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炎症——自然有效应对各类挑战的方式:对理解和管理慢性病“流行”的启示

Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases.

作者信息

Bennett Jeanette M, Reeves Glenn, Billman George E, Sturmberg Joachim P

机构信息

Department of Psychological Science, StressWAVES Biobehavioral Research Lab, The University of North Carolina at Charlotte, Charlotte, NC, United States.

School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.

出版信息

Front Med (Lausanne). 2018 Nov 27;5:316. doi: 10.3389/fmed.2018.00316. eCollection 2018.

Abstract

Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The is the body's unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the "person as a whole," enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro- and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work- and . Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to ; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.

摘要

采用孤立或单一系统的疾病管理方法是常见做法,它源于传统医学院教育。医学教科书以系统方式描述了大量不同的疾病,通常按照病因、病理、检查、鉴别诊断和治疗等标题进行阐述。这种方法表明身体对有害事件有多种反应方式。然而,生理学和系统生物学提供的证据表明,这种表型变异性背后存在一种机制。无论损伤或变化是由创伤、感染、非传染性疾病、自身免疫性疾病还是压力引起的,典型的生理反应是:损伤部位血液供应增加、白细胞向受影响组织浸润增加、吞噬活性增强以清除致病因子,随后这些机制下调从而实现愈合。这是身体在面对宏观和微观损伤时维持自身完整性的独特机制。我们假设,无论损伤的性质是身体的、环境的还是心理的,慢性病的发展和进展都与对损伤的不受控制或功能失调的炎症反应有关。因此,我们将现行的单一疾病管理方法转变为一种更综合的系统方法,即“将人作为一个整体”进行治疗,以提升患者体验、做出必要改变的能力,并使整体健康和幸福感最大化。本文第一部分回顾了促炎和抗炎调节的局部免疫级联反应以及与神经和心理途径的相互连接的反馈回路。第二部分强调了自然发挥作用的原则之一——以及。持续使这个精细调节的系统不堪重负将导致全身炎症,使慢性病得以;详细描述了几种常见病症的途径。本文最后一部分考虑了这些认识对临床护理的影响,并探讨这种视角如何塑造医患互动和卫生系统的重新设计。我们得出结论,医疗保健专业人员必须在患者层面以及地方和国家层面倡导抗炎生活方式,以增进人群的健康和幸福感。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ac/6277637/ddca8c6a6e88/fmed-05-00316-g0001.jpg

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