益气活血祛瘀类中药及其复方防治心力衰竭的作用和机制  

Role and Mechanism of Chinese Medicinal Materials and Their Compound Formulas with Effects of Replenishing Qi,Activating Blood,and Dispelling Stasis in Prevention and Treatment of Heart Failure

作　　者：陈佳萍 缪兴龙[2] 丁苗苗 苏杨焱 刘昌孝 马江[1] 何新 CHEN Jiaping;MIU Xinglong;DING Miaomiao;SU Yangyan;LIU Changxiao;MA Jiang;HE Xin(Guangdong Pharmaceutical University,Guangzhou 510006,China;Tianjin University of Traditional Chinese Medicine,Tianjin 300410,China;State Key Laboratory of Drug Delivery Technology and Pharmacokinetics,Tianjin Institute of Pharmaceutical Research,Tianjin 300193,China)

机构地区：[1]广东药科大学,广州510006 [2]天津中医药大学,天津300410 [3]天津药物研究院释药技术与药代动力学国家重点实验室,天津300193

出　　处：《中国实验方剂学杂志》2022年第21期221-234,共14页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金面上项目(82174209);广东省教育厅普通高校新冠肺炎疫情防控专项研究项目(2020KZDZX11240)。

摘　　要：心力衰竭是多种心血管疾病的终点,其患病率居高不下,患者一旦确诊通常需终生服药,严重影响患者生活质量。目前临床常用于治疗心力衰竭的药物主要包括血管紧张素转换酶抑制剂、β-受体阻滞剂、醛固酮受体拮抗剂和利尿剂,然而长期服用会导致低血压、体液耗竭、电解质紊乱等不良反应,甚至会导致患者死亡率增高。中医认为气虚血滞为心力衰竭之根本,“气不行则血不畅”,因此临床上多借助益气活血祛瘀类中药从内因外症两方面同时入手治疗心力衰竭。近期研究表明,黄芪、人参、三七、丹参、当归等益气活血祛瘀类中药及补阳还五汤、四妙勇安汤、芪苈强心胶囊、芪参益气滴丸等中药复方均具有良好的抗心衰作用,其机制主要包括抑制氧化应激和炎症反应、改善心肌纤维化和钙循环、保护线粒体功能等。该文基于心力衰竭的病理机制及信号通路,系统地阐述益气活血祛瘀类中药及其复方在防治心力衰竭中的药理作用、分子机制及临床应用研究进展,以期为抗心力衰竭中药的开发和临床用药提供科学依据。Heart failure with high prevalence is the endpoint of many cardiovascular diseases.Once diagnosed,patients usually need lifelong medication,which seriously affects their quality of life.The drugs commonly used to treat heart failure include angiotensin-converting enzyme inhibitors,beta-blockers,aldosterone receptor antagonists,and diuretics.However,the long-term use of those drugs can lead to side effects such as hypotension,depletion of body fluid,and electrolyte imbalance and even increase mortality.According to the theory of traditional Chinese medicine(TCM),Qi deficiency and blood stagnation is the major cause of heart failure and when Qi is not moving,blood is not flowing.Therefore,the TCM clinical treatment of heart failure uses the Chinese medicinal materials which replenish Qi,activate blood,and dispell stasis to treat both internal cause and external symptoms.Recent studies have demonstrated that Chinese herbal medicines such as Astragali Radix,Ginseng Radix et Rhizoma,Notoginseng Radix et Rhizoma,Salviae Miltiorrhizae Radix et Rhizoma,Angelicae Sinensis Radix,as well as the compound formulas such as Buyang Huanwutang,Simiao Yongantang,Qili Qiangxin capsules,and Qishen Yiqi drops,play a significant role in the prevention and treatment of heart failure via replenishing Qi,activating blood,and dispelling stasis.Inhibition of oxidative stress and inflammatory responses,mitigation of myocardial fibrosis,improvement of calcium cycling,and protection of mitochondrial function represent the key mechanisms for the treatment of heart failure with Chinese medicinal materials.Focusing on the pathogenic mechanisms and signaling pathways of heart failure,this paper systematically describes the pharmacological effects,molecular mechanisms,and research progress in the clinical application of Chinese medicinal herbs with effects of replenishing Qi,activating blood,and dispelling stasis and their compound formulas in the prevention and treatment of heart failure,aiming to provide scientific evidence for the development a

关 键 词：心力衰竭 心肌纤维化 钙循环 益气活血祛瘀中药 纽约心脏协会功能(NYHA)分类 

分 类 号：R2-0[医药卫生—中医学] R22R285.5R284R33