补阳还五汤对心肌缺血再灌注损伤过程中自噬的调控

Regulation of Buyang Huanwu decoction on autophagy duringmyocardial ischemia reperfusion injury

目前心急梗死治疗主要以溶栓治疗和经皮冠状动脉介入治疗为主,能迅速开通闭塞血管,减少心肌梗死面积,但由于冠状动脉的骤然开通与血流恢复,可导致心肌缺血再灌注损伤(Myocardial Ischemia-reperfusion Injury,MI/RI),诱发病死率依然居高不下。而许多研究表明心肌MI/RI与心肌细胞过度自噬有关,自噬是真核细胞维持稳态的一种保守的降解过程。近年来,中医药在调节细胞自噬方面取得了一定的进展,越来越多的中药被证实可以通过调节心肌细胞的自噬水平,通过调控自噬,对受损心肌产生保护作用。而中医根据心肌MI/RI的临床表现将其归类为"胸痹""真心痛"范畴,认为其主要病机为气虚血瘀,治宜益气活血,以补阳还五汤为代表方,此方通过纠正心肌MI/RI后气虚血瘀、改善局部微环境及能量平衡、清除氧自由基等积聚,继而有效调控细胞自噬,减少心肌细胞损害。该文综述了心肌缺血再灌注损伤过程中自噬的主要分子机制和作用及补阳还五汤对其的调控。

At present,thrombolytic therapy and percutaneous coronary intervention are the main treatment for acute myocardial infarction,which can quickly open the occluded vessels and reduce the size of myocardial infarction.However,due to the sudden opening of coronary artery and the recovery of blood flow,it can lead to myocardial ischemia-reperfusion injury(MI/RI),resulting in a high mortality rate.Many studies have shown that myocardial MI/RI is associated with excessive autophagy of myocardial cells,which is a conservative degradation process for eukaryotic cells to maintain homeostasis.In recent years,Chinese medicine has made some progress in regulating cell autophagy.More and more Chinese medicines have been proved to have protective effects on injured myocardium by regulating the level of autophagy of cardiac myocytes and autophagy.According to the clinical manifestations of myocardial MI/RI,TCM classifies it as“chest stuffiness”and“genuine pain”.It considers that its main pathogenesis is Qi deficiency and blood stasis.It is appropriate to treat Qi deficiency and blood stasis.Buyang Huanwu decoction(补阳还五汤)is the representative prescription.By correcting the accumulation of Qi deficiency and blood stasis after myocardial MI/RI,improving local microenvironment and energy balance,eliminating oxygen free radicals,it can effectively regulate cell autophagy and reduce myocardium cell damage.This article reviews the main molecular mechanisms and functions of autophagy during myocardial ischemia reperfusion injury and the regulation of Buyang Huanwu decoction.