摘要
心肌纤维化(MF)是多种心脏疾病的常见病理过程,如心肌梗死、高血压性心脏病和扩张型心肌病,其特征是细胞外基质过度沉积、心肌顺应性下降和心功能受损,可诱发心律失常和心源性猝死。目前治疗主要以抑制纤维化进展为主,疗效欠佳。MF的发病涉及多种信号通路,包括转化生长因子-β(TGF-β)/Smads信号通路、核转录因子-κB(NF-κB)信号通路、磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(Akt)信号通路、丝裂原活化蛋白激酶(MAPK)信号通路等。中医药在心血管疾病治疗方面具有丰富的经验,并具有不良反应小、安全性高的独特优势,在MF的治疗中显示出良好的疗效。近年来,越来越多的研究关注中医药在MF信号通路调控方面的应用,并表明中医药可通过调节MF相关信号通路,发挥抑制炎症反应、调节细胞自噬、增殖与凋亡、减少心肌氧化应激与损伤、抑制成纤维细胞活化和胶原合成等生理作用,具有减轻甚至逆转MF的潜力。实验研究和临床观察表明,中药复方如益心附葶饮、鹿红方、蛭龙活血通瘀胶囊、抗纤益心方等,可通过多成分调控多条细胞通路,有效改善MF,提升心功能;中药成分如金雀异黄素、黄芪甲苷等可抑制TGF-β_(1)的表达,阻断Smad信号通路;甘草素、大蒜素等可抑制NF-κB信号通路,减少心肌细胞胶原蛋白合成;连翘苷可激活PI3K/Akt信号通路,发挥抗纤维化作用。
Myocardial fibrosis(MF)is a prevalent pathological process in a spectrum of cardiac conditions,including myocardial infarction,hypertensive heart disease,and dilated cardiomyopathy.It is marked by an overabundance of extracellular matrix deposition,diminished myocardial compliance,and impaired cardiac function,which can lead to arrhythmias and sudden cardiac death.The current therapeutic approach primarily aims to suppress the progression of fibrosis,yet the therapeutic outcomes are poor.The pathogenesis of MF involves multiple signaling pathways,including the transforming growth factor-beta(TGF-β)/Smads signaling pathway,nuclear factor-kappa B(NF-κB)signaling pathway,phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)signaling pathway,and mitogen-activated protein kinase(MAPK)signaling pathway.Traditional Chinese medicine(TCM)boasts a rich history in the treatment of cardiovascular diseases,offering distinctive benefits such as minimal side effects and high safety,and it has demonstrated promising therapeutic effects in the treatment of MF.In recent years,research has turned its attention to the application of TCM in modulating the signaling pathways associated with MF.It has been demonstrated that TCM can modulate the MF-related signaling pathways to exert anti-inflammatory effects,regulate cellular autophagy,cell proliferation,and apoptosis,reduce myocardial oxidative stress and damage,and inhibit the activation of fibroblasts and collagen synthesis,thereby exhibiting the potential to mitigate or even reverse the progression of MF.Experimental research and clinical observations indicate that TCM formulas such as Yixin Futing decoction,Luhong prescription,Zhilong Huoxue Tongyu capsules,and Kangjian Yixin prescription can effectively ameliorate MF and enhance cardiac function through the multi-component regulation of multiple cellular pathways.Specific TCM constituents,including isoliquiritigenin and astragaloside,have been shown to inhibit the expression of TGF-β_(1),thereby disrupting the Smad signaling pathway.Compounds like glycyrrhizic acid and allicin can suppress the NF-κB signaling pathway and curtail collagen synthesis in myocardial cells,and forsythoside can activate the PI3K/Akt signaling pathway,contributing to its anti-fibrotic effects.
作者
闫景顺
朱林平
张红霞
黄丹妮
吕鑫良
李雯玥
李晓凤
李玉红
YAN Jingshun;ZHU Linping;ZHANG Hongxia;HUANG Danni;LYU Xinliang;LI Wenyue;LI Xiaofeng;LI Yuhong(Graduate School,Tianjin University of Traditional Chinese Medicine(TCM),Tianjin 301617,China;Second Affiliated Hospital,Tianjin University of TCM,Tianjin 300250,China;State Key Laboratory of Components of TCM,Institute of TCM,Tianjin University of TCM,Tianjin 301617,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2024年第13期230-239,共10页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(82004329)
全国名老中医药专家杜武勋传承工作室(国中医药人教函〔2022〕75号)
第五批全国中医临床优秀人才研修项目(国中医药人教函〔2022〕1号)
天津市卫生健康委中医经典传承高级人才研修项目(津卫中便函〔2022〕727号)
天津市名中医杜武勋传承工作室。
关键词
心肌纤维化
中医药
信号通路
研究进展
myocardial fibrosis
traditional Chinese medicine
signaling pathways
research progress
