针刺对洋地黄类药物治疗心衰可能的增效减毒作用机制研究思路

Considerations about Study on Mechanisms of Acupuncture Underlying Efficacy-enhancement and Toxicity-attenuation of Digitalis Drugs for Heart Failure

洋地黄作为广泛使用的治疗心衰的强心药,极易引起心律失常等毒副作用。寻找促使洋地黄增效减毒的方法对提高洋地黄的疗效和安全性意义重大。研究表明,针灸可改善缺血性心脏功能损害,抑制缺血性心律失常,针灸与化疗药物联用亦可减少其毒副作用,提示针灸与洋地黄联用可能起到增效减毒的作用。针刺有可能通过调节众多与心肌细胞内钙调节相关的分子、结构或功能,抑制心衰的发展;通过改善心肌细胞肌浆网钙泵功能、提高心肌肌钙蛋白对Ca2+的敏感性,来增强心肌收缩功能,并降低洋地黄非毒性的起效浓度,从而起到对洋地黄的增效减毒作用。上述思路为针药结合治疗心衰提供了新的线索。

Digitalis glycosides, a group of cardiotonic agents for heart failure, have been used for a long time, but may often trigger arrhythmias as a result of digitalis intoxication. It is of great significance in finding a method to reduce their toxicity and improve clinical curative effects simultaneously in the application of digitalis glycosides. It has been well documented that acu- puncture has good therapeutic effects in improving cardiac function and inhibiting arrhythmia induced by myocardial ischemia. Acupuncture combined with chemotherapeutics can reduce the adverse effects of chemotherapeutics. Accordingly, acupuncture com- bined with digitalis is likely to reduce the side effects of digitalis by regulating intracellular Ca2＋ , improving the function of Ca2＋ - ATPase in the sarcoplasmic reticulum, increasing calcium sensitivity of cardiac troponin, etc. These considerations may provide a novel clue for treatment of heart failure by joint administration of acupuncture and drugs.