基于中西医病因特点的射血分数保留性心力衰竭小动物模型建立分析

Modeling the small animal with HFpEF based on etiological characteristics of Chinese and western medicine

射血分数保留性心力衰竭(heart failure with preserved ejection fraction, HFpEF)的发病率逐年上升,成为心力衰竭的主要患病形式,但其病理机制尚未明确,目前缺乏有效治疗方案。通过合理模拟临床病因,以复制出稳定可靠的HFpEF病证一体化模型,是开展HFpEF中西医基础研究的前提。基于HFpEF的中西医病因病机特点,概述现有HFpEF及其中医证候模型的建立方法,探讨不同方法的优势与局限,阐明发展思路。HFpEF建立方法主要涉及主动脉缩窄或高血压引发的心室压力超负荷、心肌缺血损伤、糖尿病心肌损伤等。其中,主动脉缩窄所致的压力超负荷模型为优先选择,但存在每类模型仅反映HFpEF部分特征或仅代表整体病程某一阶段的局限;证候建立方法主要涉及HFpEF辨证与额外施加“证”的致病因素,两类方法相互矛盾且各自具有一定局限。据此提出多种西医病因共同作用以联合诱导HFpEF、施加中医病因应遵循HFpEF证候本质、合理把握病证发生的时间窗等发展思路,以期促进HFpEF病证一体化模型的有效建立。

The incidence of heart failure with preserved ejection fraction(HFpEF) is increasing year by year and HFpEF has become the main form of heart failure. However, its pathological mechanism remains unclear, and there is no effective treatment scheme at present. It is the premise of basic studies on HFpEF in Chinese and western medicine to replicate a stable and reliable integrated pattern-disease model of HFpEF by reasonably simulating clinical etiology. Based on the etiology and pathogenesis characteristics of HFpEF in Chinese medicine and western medicine, this paper summarized the existing establishment methods of HFpEF and its TCM pattern model, explored the advantages and limitations of different methods, and clarified the development ideas. The establishment of HFpEF mainly involved ventricular pressure overload caused by aortic coarctation or hypertension, myocardial ischemia injury, diabetic myocardial injury, and the others. Among them, the pressure overload model caused by aortic coarctation was preferred, but each model type only reflected partial characteristics of HFpEF or only represented a certain stage of the overall disease course. The methods of pattern establishment mainly involved HFpEF pattern differentiation and the pathogenic factors of additional pattern. The two methods were contradictory and each had certain limitations. Therefore, it is proposed that various western medicine etiologies should act together to induce HFpEF, and the application of TCM etiology should follow the essence of HFpEF pattern and control the time window of disease occurrence reasonably, thus enabling to establish the integrated HFpEF disease-pattern model.