基于“瘀毒”理论与线粒体自噬探讨心肌缺血再灌注损伤病因病机  

Discussion on Etiology and Pathogenesis of Myocardial Ischemia-Reperfusion Injury Based on Theory of"Stasis Toxin"and Mitochondrial Autophagy

作　　者：王洁 龙霖梓 曲华[1,2] 谭令 李洪峥 杨文文 付长庚 WANG Jie;LONG Linzi;QU Hua;TAN Ling;LI Hongzheng;YANG Wenwen;FU Changgeng(Xiyuan Hospital Affiliated to China Academy of Chinese Medical Sciences,Beijing China 100091;National Research Center for Cardiovascular Diseases of Traditional Chinese Medicine,Beijing China 100091;Beijing University of Chinese Medicine,Beijing China 100105)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]国家中医心血管病临床医学研究中心,北京100091 [3]北京中医药大学,北京100105

出　　处：《中医学报》2023年第11期2261-2267,共7页Acta Chinese Medicine

基　　金：国家中医心血管病临床医学研究中心专项科研基金项目(CMC2022010);中国中医科学院科技创新工程资助项目(CI2021A05013)。

摘　　要：心肌缺血再灌注损伤的机制较为复杂,目前认为与钙离子超载、氧化应激、细胞凋亡、线粒体功能障碍相关。在病理状态下,线粒体自噬功能障碍使残损的线粒体在体内病理性蓄积,导致心肌细胞继发性坏死和线粒体有害物质不断释放,诱导炎症反应、氧化应激和血管内皮细胞损伤,与心肌缺血再灌注损伤的发生发展密切相关。心肌缺血再灌注损伤始于血液凝滞不畅,心肌恢复血供,但瘀血并未清除,瘀血日久酿生毒邪,瘀毒交结于心脉,从而引起心肌损伤。从中医角度看,线粒体自噬的病理机制与中医“瘀毒”的病因病机有相似之处。故治疗应以解毒活血法调控线粒体自噬相关基因及蛋白的表达,减轻炎症反应、氧化应激和血管内皮细胞损伤,从而改善心肌缺血再灌注损伤,最终恢复机体“阴平阳秘”的状态。The mechanism of myocardial ischemia-reperfusion injury is complicated,which is currently considered to be related to calcium overload,oxidative stress,apoptosis and mitochondrial dysfunction.Under pathological conditions,autophagy dysfunction of mitochondria leads to pathological accumulation of damaged mitochondria in vivo,which leads to secondary necrosis of myocardial cells and continuous release of harmful substances from mitochondria,and induces inflammatory reaction,oxidative stress and vascular endothelial cell injury,which is closely related to the occurrence and development of myocardial ischemia-reperfusion injury.Myocardial ischemia-reperfusion injury begins with poor blood stasis,and blood supply to myocardium is restored,but blood stasis is not removed.Blood stasis will produce toxic pathogens for a long time,and blood stasis and toxin will cross the heart veins,thus causing myocardial injury.From the perspective of TCM,the pathophysiological mechanism of mitochondrial autophagy is similar to the etiology and pathogenesis of"blood stasis and toxin"in TCM.Therefore,the treatment should regulate the expression of mitochondrial autophagy-related genes and proteins by detoxification and activating blood circulation,reduce inflammatory reaction,oxidative stress and vascular endothelial cell damage,thus improving myocardial ischemia-reperfusion injury and finally restoring the state of"balance between Yin and Yang".

关 键 词：心肌缺血再灌注损伤 线粒体自噬 瘀毒 解毒活血法 

分 类 号：R256.2[医药卫生—中医内科学]