从“气虚血瘀”病机探析线粒体动力学治疗缺血性心脏病的病理机制

On Pathological Mechanism of Mitochondrial Dynamics in Treatment of Ischemic Heart Disease from Pathogenesis of“Qi Deficiency and Blood Stasis”

缺血性心脏病是致死率极高的疾病之一,是一种心肌缺血缺氧的状态。心脏是人体高耗能器官,三磷酸腺苷(adenosine triphosphate,ATP)的转移与利用是心肌细胞耗能的主要来源。线粒体是心肌细胞ATP生成的主要场所,维持心肌细胞的代谢,因此作为心肌细胞的“发电站”,线粒体在缺血性心脏病中发挥重要的作用。此外,心肌线粒体氧化代谢为心肌细胞提供能量,虽然心肌细胞在动物出生后不再分裂,但线粒体则可以不断更新。中医“卫气”的物质属性是现代医学的“线粒体”,西医的“线粒体”的功能体现中医“卫气”的作用,心居于胸中,主血脉,为阳中之太阳,气能行血,血液的运动有赖于气的温煦和推动。若气虚则失去温煦和推动,导致血脉闭塞瘀阻,不通则痛,发为胸痹心痛。从气虚血瘀探讨线粒体动力学不仅对于缺血性心脏病的病理机制研究具有重要的指导意义,而且对阐释益气活血法治疗缺血性心脏病的学术思想的科学内涵提供了新的思路和方法。

Ischemic heart disease is one of the diseases with the highest mortality.It is a state of myocardial ischemia and hypoxia.The heart is a high energy consuming organ of human body.The transfer and utilization of adenosine triphosphate(ATP)is the main source of energy consumption of cardiomyocytes.Mitochondria are the main place for ATP production of car⁃diomyocytes,maintaining the metabolism of cardiomyocytes.Therefore,as the"power station"of cardiomyocytes,mitochondria play an important role in ischemic heart disease.In addition,the oxidative metabolism of myocardial mitochondria provides ener⁃gy.Although cardiomyocytes no longer divide after birth,the mitochondria can be renewed continuously.The material attribute of"defending Qi"is the"mitochondria".The function of"mitochondria"reflects the role of"defending Qi".The heart lives in the chest,governing blood and vessels,and it is Taiyang in the Yang.Qi can move blood and the movement of blood depends on the warmth and promotion of Qi.If Qi deficiency occurs,the warmth and promotion will be lost,which will lead to blockage of blood vessels,pain and chest pain.It not only has important guiding significance for the pathological mechanism of ischemic heart disease on mitochondrial dynamics from Qi deficiency and blood stasis,but also provides new ideas and methods for explaining the academic thought of supplementing Qi and activating blood circulation method in the treatment of ischemic heart disease.