黄芪及其提取物治疗糖尿病心肌病的药理机制研究进展  

Research progress of astragalus in the treatment of diabetic cardiomyopathy

作　　者：侯可可 陈琳[1] 沙雯君 杨芸艺 徐媛颖 雷涛[1] HOU Keke;CHEN Lin;SHA Wenjun;YANG Yunyi;XU Yuanying;LEI Tao(Endocrinology Department,Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200062,China)

机构地区：[1]上海中医药大学附属普陀医院内分泌科,200062

出　　处：《环球中医药》2023年第5期1036-1043,共8页Global Traditional Chinese Medicine

基　　金：国家自然科学基金青年项目(81704027);上海市医学重点专科建设项目(ZK2019B16);上海市普陀区卫生健康系统临床特色专科建设项目(2020tszk01);普陀区卫生健康系统科技创新项目(ptkwws202011)。

摘　　要：黄芪有效成分多样,包括黄酮类、皂苷类、多糖类及氨基酸类物质等,具有改善糖脂代谢、增加胰岛素敏感性、调节免疫、保护心肌超微结构等功能。本文主要从改善糖脂及能量代谢、抗应激与炎症、改善心肌纤维化、调控细胞自噬与调亡等方面对黄芪改善糖尿病心肌病变的作用机制进行总结,发现黄芪及其提取物从改善胰岛素抵抗,调整心脏过氧化物酶体增殖物激活受体机制,改善线粒体功能,影响肠道菌群多样性及肠促胰岛素等来改善糖脂及能量代谢障碍。此外,黄芪还可以通过调控氧化应激标志物水平以及相关信号通路来抗氧化应激,抑制内质网应激的相关因子及调节细胞内钙浓度变化来抑制内质网应激,降低炎症因子水平及抑制炎症信号通路来抗炎;抑制促纤维化因子转化生长因子β1及蛋白的表达,抑制肾素—血管紧张素系统来减少心肌纤维化;调控自噬蛋白来上调心肌细胞自噬、调控凋亡因子水平及凋亡通路来减少细胞凋亡等方面保护心肌细胞,延缓糖尿病心肌病变。目前黄芪及其提取物治疗糖尿病心肌病的主要成分集中在多糖类和皂苷类,其他类成分治疗作用研究较少,仍需要进一步研究,为黄芪的开发和应用提供依据。Astragalus is commonly used in traditional Chinese medicine with various active ingredients,including flavonoids,saponins,polysaccharides and amino acids,etc.Astragalus have the functions of improving glucose and lipid metabolism,increasing insulin sensitivity,regulating immunity,and protecting myocardial ultrastructure.This paper mainly summarized the mechanism of Astragalus replacement in improving diabetic cardiomyopathy from the aspects of improving glycolipid and energy metabolism,anti-stress and inflammation,improving myocardial fibrosis,regulating autophagy and apoptosis,etc.It was found that Astragalus and its extracts could improve insulin resistance,adjust cardiac PPAR mechanism,improve mitochondrial function,affect the diversity of intestinal flora and incretin to improve glucose and lipid and energy metabolism disorders;astragalus could also resist oxidative stress by regulating the levels of oxidative stress markers and related signaling pathways,inhibit the related factors of endoplasmic reticulum stress and regulate the change of intracellular calcium concentration to achieve the purpose of inhibiting endoplasmic reticulum stress,reduce the level of inflammatory factors and inhibiting the inflammatory signaling pathway to inhibit inflammation;inhibit the expression of pro-fibrotic factor TGF-β1 and its protein,inhibit the RAS system to reduce myocardial fibrosis.Astragalus could up-regulate autophagy in cardiomyocytes by regulating autophagy proteins and regulate the levels of apoptotic factors and apoptotic pathways to reduce apoptosis and protect cardiomyocytes.These may delay diabetic cardiomyopathy.At present,the main components of astragalus and its extracts in the treatment of diabetic cardiomyopathy are concentrated in polysaccharides and saponins,few studies on the therapeutic effects of other components.However,further research is still needed to provide a basis for the development and application of Astragalus.

关 键 词：黄芪 糖尿病心肌病变 糖脂 应激 炎症 心肌纤维化 调亡 自噬 

分 类 号：R259[医药卫生—中西医结合]