基于“正邪理论”探讨自噬在慢性心力衰竭发展中的作用

Function of Autophagy in Development of Chronic Heart Failure Based on Theory of Healthy Qi and Pathogenic Qi

慢性心力衰竭是以呼吸困难、活动耐量受限等为主要临床表现的一种严重的心脏疾病,自噬是存在于真核细胞中的一种自我保护机制,在心力衰竭的发展中起重要作用。心力衰竭代偿期适当提高自噬水平以及时清除坏死的心肌细胞器及其他有害垃圾可一定程度上抑制心肌肥厚,缓解心肌重构,从而延缓心力衰竭。正邪理论是中医学阐释疾病发生的重要基础理论,正邪相争存在于慢性心力衰竭的整个发病过程中,而邪侵正亏则是其发展的结果。细胞自噬对心肌细胞的调节作用与中医正邪理论有着相似之处,自噬是机体自我对于正气及邪气两者的调控机制,其存在一种量效关系,即自噬只在一定程度上对机体细胞起到保护作用,正气也只能在一定范围和程度内起到抵御外邪保护机体的作用,过度自噬或自噬不足均可能破坏机体内环境的稳定,导致疾病的发生。基于此,笔者拟用正邪理论为切入点,从宏观及微观角度来阐明自噬在慢性心力衰竭发展中的作用,提出调整机体正邪平衡,调节心肌细胞自噬,寻求其平衡点的防治原则,以期为中医理论阐述自噬在慢性心力衰竭发展作用的现代研究奠定基础,为治疗不同阶段的慢性心力衰竭寻找新方法,为慢性心力衰竭的诊断及治疗提供新的理论依据。

Chronic heart failure is a serious heart disease with dyspnea and limited activity tolerance as the main clinical manifestations.Autophagy is a self-protection mechanism in eukaryotic cells and plays an important role in the development of heart failure.Appropriately increasing the level of autophagy during the compensated stage of heart failure and timely removal of necrotic myocardial organelles and other harmful garbage can inhibit myocardial hypertrophy to a certain extent,alleviate myocardial remodeling,and delay heart failure.The theory of healthy Qi and pathogenic Qi is an important basic theory for explaining the occurrence of diseases,and struggle between healthy Qi and pathogenic Qi exists in the entire onset of chronic heart failure,which may lead to pathogenic Qi invasion and healthy Qi deficiency.The regulatory effect of autophagy on cardiomyocytes is similar to the theory of healthy Qi and pathogenic Qi in traditional Chinese medicine(TCM).Autophagy is the body’s self-regulatory mechanism for healthy Qi and pathogenic Qi in a dose-effect manner,Specifically,autophagy can only protect the body’s cells to a certain extent,and healthy Qi can only take effect within a certain range and degree.To protect the body from external pathogenic factors,excessive or insufficient autophagy may destroy the stability of the body’s environment.In this regard,we use the theory of healthy Qi and pathogenic Qi as a starting point to clarify the function of autophagy in the development of chronic heart failure from a macro and micro perspective,and propose adjusting the balance of healthy Qi and pathogenic Qi in the body to regulate the autophagy of cardiomyocytes.The principle of prevention and treatment is expected to lay the foundation for modern research on the function of autophagy in the development of chronic heart failure in TCM,find novel therapy for chronic heart failure at different stages,and provide new insights into the diagnosis and treatment of chronic heart failure.