM syndromes:No large-scale clinical studies have been conducted based on patients with"kidney deficiency and blood stasis"syndrome,leaving the correlation be-tween syndrome severity/subtype and quantitative indicators such as blood or tissue ACE2 levels unanalyzed,thus hindering the estab-lishment of modern biological subtyping standards for TCM syndromes;(3)Insufficient analysis of the multi-target network mechanisms of Chinese medicinals:Most studies remain at the level of phenotypic observation and single-pathway validation(e.g.,ACE2 protein expression).There is a serious lack of systematic research on how Chinese medicinals coordinately regulate the ACE2/RAS axis and downstream neurovascular unit homeostasis via a"multi-component,multi-target,multi-pathway"network;(4)Incomplete integrated e-valuation system for traditional Chinese and Western medicine:Current IS evaluations predominantly focus on Western neurological defi-cit scales,lacking a comprehensive assessment system that incorporates the dynamic evolution of TCM syndromes.Moreover,high-level evidence-based medical evidence is insufficient.Therefore,future research should urgently integrate multi-omics technologies with"kid-ney deficiency and blood stasis"-specific animal models to deeply dissect the causal feedback network of"kidney deficiency-blood sta-sis-ACE2 dysregulation-brain injury."At the same time,it is necessary to conduct large-scale clinical studies to identify quantitative bi-omarkers for syndromes,along with rigorous randomized controlled trials(RCTs)to evaluate the efficacy and safety of integrated TCM-Western medicine approaches at different stages of IS(acute phase,recovery phase,and secondary prevention).Ultimately,an integrat-ed evaluation system incorporating core indicators from both TCM and Western medicine should be established.