新冠肺炎引起心肌损伤的机制及其治疗探讨  

Discussion on the Mechanism and Treatment of Myocardial Injury Caused by COVID-19

作　　者：郦琳 唐宇俊 王俏[1] 王明珠 孔祥聿 温成平[1] 黄琳[1] LI Lin;TANG Yujun;WANG Qiao(Zhejiang Chinese Medical University,Hangzhou(310053),China)

机构地区：[1]浙江中医药大学,杭州310053

出　　处：《浙江中医药大学学报》2021年第4期319-324,共6页Journal of Zhejiang Chinese Medical University

基　　金：浙江省自然科学基金“新型冠状病毒肺炎应急防治”专项(LEZ20H190001)。

摘　　要：[目的]探讨新型冠状病毒肺炎(Corona Virus Disease 2019,COVID-19)引起心肌损伤的中西医机制及培元宣化解毒法治疗本病的机制。[方法]通过阅读论述瘟疫的相关古籍以及有关COVID-19的最新文献,总结COVID-19引起心肌损伤的中西医机制,分析其病因病机与治疗方法,并通过验案一则加以佐证。[结果]COVID-19引起心肌损伤的机制主要是通过病毒表面的s蛋白与表达于心血管系统的血管紧张素转化酶Ⅱ(angiotensinconverting enzyme 2,ACE2)受体结合而感染细胞。COVID-19属于中医“寒湿疫”,根据卫气营血传变规律显示疫毒入侵,脾虚湿困,肺气受损,反侮心火,导致逆传心包,造成心肌损伤,由此本团队提出培土生金、宣肺疏风、化湿解毒的方法。病案所示为肺脾气虚型COVID-19患者,通过培元宣化解毒法可抗病毒,改善肺部炎症,且能够减轻心肌损伤,改善心功能。[结论]COVID-19引起心肌损伤的机制与ACE2有关,培元宣化解毒法通过补益脾肺、顾护正气、化湿解毒以排出疫毒之邪,防止病邪逆传心包,治疗COVID-19及顾护心肌效果良好,拓展了COVID-19的治疗方法,值得临床推广。[Objective]To explore the mechanism of myocardial injury caused by Corona Virus Disease 2019(COVID-19)in traditional Chinese and western medicine and the mechanism of Peiyuan Xuanhua Jiedu method in the treatment of COVID-19.[Methods]Through reading plague-related ancient books and the latest literatures about COVID-19,the mechanism of Chinese and western medicine on myocardial injury caused by COVID-19 was summarized,and the etiology,pathogenesis and treatment methods were analyzed,and Peiyuan Xuanhua Jiedu method was put forward and verified by a medical case.[Results]The mechanism of myocardial injury induced by COVID-19 is that it infects cells mainly through the binding of s protein to angiotensinconverting enzymeⅡ(ACE2)receptor expressed in cardiovascular system,which leads to myocardial injury.COVID-19 belongs to“cold-dampness epidemic”in traditional Chinese medicine and the regularity of defensive-Qi-nutrient-blood shows that due to the epidemic toxin invasion,splenic asthenia and stagnation of dampness,the injury of lung Qi,the heart fire will be affected,then the pericardium is reversed,causing the damage of myocardial,therefore,the team puts forward the method of reinforcing earth to strengthen metal,dispersing the lung to dispel wind,removing dampness and detoxification.The patient in the medical case was COVID-19 with deficiency of lung and spleen Qi,Peiyuan Xuanhua Jiedu method could effectively antivirus,improve pulmonary inflammation,and reduce the level of myocardial injury and improve cardiac function.[Conclusion]The mechanism of myocardial injury caused by COVID-19 is related to ACE2.Peiyuan Xuanhua Jiedu method can nourish the spleen and lung,protect Qi,removing dampness and detoxification to expel pathogenic factors,and prevent the reverse transmission of pathogenic factors to pericardium,which extends the treatment of COVID-19 and is worthy of clinical promotion.

关 键 词：新型冠状病毒肺炎 寒湿疫 血管紧张素转化酶Ⅱ 心肌损伤 机制 培元宣化解毒法 验案 瘟疫 

分 类 号：R273[医药卫生—中西医结合]