线粒体障碍在糖尿病性心肌病中的作用及中医药研究进展

Effect of mitochondrial dysfunction in diabetic cardiomyopathy and intervention of traditional Chinese medicine

随着生活水平的提高和生活方式的改变,糖尿病的发病率及死亡率逐年上升。糖尿病发病10年后,约30%-40%的患者至少会发生一种并发症,如糖尿病视网膜病变、肾脏病变或心血管病变等,这些慢性并发症大大影响患者生活质量和寿命。糖尿病性心肌病（diabetic cardiomyopathy,DCM）是指糖尿病患者出现左心室肥厚和舒张功能障碍,进而发展为收缩功能不全,且这种改变不与患者其他潜在的心血管疾病相关。线粒体是细胞内重要的能量代谢场所,它直接参与细胞生长、增殖、胞内信号转导和细胞凋亡等过程。近年来研究发现,线粒体障碍与DCM多个发病环节密切相关,其作用涉及糖脂代谢紊乱、氧化应激损伤、钙调控障碍、线粒体脱偶联、质量控制失衡以及MicroRNAs对线粒体的调节等多个方面。现代生物学研究进展同样启发中医药工作者以线粒体为靶向探寻有效治疗措施,越来越多的单味中药或其提取物（如人参、黄芪、葛根、黄连、姜黄、白藜芦醇等）以及复方制剂（如止消通脉宁、糖心乐、通心络等）被证实可以通过调节线粒体功能,改善糖尿病性心肌损伤。基于以上背景,该文将就线粒体障碍在DCM发病中的作用以及中医药在该领域的干预研究进展进行综述,以期为DCM的预防和治疗提供新的思路。

Diabetic cardiomyopathy（DCM） is characterized by left ventricular hypertrophy,myocardial fibrosis and diastolic dysfunction,which are uncorrelated with underlying coronary artery disease or hypertension.As an important metabolic organelle,mitochondria directly involve the process of cell growth,proliferation,signal transduction,apoptosis and so on.Recent studies have demonstrated a close correlation between the mitochondrial dysfunction and the pathogenesis of diabetic cardiomyopathy.The underlying effects of mitochondrial dysfunction in the progress of diabetic cardiomyopathy involve disturbed metabolism,oxidative stress,defective calcium handling,mitochondrial uncoupling,apoptosis,imbalance of mitochondrial quality control and regulation of MicroRNAs.Traditional Chinese medicines have been widely applied in clinic.Nowadays,more and more herbs of extracts of traditional Chinese medicines have been proved to ameliorate diabetic myocardial injury.Because the improvement of mitochondrial dysfunction has emerged as a promising therapeutic strategy,this review summarizes these effects of mitochondrial dysfunction in diabetic cardiomyopathy,and discusses the intervention studies of traditional Chinese medicine in the field,in expectation to provide new ideas for DCM prevention and treatment.