溃疡性结肠炎“炎-癌”转化机制及中医药治疗研究进展

溃疡性结肠炎“炎-癌”转化（ulcerative colitis-related colitis-associated cancer，UC-CAC）是在长期慢性UC基础上，肠道黏膜经历一系列复杂的生物学演变，最终进展为结直肠癌（colorectal cancer，CRC）的过程。在我国，UC发病率呈显著增长趋势，进展率高，给患者造成极大的身体和精神负担。现代医学治疗UC-CAC主要依靠药物治疗，手术率低，且易复发、迁延难愈，因此寻找针对UC-CAC的具有预防性、逆转性及降低复发率的治疗手段势在必行。随着近年来中医药对CAC相关研究的不断深入及中西医诊疗模式的不断完善，中医药多成分、多靶点、多机制的优势逐渐显现。该研究通过查阅最近5年文献，从肠道屏障功能、炎症微环境与免疫调控、代谢重编程与能量代谢、遗传与表观遗传、细胞异质性与肿瘤微环境5个方面阐述UC-CAC演变机制，并结合当代中医理论对UC-CAC机制的不同认识，探讨中医药治疗UC-CAC的具体机制，以期为今后临床实践提供一定的理论依据和治疗思路。

Ulcerative colitis-carcinoma association (UC-CAC) represents the progression from chronic ulcerative colitis to colorectal cancer (CRC) through a series of complex biological transformations within the intestinal mucosa. In China, the incidence of ulcerative colitis is rising significantly, with a high progression rate imposing substantial physical and psychological burdens on patients. Modern medical management of UC-CAC primarily relies on pharmacological interventions, with low surgical rates and a tendency towards recurrence and protracted, difficult-to-treat disease. Consequently, identifying therapeutic approaches for UC-CAC that offer preventive, reversing, and recurrence-reducing effects is imperative. Recent advances in traditional Chinese medicine (TCM) research on CAC, coupled with the refinement of integrated Chinese-Western diagnostic and therapeutic models, have increasingly highlighted the advantages of TCM's multi-component, multi-target, and multi-mechanism approaches. This study, through reviewing literature from the past five years, examining five key aspects: intestinal barrier function, inflammatory microenvironment and immune regulation, metabolic reprogramming and energy metabolism, genetics and epigenetics, and cellular heterogeneity and tumour microenvironment. It explores the specific mechanisms of TCM treatment for UC-CAC by integrating contemporary TCM perspectives on the underlying mechanisms, aiming to provide theoretical foundations and therapeutic approaches for future clinical practice.