

浏览全部资源
扫码关注微信
1.中国中医科学院 西苑医院,北京 100091
2.昆山市中医医院,江苏 昆山 215300
Received:16 July 2024,
Published Online:23 September 2024,
Published:05 December 2024
移动端阅览
彭涵,辛高杰,曹策等.基于“气血交互于脉”理论探讨益气活血中药防治心肌缺血再灌注损伤的作用机制[J].中国实验方剂学杂志,2024,30(23):27-34.
PENG Han,XIN Gaojie,CAO Ce,et al.Mechanism of Prevention and Treatment of Myocardial Ischemia-reperfusion Injury by Qi-replenishing and Blood-activating Chinese Medicines Based on Theory of Qi and Blood Interacting in Vessels[J].Chinese Journal of Experimental Traditional Medical Formulae,2024,30(23):27-34.
彭涵,辛高杰,曹策等.基于“气血交互于脉”理论探讨益气活血中药防治心肌缺血再灌注损伤的作用机制[J].中国实验方剂学杂志,2024,30(23):27-34. DOI: 10.13422/j.cnki.syfjx.20242222.
PENG Han,XIN Gaojie,CAO Ce,et al.Mechanism of Prevention and Treatment of Myocardial Ischemia-reperfusion Injury by Qi-replenishing and Blood-activating Chinese Medicines Based on Theory of Qi and Blood Interacting in Vessels[J].Chinese Journal of Experimental Traditional Medical Formulae,2024,30(23):27-34. DOI: 10.13422/j.cnki.syfjx.20242222.
心肌缺血再灌注损伤(MIRI)为缺血性心脏病在治疗过程中的常见损伤,可归属于中医学“胸痹”“心悸”范畴,其发生发展与气血失和导致的血脉损伤相关。气血同病是MIRI发生发展的重要病机,气血辨证是辨证论治的基本方法。“气血交互于脉”由该团队基于“气为血帅,血为气母”的气血理论,结合相关研究而提出,具体内容为“气以脉而帅血,血由脉而载气,气血交互于脉”。MIRI阶段线粒体功能失常、血小板功能异常、血管内皮损伤,线粒体功能障碍与气虚、血小板功能异常与血瘀、血管内皮损伤与脉损具有相关性,线粒体、血小板与血管内皮相互影响引发的结构与功能改变是气虚血瘀脉损导致MIRI发生发展的机制之一。该文通过探讨中医理论“气”与线粒体,“血”与血小板,“脉”与血管的相关性,阐释中医“气血交互于脉”理论的现代科学内涵与MIRI机制。根据核心病机“气血失和于脉”探讨“益气”中药、“活血”中药与“益气活血”复方对MIRI防治的中药药理学机制。结合该团队以“气血交互于脉”理论为指导开展的益气活血中药防治MIRI的相关研究,分析益气活血中药对气血脉的影响,传承和发展气血理论,揭示其防治心血管疾病的理论依据和科学内涵,以期为临床应用中医药防治心血管疾病提供新的思路和参考。
Myocardial ischemia-reperfusion injury (MIRI) is a common injury in the treatment of ischemic heart diseases. MIRI can be categorized as chest impediment and palpitation in traditional Chinese medicine, with the pathogenesis related to Qi and blood disharmony. The simultaneous disorders of Qi and blood are the key mechanism of MIRI, and thus the differentiation of Qi and blood syndromes is the prerequisite for the treatment. The theory of Qi and blood interacting in vessels is proposed by our team based on Qi being the commander of blood and blood being the mother of Qi as well as previous pharmacological studies. Specifically, Qi marshals blood by vessels, and the blood carries Qi by vessels. Accordingly, Qi and blood interact in the vessels. MIRI is accompanied by mitochondrial dysfunction, platelet function abnormality, and vascular endothelial damage, which are correlated with Qi deficiency, blood stasis, and vessel damage, respectively. Mitochondrial, platelet, and vascular endothelial structural and functional changes triggered by their interactions are one of the mechanisms by which Qi deficiency, blood stasis, and vessel damage lead to the occurrence and development of MIRI. By exploring the correlations between Qi and mitochondria, between blood and platelets, and between vessels and blood vessels, we can explain the modern scientific content of the theory of Qi and blood interacting in vessels in traditional Chinese medicine. According to the pathogenesis of Qi and blood disharmony in vessels, we discussed the pharmacological mechanisms of Qi-replenishing medicines, blood-activating medicines, and their combinations in the prevention and treatment of MIRI. On the basis of the research achievements in the prevention and treatment of MIRI by Qi-replenishing and blood-activating Chinese medicines based on the theory of Qi and blood interacting in vessels, we analyzed the effects of these medicines on Qi, blood, and vessels. According to the theory of Qi and blood, this article reveals the theoretical basis and scientific connotations of the prevention and treatment of cardiovascular diseases, with the aim of providing new ideas and references for the clinical application of traditional Chinese medicine in the prevention and treatment of cardiovascular diseases.
KIRVALIDZE I , JORBENADZE T , KHETSURIANI R . Etiopathogenesis of cardiomyopathies: A review [J]. Georgian Med News , 2009 , 16 ( 174 ): 104 - 108 .
BRADLEY C , BERRY C . Definition and epidemiology of coronary microvascular disease [J]. J Nucl Cardiol , 2022 , 29 ( 4 ): 1763 - 1775 .
葛均波 , 徐永健 , 王辰 . 内科学 [M]. 9版 . 北京 : 人民卫生出版社 , 2018 : 228 .
SAGRIS M , APOSTOLOS A , THEOFILIS P , et al . Myocardial ischemia-reperfusion injury: Unraveling pathophysiology, clinical manifestations, and emerging prevention strategies [J]. Biomedicines , 2024 , 12 ( 4 ): 802 .
谢连娣 , 刘洋 , 周琨 , 等 . 心肌缺血再灌注损伤的中医病机浅识 [J]. 中华中医药杂志 , 2015 , 30 ( 9 ): 3139 - 3141 .
曹蛟 , 张杼惠 , 刘建和 . 从中医“阳气亏虚,痰瘀内阻”理论探讨中医药防治心肌缺血再灌注损伤的机制 [J]. 世界科学技术—中医药现代化 , 2021 , 23 ( 2 ): 510 - 515 .
赵爱梅 , 任钧国 , 刘建勋 . 益气活血方治疗冠心病气虚血瘀证作用机制研究进展 [J]. 中国实验方剂学杂志 , 2017 , 23 ( 7 ): 215 - 220 .
曹策 , 李玲美 , 王紫艳 , 等 . 基于功能代谢学分析血液环境异常情况下血小板变化及中医药治疗现状 [J]. 中华中医药杂志 , 2023 , 38 ( 6 ): 2728 - 2733 .
陈可冀 , 李连达 , 翁维良 . 血瘀证与活血化瘀研究 [J]. 中西医结合心脑血管病杂志 , 2005 ( 1 ): 1 - 2 .
刘建勋 , 陈进成 , 郭浩 , 等 . 气血交互于脉的理论基础与实践 [J]. 中医杂志 , 2020 , 61 ( 2 ): 98 - 102 .
孙广仁 . 《内经》中气的涵义辨析 [J]. 浙江中医学院学报 , 2000 , 24 ( 5 ): 15 .
BRUTSAERT D L . Cardiac endothelial-myocardial signaling: Its role in cardiac growth, contractile performance, and rhythmicity [J]. Physiol Rev , 2003 , 83 ( 1 ): 59 - 115 .
BRUTSAERT D L , FRANSEN P , ANDRIES L J , et al . Cardiac endothelium and myocardial function [J]. Cardiovasc Res , 1998 , 38 ( 2 ): 281 - 290 .
KANG P T , CHEN C L , LIN P , et al . Impairment of pH gradient and membrane potential mediates redox dysfunction in the mitochondria of the post-ischemic heart [J]. Basic Res Cardiol , 2017 , 112 ( 4 ): 36 .
LESNEFSKY E J , CHEN Q , TANDLER B , et al . Mitochondrial dysfunction and myocardial ischemia-reperfusion: Implications for novel therapies [J]. Annu Rev Pharmacol Toxicol , 2017 , 57 ( 1 ): 535 - 565 .
ONG S B , SUBRAYAN S , LIM S Y , et al . Inhibiting mitochondrial fission protects the heart against ischemia/reperfusion injury [J]. Circulation , 2010 , 121 ( 18 ): 2012 - 2022 .
HANSEN P R . Inflammatory alterations in the myocardial microcirculation [J]. J Mol Cell Cardiol , 1998 , 30 ( 12 ): 2555 - 2559 .
WU Q , XU R , ZHANG K , et al . Characterization of early myocardial inflammation in ischemia-reperfusion injury [J]. Front Immunol , 2022 , 13 : 1081719 .
HANSEN P R . Inflammatory alterations in the myocardial microcirculation [J]. J Mol Cell Cardiol , 1998 , 30 ( 12 ): 2555 - 2559 .
SCHANZE N , HAMAD M A , NUHRENBERG T G , et al . Platelets in myocardial ischemia/reperfusion injury [J]. Hämostaseologie , 2023 , 43 ( 2 ): 110 - 121 .
SCHANZE N , BODE C , DUERSCHMIED D . Platelet contributions to myocardial ischemia/reperfusion injury [J]. Front Immunol , 2019 , 10 : 1260 .
刘燕君 , 胡镜清 , 江丽杰 . 冠心病痰瘀互结分子生物学机理研究现状 [J]. 世界科学技术—中医药现代化 , 2016 , 18 ( 5 ): 791 - 799 .
SINGHAL A K , SYMONS J D , BOUDINA S , et al . Role of endothelial cells in myocardial ischemia-reperfusion injury [J]. Vasc Dis Prev , 2010 , 7 : 1 - 14 .
HABAZETTL H , HANUSCH P , KUPATT C . Effects of endothelium/leukocytes/platelet interaction on myocardial ischemia - reperfusion injury [J]. Z Kardiol , 2000 , 89 ( Suppl 9 ): IX/92 - 95 .
VINTEN J . Nitric oxide and the vascular endothelium in myocardial ischemia-reperfusion injury [J]. Pathophysiology , 1998 , 1001 ( 5 ): 39 .
王万铁 , 徐正祄 , 林丽娜 , 等 . 川芎嗪对实验性心肌缺血再灌注损伤中一氧化氮和内皮素的干预 [J]. 中国病理生理杂志 , 2001 , 17 ( 3 ): 230 - 234 .
JUN M , FOOTE C , LV J , et al . Effects of fibrates on cardiovascular outcomes: A systematic review and Meta-analysis [J]. Lancet , 2010 , 375 ( 9729 ): 1875 - 1884 .
WANG J , TOAN S , ZHOU H . New insights into the role of mitochondria in cardiac microvascular ischemia/reperfusion injury [J]. Angiogenesis , 2020 , 23 ( 3 ): 299 - 314 .
李睿 , 刘诗怡 , 纪树亮 , 等 . 心肌缺血再灌注损伤中医辨证论治研究进展 [J]. 中国中医基础医学杂志 , 2024 , 30 ( 1 ): 145 - 151 .
郭浩 , 刘建勋 . 线粒体动力学相关MicroRNA在气虚血瘀病症结合大鼠模型中的意义及益气活血中药干预机制研究 [R]. 北京市,中国中医科学院西苑医院 , 2018 : 12 - 01 .
武思晴 , 苗明三 , 苗晋鑫 . 中药多糖改善心肌缺血再灌注损伤的作用机制 [J]. 中国实验方剂学杂志 , 2024 , doi: 10.13422/j.cnki.syfjx.20241921 http://dx.doi.org/10.13422/j.cnki.syfjx.20241921 .
赵烨婧 , 彭红玉 , 刘建勋 , 等 . 急性冠脉综合征患者介入治疗前后气滞血瘀气虚血瘀证候演变规律及预后分析 [J]. 中国中西医结合杂志 , 2023 , 43 ( 2 ): 162 - 168 .
吴昱杰 , 刘建勋 . 益气活血中药改善慢性心衰心气虚证作用机制研究进展 [J]. 中药药理与临床 , 2021 , 37 ( 1 ): 234 - 239 .
高卉 , 杨泽祺 , 刘欣 , 等 . 益气温阳活血利水组分配伍对CHF大鼠心功能及心肌能量代谢的影响 [J]. 中国实验方剂学杂志 , 2024 , doi: 10.13422/j.cnki.syfjx.20240837 http://dx.doi.org/10.13422/j.cnki.syfjx.20240837 .
黄婷婷 , 韩笑 , 刘建勋 , 等 . 益气活血方对气虚血瘀证大鼠血管内皮功能的影响 [J]. 中国实验方剂学杂志 , 2019 , 25 ( 8 ): 40 - 46 .
陈佳萍 , 尚菊菊 , 刘红旭 , 等 . 益气活血/逐瘀类口服中成药干预冠状动脉微血管病的Meta分析及GRADE证据评价 [J]. 中国实验方剂学杂志 , 2024 , doi: 10.13422/j.cnki.syfjx.20242497 http://dx.doi.org/10.13422/j.cnki.syfjx.20242497 .
辛高杰 , 陈原原 , 刘子馨 , 等 . 人参皂苷Re通过Nrf2/HO-1/PGC-1 α 通路调控线粒体生物发生减轻H9c2心肌细胞缺氧/复氧损伤的研究 [J]. 中国中药杂志 , 2024 , 49 ( 4 ): 1064 - 1072 .
李澎 , 王建农 , 卢树杰 , 等 . 山楂叶原花青素对乳鼠心肌细胞缺血再灌注损伤的保护作用 [J]. 中国中药杂志 , 2009 , 34 ( 1 ): 96 - 99 .
付建华 , 李澎 , 李欣志 , 等 . 山楂叶提取物对犬急性心肌缺血再灌注损伤的保护作用 [J]. 世界科学技术—中医药现代化 , 2006 , 8 ( 2 ): 6 - 12 .
李澎 , 付建华 , 李欣志 , 等 . 山楂叶提取物及其制剂对人脐静脉内皮细胞缺氧复氧损伤中性粒细胞黏附的影响 [J]. 中国中西医结合杂志 , 2008 , 28 ( 8 ): 716 - 720 .
宋文婷 , 曹慧 , 张业昊 , 等 . 红景天苷对脑缺血再灌注模型大鼠内皮细胞屏障的保护作用及机制研究 [J]. 中国中药杂志 , 2022 , 47 ( 19 ): 5284 - 5291 .
刘子馨 , 辛高杰 , 尤越 , 等 . 基于线粒体分裂融合探讨丹酚酸B保护H9C2细胞OGD/R损伤的作用机制研究 [J]. 药学学报 , 2024 , 59 ( 2 ): 374 - 381 .
李玲美 , 付建华 , 郭浩 , 等 . 注射用红花黄色素经TLR-NF- κ B炎症通路抗大鼠MIRI的保护作用研究 [J]. 中国中药杂志 , 2019 , 44 ( 12 ): 2566 - 2571 .
韩笑 , 郭浩 , 杨斌 , 等 . 丹红滴丸抑制缺血再灌注损伤大鼠心肌NF- κ B活化减轻炎症保护心肌 [J]. 贵州中医药大学学报 , 2020 , 42 ( 1 ): 27 - 32 .
辛高杰 , 刘子馨 , 陈原原 , 等 . 延胡索乙素通过ULK1/FUNDC1通路抑制线粒体自噬减轻H9c2心肌细胞缺氧/复氧损伤 [J]. 中国中药杂志 , 2024 , 49 ( 5 ): 1286 - 1294 .
曹策 , 李玲美 , 韩笑 , 等 . 基于PI3K/Akt/Beclin-1信号通路探析积雪草苷对OGD/R诱导损伤H9C2心肌细胞的影响 [J]. 药学学报 , 2023 , 58 ( 5 ): 1149 - 1155 .
韩笑 , 郭浩 , 杨斌 , 等 . 丹红滴丸调节Bcl-2/Bax- Cyt-C-Caspase-3抑制心肌缺血再灌注大鼠心肌细胞凋亡 [J]. 中药药理与临床 , 2020 , 36 ( 3 ): 154 - 158 .
李玲美 , 曹策 , 韩笑 , 等 . 羟基红花黄色素A对缺氧缺糖/复氧复糖损伤的大鼠H9C2心肌细胞氧化应激和细胞凋亡的影响 [J]. 中国比较医学杂志 , 2023 , 33 ( 3 ): 9 - 16 .
宋文婷 , 苗兰 , 孙明谦 , 等 . 益气活血方及其拆方对气虚血瘀型脑梗大鼠影响的比较研究 [J]. 中国中医基础医学杂志 , 2021 , 27 ( 6 ): 921 - 926 .
王智博 , 吴昱杰 , 张业昊 , 等 . 基于“益气活血法”的复方人参补气颗粒对心梗后心衰大鼠心肌保护药效学研究 [J]. 中药药理与临床 , 2021 , 37 ( 3 ): 150 - 157 .
李磊 , 孟红旭 , 辛高杰 , 等 . 双参宁心胶囊对冠脉微循环障碍大鼠心肌微血管灌注及内皮的影响 [J]. 中华中医药杂志 , 2022 , 37 ( 12 ): 7012 - 7018 .
赵雨薇 , 付建华 , 李磊 , 等 . 双参宁心胶囊通过调控线粒体ATP敏感性钾通道减轻大鼠心肌缺血/再灌注损伤 [J]. 中国实验方剂学杂志 , 2020 , 26 ( 13 ): 104 - 110 .
辛高杰 , 陈原原 , 刘子馨 , 等 . 双参宁心胶囊调控线粒体分裂、融合减轻大鼠心肌缺血再灌注损伤 [J]. 中国实验方剂学杂志 , 2024 , 30 ( 7 ): 87 - 94 .
王紫艳 , 李磊 , 刘建勋 , 等 . 补阳还五汤对多因素诱导急性血瘀证模型大鼠血小板功能及相关炎性因子的影响 [J]. 中国实验方剂学杂志 , 2022 , 28 ( 21 ): 1 - 9 .
宋文婷 , 丁昭 , 苗兰 , 等 . 补阳还五汤治疗大鼠气虚血瘀型脑缺血的代谢组学研究 [J]. 世界中医药 , 2023 , 18 ( 15 ): 2154 - 2159 .
李玲美 , 付建华 , 林成仁 , 等 . 天龙通心片对心肌缺血再灌注损伤及血液流变学的影响 [J]. 中国实验方剂学杂志 , 2019 , 25 ( 10 ): 41 - 47 .
张翠香 , 刘建勋 , 李丹 , 等 . 冠脉通片对心肌缺血再灌注损伤大鼠心肌酶及心肌细胞凋亡的影响 [J]. 中医杂志 , 2014 , 55 ( 20 ): 1760 - 1763 .
国家心血管病中心 , 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2023概要 [J]. 中国循环杂志 , 2024 , 39 ( 7 ): 625 - 660 .
0
Views
249
下载量
1
CSCD
Publicity Resources
Related Articles
Related Author
Related Institution
京公网安备11010802024621