益气活血法抗心肌缺血再灌注损伤的作用机制

Mechanism of Therapy of Reinforcing Qi and Activating Blood Circulation Against Myocardial Ischemia Reperfusion Injury

心肌缺血再灌注后常易引发心律失常、心功能下降、心肌坏死等一系列损伤,严重影响了治疗效果。因此,深入研究心肌缺血再灌注损伤的病理机制和防治策略是目前的研究热点和难点。心肌缺血再灌注损伤的机制研究目前主要集中在心肌能量代谢障碍、氧化应激、钙超载、线粒体损伤、炎症、细胞凋亡等方面,这些病理过程又存在复杂的相互影响、相互促进关系,使临床防治较困难。现代西医药物因作用靶点单一、不良反应多限制了其防治效果,而中医药具有多信号通路、多靶点等优势,对心血管疾病的预防和治疗均有显著效果。心肌缺血再灌注损伤在中国传统医学中被归于胸痹范畴,益气活血法是其主要治则,在临床上运用广泛。国内外实验表明,益气活血类中药对心肌缺血再灌注损伤的多条病理机制有干预作用,能明显改善心肌损伤、减少心肌细胞炎性浸润,其作用机制包括对抗氧化应激、抑制钙超载、减轻线粒体损伤、改善心肌能量代谢障碍、对抗炎症、减少细胞凋亡等。益气活血法抗再灌注损伤的作用效果优于单用益气类或活血类中药,具有协同作用。但目前多数机制研究都集中于中药单体活性成分,对益气活血法成方的研究较少。本文就国内外益气活血中药及益气活血法防治心肌再灌注损伤的实验研究进行整理,从单体、药对、组方3个层面进行综述,以期为临床应用益气活血法抗心肌缺血再灌注损伤提供理论依据。

Myocardial ischemia and reperfusion are easy to cause a series of injuries,such as arrhythmia,cardiac function decline and myocardial necrosis,which seriously affect the therapeutic effect. Therefore,in-depth study of the pathological mechanism and the prevention and treatment measures of myocardial ischemia-reperfusion injury is the current research hotspot and difficulty. The current mechanism of myocardial ischemia-reperfusion injury focuses on myocardial energy metabolism disorders, oxidative stress, calcium overload, mitochondrial damage,inflammation,and apoptosis. These pathological processes also have complex interactions and mutual promotion relationship,which make clinical control more difficult. Modern western medicine has a limited effect due to its simple target and more adverse reactions. Traditional Chinese medicine（TCM） has many advantages,such as multiple signaling pathways and multiple targets,which have significant effects in the prevention and treatment of cardiovascular diseases. Myocardial ischemia-reperfusion injury is defined as chest apoplexyin TCM.The therapy of ‘reinforcing Qi and activating blood circulation＇is the main therapeutic principle of preventing and treating myocardial ischemia-reperfusion injury in TCM,which is widely applied in clinical practice. Experiments show that TCMs have a intervening effect on multiple pathological mechanisms of myocardial ischemia-reperfusion injury,which can significantly improve myocardial injury and reduce inflammatory infiltration of myocardial cells.Its mechanisms of action include resisting oxidative stress,inhibiting calcium overload,reducing mitochondrial damage,improving myocardial energy metabolism,resisting inflammation,and reducing apoptosis. However,most of the current researches focus on active ingredients of TCM,and there are only a few researches on the therapy of‘reinforcing Qi and activating blood circulation＇. This paper summarizes researches of this therapy on myocardial reperfusion injury,and reviews monomers,drug pairs and group prescriptions,in the expectation of providing a theoretical basis for the clinical application against myocardial ischemia-reperfusion injury.