中药调控自噬与缺血性心脏病关系的研究进展

Research progress of traditional Chinese medicine in regulating autophagy and ischemic heart disease

缺血性心脏病(ischemic heart disease,IHD)是一种严重危害人类健康的常见病、多发病。自噬(autophagy)是一种通过降解细胞内受损细胞器等大分子物质以维持细胞稳态的生命过程。在缺血性心脏病发生发展过程中,一方面心肌细胞通过自噬降解受损细胞器等大分子物质为细胞提供能量合成的物质基础并维持细胞稳态,另一方面过度激活的自噬也会增加心肌细胞死亡。缺血性心脏病病理机制复杂,自噬的发生与心肌细胞生存或死亡有着密不可分的联系,调控自噬可能为缺血性心脏病重要的治疗靶点。中医药在缺血性心脏病治疗中应用广泛、效果明显,有着独特优势和巨大潜力,近年来越来越多研究发现中药通过调控心肌细胞自噬而发挥保护心肌的作用。该文针对近年来有关中药调控缺血性心脏病发生时心肌细胞自噬的研究进行综述,从活性成分、提取物和药对、复方3个层次,通过促进或抑制自噬的不同作用方式,对中药调控自噬保护心肌细胞的药理机制进行综述,探讨中药调控自噬保护缺血性心脏病的具体机制,以期为缺血性心脏病的临床治疗与药物研发提供参考或新思路。

Ischemic heart disease(IHD)is a common and frequently-occurring disease that causes serious harm to human health.Autophagy is a life process that maintains cell homeostasis by degrading macromolecules such as damaged organelles in cells.In the process of ischemic heart disease development,on the one hand,cardiomyocytes degrade macromolecules such as damaged organelles by autophagy to provide material basis for energy synthesis and maintain cell homeostasis;on the other hand,over-activated autophagy can also increase cardiomyocyte death.Ischemic heart disease has a complex pathological mechanism,and the occurrence of autophagy is closely related to the survival or death of myocardial cells,so the regulation of autophagy may be an important therapeutic target for ischemic heart disease.Traditional Chinese medicine(TCM)with obvious effects,unique advantages and great potential has been widely used in the treatment of ischemic heart disease.In recent years,more and more studies have found that TCM can protect myocardium by regulating autophagy of cardiomyocytes.In this review,we summarized recent studies on the regulation of autophagy in myocardial cells by traditional Chinese medicine in ischemic heart disease.The pharmacological mechanism of Chinese medicinein regulating autophagy to protect cardiomyocytes was reviewed through different ways(promoting or inhibiting autophagy)from three levels,i.e.active ingredient,as well as drug pair and compound.The specific mechanism of Chinese medicine in regulating autophagy to protect ischemic heart disease was explored to provide references or new ideas for clinical treatment and drug development of ischemic heart disease.