NLRP3炎症小体与糖尿病心肌病的关系及中医药调控研究进展

Relationship Between NLRP3 Inflammasome and Diabetic Cardiomyopathy and Intervention Effect of Traditional Chinese Medicine:A Review

糖尿病心肌病(DCM)是糖尿病的并发症之一,是指发生在糖尿病中,其发病机制区别于其他心血管疾病如冠心病、心脏瓣膜病、亦或先天性心脏病的一种特发类心肌病,亦是多年以来糖尿病患者的主要致死病因之一。研究表明,DCM的发病机制与胰岛素抵抗、多种炎症反应激活、氧化应激增加、冠状动脉微循环受阻、晚期糖基化终产物(AGEs)积累等过程有密切联系。而在多种炎症反应中,NOD样受体蛋白3(NLRP3)炎症小体激活可通过炎症的级联反应诱导分泌出大量促炎细胞因子,继而介导细胞焦亡过程,促进心肌损伤。目前基于NLRP3炎症小体在DCM损伤防治重要作用功能,国内外开展了大量中医药实验研究,证明了黄芪多糖、人参皂苷Rb_(1)等中药提取物或单味中药如云芝、冬虫夏草亦或抵挡汤、加味桃核承气汤等组方制剂及针刺、中医运动疗法等可通过调控NLRP3炎症小体的相关通路从而抑制其组装或激活,降低炎症反应,进而抑制DCM中心肌的重构,改善DCM的心脏功能。该文就NLRP3炎症小体与DCM的关系及中医药在此领域中发挥抗炎效应的研究进展进行综述,旨在为DCM开发治疗手段提供新的思路。

Diabetic cardiomyopathy(DCM)is one of the complications of diabetes.It refers to a specific type of idiopathic cardiomyopathy that occurs in individuals with diabetes,distinct from other cardiovascular diseases such as coronary heart disease,valvular heart disease,or congenital heart disease.It has also been identified as one of the leading causes of death in diabetic patients for many years.Research has shown that the pathogenesis of DCM is closely associated with insulin resistance,activation of various inflammatory responses,increased oxidative stress,impaired coronary microcirculation,and accumulation of advanced glycation end products(AGEs).Among various inflammatory responses,the activation of the NOD-like receptor protein 3(NLRP3)inflammasome can induce the secretion of a large amount of pro-inflammatory cytokines through the cascade reaction of inflammation,subsequently mediating cellular pyroptosis and promoting myocardial damage.Currently,extensive experimental studies on traditional Chinese medicine(TCM)have been conducted in China and abroad based on the significant role of the NLRP3 inflammasome in the prevention and treatment of DCM.These studies have demonstrated that Chinese medicinal extracts,such as Astragalus polysaccharide and ginsenoside Rb_(1),single drugs like Coriolus and Cordyceps,and Chinese medicinal formulas like Didangtang and modified Taohe Chengqitang,as well as acupuncture and TCM exercise therapy,can regulate the relevant pathways of the NLRP3 inflammasome to inhibit its assembly or activation,reduce inflammatory responses,inhibit myocardial remodeling in DCM,and improve cardiac function.This article reviewed the relationship between the NLRP3 inflammasome and DCM,as well as the research progress on TCM in exerting anti-inflammatory effects in this field,aiming to provide new insights for the development of therapeutic approaches for DCM.