

浏览全部资源
扫码关注微信
中国中医科学院 中药研究所,北京 100700
Received:02 February 2021,
Published Online:07 April 2021,
Published:20 June 2021
移动端阅览
常梦丽,许静,张方博等.脑心互损病理机制研究及中医药防治进展[J].中国实验方剂学杂志,2021,27(12):216-225.
CHANG Meng-li,XU Jing,ZHANG Fang-bo,et al.Pathological Mechanisms of Brain-Heart Mutual Damage and Treatment with Traditional Chinese Medicine: A review[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(12):216-225.
常梦丽,许静,张方博等.脑心互损病理机制研究及中医药防治进展[J].中国实验方剂学杂志,2021,27(12):216-225. DOI: 10.13422/j.cnki.syfjx.20211105.
CHANG Meng-li,XU Jing,ZHANG Fang-bo,et al.Pathological Mechanisms of Brain-Heart Mutual Damage and Treatment with Traditional Chinese Medicine: A review[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(12):216-225. DOI: 10.13422/j.cnki.syfjx.20211105.
在心脑血管疾病的发生发展中,脑心之间生理病理关系紧密,临床病证相互影响,病理机制复杂。临床研究表明,脑部疾病如卒中多并发心脏疾病,心脏疾病如心心房颤动动也会引发脑部疾病,甚至加重患者脑萎缩,出现认知障碍等。中医也认为“神明之体藏于脑,神明之用发于心”,元神在脑,识神在心,心脑息息相关。脑之神明伤,累及于心,心之神明伤,累及于脑。因此,脑病及心,心病及脑,脑心互损的病理机制成为当今研究的热点之一。该文结合脑心疾病相互影响的临床研究现状,对脑心互损的病理机制进行了总结,从炎症反应、自主神经调节紊乱、细胞凋亡、能量代谢、氧化应激等几个方面的整理和分析,阐述了各种机制的研究概况。在此基础上,根据中医药对脑心功能的认识,以及中医药防治脑心疾病的整体观念,提出需要重视脑心同治的防治理念,并概述了以脑心通胶囊为代表的中医药防治脑心同病的研究进展。该文综述脑心互损的病理机制及其中医药防治的研究现状,将对心脑血管疾病的防治及其深入研究提供参考和借鉴。
The brain and heart has a tight relationship upon physiology and pathology during the development of cardiovascular and cerebrovascular diseases with clinical conditions interacting with each other and complex pathological mechanisms. Clinical studies prove that cerebral diseases such as stroke usually happen with cardiac diseases as complications, and cardiac diseases such as atrial fibrillation can also cause cerebral diseases, which can even aggravate brain atrophy and lead to cognitive impairment. Traditional Chinese medicine (TCM) also believes that “the substance of Shenming is located in the brain and the function in the heart.” Specifically, Yuanshen is in the brain and Shishen is in the heart, which thus makes the heart and brain closely related. If Shenming in any of them is impaired, the other one would also be injured. Therefore, the pathological mechanisms of brain-heart mutual damage have become one of the current research hotspots. This paper, combined with the clinical research status of the brain-heart mutual damage, summarized its pathological mechanisms from the perspectives of inflammatory responses, dysregulation of autonomic nervous system, apoptosis, energy metabolism and oxidative stress. The necessity of “brain-heart concurrent regulation” was proposed and the research progress on the treatment of cerebral and cardiac diseases with TCM represented by Naoxintong capsule was profiled in the light of heart and brain function described by TCM and the holistic concept of TCM treating cerebral and cardiac diseases. This paper reviews the pathological mechanisms of brain-heart mutual damage and the research progress on its treatment with TCM, which can provide reference for the prevention and treatment of cardiovascular and cerebrovascular diseases and further research on them.
VOS T , LIM S S , BISIGNANO C , et al . Global burden of 369 diseases and injuries in 204 countries and territories,1990-2019-a systematic analysis for the Global Burden of Disease Study 2019 [J]. Lancet , 2020 , 396 ( 10258 ): 1204 - 1222 .
中国心血管健康与疾病报告编写组 . 中国心血管健康与疾病报告2019概要 [J]. 中国循环杂志 , 2020 , 35 ( 9 ): 833 - 854 .
《中国脑卒中防治报告》编写组 . 《中国脑卒中防治报告2019》概要 [J]. 中国脑血管病杂志 , 2020 , 17 ( 5 ): 272 - 281 .
柴培培 , 翟铁民 , 万泉 , 等 . 我国心脑血管疾病治疗费用与基本医疗保险支出核算与分析 [J]. 中国医疗保险 , 2021 , 1 : 72 - 77 .
BYER E , ASHMAN R , TOTH L A . Electrocardiograms with large,upright T waves and long Q-T intervals [J]. Am Heart J , 1947 , 33 ( 6 ): 796 - 806 .
BURCH G E , MEYERS R , ABILDSKOV J A . A new electrocardiographic pattern observed in cerebrovascular accidents [J]. Circulation , 1954 , 9 ( 5 ): 719 - 723 .
CHEN Z , VENKAT P , SEYFRIED D , et al . Brain-heart interaction [J]. Circ Res , 2017 , 121 ( 4 ): 451 - 468 .
OSTERAAS N D , LEE V H . Neurocardiology [J]. Handb Clin Neurol , 2017 , 140 : 49 - 65 .
刘卫红 , 周明学 , 李思耐 , 等 . 脑心同治理论对临床的指导意义 [J]. 世界中医药 , 2017 , 12 ( 2 ): 241 - 242 .
MÉLOUX A , BÉJOT Y , ROCHETTE L , et al . Brain-heart interactions during ischemic processes [J]. Stroke , 2020 , 51 ( 2 ): 679 - 686 .
MIERZEWSKA-SCHMIDT M , GAWECKA A . Neurogenic stunned myocardium-do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure? [J]. Anaesthesiol Intensive Ther , 2015 , 47 ( 2 ): 175 - 180 .
胡英 , 张鑫 . 急性脑卒中并发脑心综合征的临床特点 [J]. 中国当代医药 , 2019 , 26 ( 7 ): 102 - 104 .
刘丽丽 . 急性脑梗死合并心脏改变的回顾性研究 [D]. 广州 : 暨南大学 , 2014 .
安洁琼 , 李昊 , 孙明明 . 针刺辅助治疗急性脑出血的疗效及安全性分析 [J]. 世界中医药 , 2020 , 15 ( 6 ): 892 - 895,900 .
GUNNOO T , HASAN N , KHAN M S , et al . Quantifying the risk of heart disease following acute ischaemic stroke:a Meta-analysis of over 50,000 participants [J]. BMJ Open , 2016 , 6 ( 1 ): e9535 .
LAVY S , STERN S , MELAMED E , et al . Effect of chronic atrial fibrillation on regional cerebral blood flow [J]. Stroke , 1980 , 11 ( 1 ): 35 - 38 .
WOLF P A , ABBOTT R D , KANNEL W B . Atrial fibrillation as an independent risk factor for stroke: the Framingham Study [J]. Stroke , 1991 , 22 ( 8 ): 983 - 988 .
BALL J , CARRINGTON M J , STEWART S . Mild cognitive impairment in high-risk patients with chronic atrial fibrillation:a forgotten component of clinical management? [J]. Heart , 2013 , 99 ( 8 ): 542 - 547 .
ALONSO A , KNOPMAN D S , GOTTESMAN R F , et al . Correlates of dementia and mild cognitive impairment in patients with atrial fibrillation:the atherosclerosis risk in communities neurocognitive study (ARIC-NCS) [J]. J Am Heart Assoc , 2017 , 6 ( 7 ): e006014 .
CHANDER R J , LIM L , HANDA S , et al . Atrial fibrillation is independently associated with cognitive impairment after ischemic stroke [J]. J Alzheimers Dis , 2017 , 60 ( 3 ): 867 - 875 .
DAHLIN A A , PARSONS C C , BARENGO N C , et al . Association of ventricular arrhythmia and in-hospital mortality in stroke patients in Florida [J]. Medicine , 2017 , 96 ( 28 ): e7403 .
ELSAID N , BIGLIARDI G , DELL'ACQUA M L , et al . The relation between aortic arch branching types and the laterality of cardio-embolic stroke [J]. J Stroke Cerebrovasc Dis , 2020 , 29 ( 7 ): 104917 .
WITT L S , ROTTER J , STEARNS S C , et al . Heart failure and cognitive impairment in the atherosclerosis risk in communities (ARIC) study [J]. J Gen Intern Med , 2018 , 33 ( 10 ): 1721 - 1728 .
HSIEH C , LEE C , WU D P , et al . Characteristics and outcomes of ischemic stroke in patients with known atrial fibrillation or atrial fibrillation diagnosed after stroke [J]. Int J Cardiol , 2018 , 261 : 68 - 72 .
YANG X , RAO Z , GU H , et al . Atrial fibrillation known before or detected after stroke share similar risk of ischemic stroke recurrence and death [J]. Stroke , 2019 , 50 ( 5 ): 1124 - 1129 .
TOLEDO C , LUCERO C , ANDRADE D C , et al . Cognitive impairment in heart failure is associated with altered Wnt signaling in the hippocampus [J]. Aging (Albany NY) , 2019 , 11 ( 16 ): 5924 - 5942 .
MELOUX A , RIGAL E , ROCHETTE L , et al . Ischemic stroke increases heart vulnerability to ischemia-reperfusion and alters myocardial cardioprotective pathways [J]. Stroke , 2018 , 49 ( 11 ): 2752 - 2760 .
ALTHAMMER F , FERREIRA-NETO H C , RUBAHARAN M , et al . Three-dimensional morphometric analysis reveals time-dependent structural changes in microglia and astrocytes in the central amygdala and hypothalamic paraventricular nucleus of heart failure rats [J]. J Neuroinflammation , 2020 , 17 ( 1 ): 221 .
赵博 , 马莉 , 詹丽英 , 等 . SAFE通路介导的炎症因子在大鼠心肌缺血再灌注致脑损伤中的作用 [J]. 海南医学 , 2017 , 28 ( 20 ): 3269 - 3271 .
李巍 . 免疫-炎症反应介导了脑出血后的心脏损害 [D]. 天津 : 天津医科大学 , 2019 .
郭瑜 . 远隔缺血后处理对大鼠窒息性心搏骤停脑损伤的作用研究 [D]. 西安 : 第四军医大学 , 2015 .
JIA S , XIA Q , ZHANG B , et al . Involvement of the paraventricular nucleus in the occurrence of arrhythmias in middle cerebral artery occlusion rats [J]. J Stroke Cerebrovasc Dis , 2015 , 24 ( 4 ): 844 - 851 .
INFANGER D W , CAO X , BUTLER S D , et al . Silencing nox4 in the paraventricular nucleus improves myocardial infarction-induced cardiac dysfunction by attenuating sympathoexcitation and peri-infarct apoptosis [J]. Circ Res , 2010 , 106 ( 11 ): 1763 - 1774 .
ZHAO Q , YAN T , LI L , et al . Immune response mediates cardiac dysfunction after traumatic brain injury [J]. J Neurotrauma , 2019 , 36 ( 4 ): 619 - 629 .
CHAIKITTISILPA N , KRISHNAMOORTHY V , LELE A V , et al . Characterizing the relationship between systemic inflammatory response syndrome and early cardiac dysfunction in traumatic brain injury [J]. J Neurosci Res , 2018 , 96 ( 4 ): 661 - 670 .
ROSENBERG G A . Neurological diseases in relation to the blood-brain barrier [J]. J Cereb Blood Flow Metab , 2012 , 32 ( 7 ): 1139 - 1151 .
李然 . 免疫反应介导了蛛网膜下腔出血后心脑功能损伤 [D]. 天津 : 天津医科大学 , 2019 .
YAN T , CHEN Z , CHOPP M , et al . Inflammatory responses mediate brain-heart interaction after ischemic stroke in adult mice [J]. J Cereb Blood Flow Metab , 2020 , 40 ( 6 ): 1213 - 1229 .
LICATA G , TUTTOLOMONDO A , DI RAIMONDO D , et al . Immuno-inflammatory activation in acute cardio-embolic strokes in comparison with other subtypes of ischaemic stroke [J]. Thromb Haemost , 2009 , 101 ( 5 ): 929 - 937 .
陈跃武 , 刘先霞 , 陈卫卫 , 等 . 慢性心力衰竭患者血清S100B蛋白表达与RAGE水平的相关性研究及临床意义 [J]. 中国医药导报 , 2019 , 16 ( 20 ): 68 - 71 .
LUAN H H , WANG A , HILLIARD B K , et al . GDF15 is an inflammation-induced central mediator of tissue tolerance [J]. Cell , 2019 , 178 ( 5 ): 1231 - 1244 .
SINGH R B , HRISTOVA K , FEDACKO J , et al . Chronic heart failure:a disease of the brain [J]. Heart Fail Rev , 2019 , 24 ( 2 ): 301 - 307 .
TAGGART P . Brain-heart interactions and cardiac ventricular arrhythmias [J]. Neth Heart J , 2013 , 21 ( 2 ): 78 - 81 .
LOPSHIRE J C , ZHOU X , DUSA C , et al . Spinal cord stimulation improves ventricular function and reduces ventricular arrhythmias in a canine postinfarction heart failure model [J]. Circulation , 2009 , 120 ( 4 ): 286 - 294 .
NORTON K N , BADROV M B , BARRON C C , et al . Coronary artery disease affects cortical circuitry associated with brain-heart integration during volitional exercise [J]. J Neurophysiol , 2015 , 114 ( 2 ): 835 - 845 .
ZOU R , ZHANG D , LV L , et al . Bioinformatic gene analysis for potential biomarkers and therapeutic targets of atrial fibrillation-related stroke [J]. J Transl Med , 2019 , 17 ( 1 ): 45 .
ISHIKAWA H , TAJIRI N , VASCONCELLOS J , et al . Ischemic stroke brain sends indirect cell death signals to the heart [J]. Stroke , 2013 , 44 ( 11 ): 3175 - 3182 .
李梦瑶 , 何亚丽 , 毛玉娟 , 等 . 外泌体在心脑血管疾病中的研究现状 [J]. 中国临床药理学杂志 , 2020 , 36 ( 22 ): 3823 - 3827 .
CHEN Y , LI G , LIU M L . Microvesicles as emerging biomarkers and therapeutic targets in cardiometabolic diseases [J]. Genomics Proteomics Bioinformatics , 2018 , 16 ( 1 ): 50 - 62 .
MANEK R , MOGHIEB A , YANG Z , et al . Protein biomarkers and neuroproteomics characterization of microvesicles/exosomes from human cerebrospinal fluid following traumatic brain injury [J]. Mol Neurobiol , 2018 , 55 ( 7 ): 6112 - 6128 .
STANLEY W C , RECCHIA F A , LOPASCHUK G D . Myocardial substrate metabolism in the normal and failing heart [J]. Physiol Rev , 2005 , 85 ( 3 ): 1093 - 1129 .
KOLWICZ S J , PUROHIT S , TIAN R . Cardiac metabolism and its interactions with contraction,growth,and survival of cardiomyocytes [J]. Circ Res , 2013 , 113 ( 5 ): 603 - 616 .
FILLMORE N , LEVASSEUR J L , FUKUSHIMA A , et al . Uncoupling of glycolysis from glucose oxidation accompanies the development of heart failure with preserved ejection fraction [J]. Mol Med , 2018 , doi: 10.1186/s10020-018-0005-x http://dx.doi.org/10.1186/s10020-018-0005-x .
NELSON S E , AMENT Z , WOLCOTT Z , et al . Succinate links atrial dysfunction and cardioembolic stroke [J]. Neurology , 2019 , 92 ( 8 ): e802 - e810 .
BUSNARDO C , TAVARES R F , CORREA F M . Role of N -methyl- D -aspartate and non- N -methyl- D -aspartate receptors in the cardiovascular effects of L-glutamate microinjection into the hypothalamic paraventricular nucleus of unanesthetized rats [J]. J Neurosci Res , 2009 , 87 ( 9 ): 2066 - 2077 .
LONGHURST J C , TJEN-A-LOOI S C , FU L W . Cardiac sympathetic afferent activation provoked by myocardial ischemia and reperfusion.Mechanisms and reflexes [J]. Ann N Y Acad Sci , 2001 , 940 : 74 - 95 .
杨涛 , 赵明镜 , 王蕾 , 等 .“ 心主神明”的内涵及现代科学依据 [J]. 北京中医药大学学报 , 2016 , 39 ( 10 ): 811 - 814 .
VAN DEN HURK K , REIJMER Y D , VAN DEN BERG E , et al . Heart failure and cognitive function in the general population:the Hoorn Study [J]. Eur J Heart Fail , 2011 , 13 ( 12 ): 1362 - 1369 .
苏便苓 , 李拥军 , 刘振红 . 抗抑郁治疗对急性心肌梗死患者预后的影响 [J]. 中国综合临床 , 2006 , 22 ( 4 ): 306 - 308 .
杨光铭 , 魏子秀 , 闫中瑞 , 等 . 急性冠脉综合征患者抑郁与心血管结局的关系 [J]. 中西医结合心血管病电子杂志 , 2017 , 5 ( 26 ): 19 - 20 .
唐卓然 , 陈雅丽 , 侯季秋 , 等 . 从“心主神明”论冠心病合并抑郁 [J]. 中西医结合心脑血管病杂志 , 2020 , 18 ( 22 ): 3892 - 3893 .
张晓梅 , 刘天浩 , 卫娜 , 等 . 基于肠道微环境探讨“心主神明”的内涵与外延 [J]. 中医杂志 , 2017 , 58 ( 19 ): 1629 - 1632 .
贾蔷 , 唐仕欢 , 石作荣 , 等 . 从中医气血理论探析“脑心同治 ”[J]. 世界中医药 , 2014 , 9 ( 10 ): 1293 - 1295 .
曹晓岚 , 韩宁 . 心脑同治学说的涵义及临床应用 [J]. 世界中西医结合杂志 , 2008 , 3 ( 3 ): 129 - 131 .
赵步长 . 脑心同治 [C]//第五次全国中西医结合血瘀证及活血化瘀研究学术大会论文汇编,北海:[出版社不详], 2001 : 73 - 75 .
刘焯辉 . 辨证求因论治心脑血管疾患浅析 [J]. 中国中医急症 , 2000 , S1 : 32 - 33 .
陈迪 , 唐仕欢 , 卢朋 , 等 . 基于数据科学的脑心同治机制研究 [J]. 中国中药杂志 , 2015 , 40 ( 21 ): 4288 - 4296 .
李春晓 , 陈玉欢 , 李学林 , 等 . 脑心通胶囊治疗冠心病心绞痛有效性和安全性的系统评价 [J]. 中国医院用药评价与分析 , 2019 , 19 ( 12 ): 1494 - 1499 .
王景武 , 李彬彬 , 孙克陆 , 等 . 脑心通对高血压大鼠左心室重构的影响及机制 [J]. 世界中医药 , 2019 , 14 ( 12 ): 3198 - 3201 .
陈迪 , 卢朋 , 张方博 , 等 . 基于数据挖掘和网络分析的“脑心同治”分子机制研究 [J]. 中国中药杂志 , 2013 , 38 ( 1 ): 91 - 98 .
赵涛 , 王一民 , 刘娜 , 等 . 从补阳还五汤到脑心通胶囊——脑心同治的思路探讨 [J]. 世界中西医结合杂志 , 2012 , 7 ( 10 ): 900 - 903 .
QIUER L , YUNFEI C , RUIXUE C , et al . The effect of naoxintong capsule in the treatment of patients with cerebral infarction and carotid atherosclerosis:a systematic review and Meta-analysis of randomized trials [J]. Evid Based Complement Alternat Med , 2018 , doi: 10.1155/2018/5892306 http://dx.doi.org/10.1155/2018/5892306 .
WANG X , YIN Z , CAO P , et al . NaoXinTong Capsule ameliorates memory deficit in APP/PS1 mice by regulating inflammatory cytokines [J]. Biomed Pharmacother , 2021 , 133 : 110964 .
YUAN S , JIN J , CHEN L , et al . Naoxintong/PPARgamma signaling inhibits cardiac hypertrophy via activation of autophagy [J]. Evid Based Complement Alternat Med , 2017 , 2 : 3801976 - 3801984 .
娄序笙 , 李平 . 灯盏生脉胶囊联合常规疗法治疗气虚血瘀型冠状动脉粥样硬化性心脏病伴高脂血症的临床观察 [J]. 上海中医药杂志 , 2020 , 54 ( 12 ): 45 - 49 .
穆雪梅 , 米楠 , 祖先鹏 , 等 . 灯盏生脉胶囊化学成分、药理作用及临床应用研究进展 [J]. 中国中药杂志 , 2019 , 44 ( 18 ): 3917 - 3923 .
高志杰 , 王立新 . 通心络胶囊对脑缺血再灌注损伤小鼠的保护作用及作用机制 [J]. 中国实验方剂学杂志 , 2020 , 26 ( 11 ): 93 - 99 .
韩宁 .“ 心脑同治”学说及益气心脑宁治疗脑梗塞合并冠心病心绞痛的临床研究 [D]. 济南 : 山东中医药大学 , 2006 .
曹晓岚 , 王敏 . 益气心脑宁防治老年心脑缺血临床研究 [J]. 环球中医药 , 2009 , 2 ( 2 ): 90 - 94 .
陈寅萤 , 李华 , 吴萍 , 等 . 丹红注射液治疗心脑血管疾病的药理作用机制研究进展 [J]. 中国实验方剂学杂志 , 2021 , doi: 10.13422/j.cnki.syfjx.20210349 http://dx.doi.org/10.13422/j.cnki.syfjx.20210349 .
FENG C , WAN H , ZHANG Y , et al . Neuroprotective effect of danhong injection on cerebral ischemia-reperfusion injury in rats by activation of the PI3K-Akt pathway [J]. Front Pharmacol , 2020 , 11 : 298 .
ZHOU M , REN P , LI S , et al . Danhong injection attenuates high-fat-induced atherosclerosis and macrophage lipid accumulation by regulating the PI3K/AKT insulin pathway [J]. J Cardiovasc Pharmacol , 2019 , 74 ( 2 ): 152 - 161 .
WANG S , YU L , SUN G , et al . Danhong injection protects hemorrhagic brain by increasing Peroxiredoxin 1 in aged rats [J]. Front Pharmacol , 2020 , doi: 10.3389/fphar.2020.00346 http://dx.doi.org/10.3389/fphar.2020.00346 .
SRIDHARAN K , AL B R , QADER A M , et al . Evaluation of inter-patient variability in the pharmacodynamic indices of warfarin [J]. Expert Rev Cardiovasc Ther , 2020 : 1 - 6 .
李楠 , 华潞 . 华法林与心血管疾病常用药物相互作用的研究进展 [J]. 山东医药 , 2019 , 59 ( 23 ): 83 - 87 .
ARRIBAS J M , GARCIA E , JARA R , et al . Incidence and etiological mechanism of stroke in cardiac surgery [J]. Neurologia , 2020 , 35 ( 7 ): 458 - 463 .
MORINO Y , NAKAJIMA Y . Structural heart intervention for prevention of embolic and hemorrhagic stroke:the new field of neurocardiology [J]. J Cardiol , 2020 , 76 ( 3 ): 227 - 235 .
陆佳楠 , 张建民 . 脑血管病防治:从心脑血管病联防联治谈起 [J]. 心脑血管病防治 , 2020 , 20 ( 1 ): 25 - 37 .
0
Views
21
下载量
6
CSCD
Publicity Resources
Related Articles
Related Author
Related Institution
京公网安备11010802024621