基于“心肾相关”探讨水通道蛋白在心衰中的作用

Role of Aquaporins in Heart Failure from Theory of Cardiac and Renal Coordination

心力衰竭(简称心衰)指因心脏结构或者功能异常导致心室射血或充盈受损,从而引起的一组临床综合征。中医学提出了“心肾相关”理论,并认为肾者主水,肾脏在维持水液代谢平衡中具有重要的作用。因此,对于心衰中水潴留的状态,可从心肾论治。心衰的基本病机是肾虚血瘀、水液内停,治法包含交通心肾、温阳利水、补肾活血和疏通经络。水通道蛋白(AQPs)是水液代谢的关键分子基础,与精氨酸加压素系统(AVP)、肾素-血管紧张素-醛固酮系统(RAAS)、利尿剂抵抗共同参与心衰水潴留的发病。研究表明,调补心肾中药通过靶向AQPs改善心衰水潴留状态,从而延缓甚至逆转心衰进程。笔者从心肾相关理论出发,探讨了心衰的中医病名及病机,论述了AQPs在心衰水潴留发病中的作用,诠释了调补心肾法治疗心衰的现代内涵,旨在为中医药防治心衰水潴留提供思路。

Heart failure refers to a group of clinical syndromes caused by structural or functional abnormalities of the heart that lead to impaired ejection or filling of the ventricles.The traditional Chinese medicine(TCM) theory of cardiac and renal coordination holds that the kidney governs water and plays a key role in maintaining the balance of fluid metabolism.Therefore,the treatment of water retention in heart failure can start from the heart and kidney.The basic pathogenesis of heart failure is kidney deficiency,blood stasis,and water stagnation,and the therapies including dredging the heart and kidneys,warming yang and excreting water,tonifying kidneys and activating blood,and dredging meridians and collaterals.Aquaporins(AQPs),the key molecular basis of water metabolism,are involved in the pathogenesis of water retention in heart failure together with the arginine vasopressin system(AVP),renin-angiotensin-aldosterone system(RAAS),and diuretic resistance.Studies have shown that herbal medicines that regulate the heart and kidney can alleviate water retention in heart failure by targeting AQPs,thereby delaying or even reversing the progression of heart failure.This paper expounds the TCM name and pathogenesis of heart failure from the theory of cardiac and renal coordination,the role of AQPs in the pathogenesis of water retention in heart failure,and the modern connotation of the therapy of tonifying heart and kidney for heart failure,aiming to provide ideas for the prevention and treatment of water retention in heart failure by TCM.