生脉散调控气阴两虚型心律失常的心脏重构机制探析  

Mechanism of Shengmaisan Regulating Cardiac Remodeling of Arrhythmias with Deficiency of Qi and Yin

作　　者：魏靖恒 石晓路[1] 杨威[2] 黄聪 史梦茹 马润灏 孙明杰[1] WEI Jingheng;SHI Xiaolu;YANG Wei;HUANG Cong;SHI Mengru;MA Runhao;SUN Mingjie(Key Laboratory of Traditional Chinese medicine Basic Research on Prevention and Treatment of Major Disease,Experimental Research Center,China Academy of Chinese Medical Sciences,Beijing 100700,China;Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]中国中医科学院医学实验中心,北京市中医药防治重大疾病基础研究重点实验室,北京100700 [2]中国中医科学院中医基础理论研究所,北京100700

出　　处：《中国实验方剂学杂志》2024年第4期248-259,共12页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金青年基金项目(82004244);中央级公益性科研院所基本科研业务费专项(ZZ2019011);中国中医科学院医学实验中心协同创新团队项目(XTCX2021004)。

摘　　要：心律失常是心血管疾病中重要的一种疾病,临床上常发生由于离子通道异常、电活动紊乱、心肌纤维化、炎症、线粒体生物发生失调、线粒体钙超载、能量代谢失衡、氧化应激、交感神经亢进等病理性心脏重构活动而诱发的恶性心律失常,这是造成心源性猝死的主要原因。中医认为心律失常病属心悸,常见于气阴两虚证,往往是脾胃先虚致使气机失常而后心功能下降尤甚的表现。生脉散是益气养阴的代表方剂,由人参、麦冬、五味子组成,近年来临床研究表明生脉散及其加减方常用于治疗心律失常。该篇文章即综述了生脉散各味单药的有效成分在心脏电生理、生化、结构、自主神经、亚细胞成分的调控机制,阐述生脉散治疗气阴两虚型心律失常的多靶点、多系统、整体性的特点。能量代谢障碍与气阴两虚证密切相关,与心肌能量代谢相关的线粒体功能损伤在心脏重构中发挥的重要作用,开展生脉散保护线粒体功能干预能量代谢减少心脏病理性重构的机制探讨具有重要意义,也将为此类心律失常的临床治疗提供更多理论依据。Arrhythmia is an important disease among cardiovascular diseases.Malignant arrhythmias often occur clinically and are induced by abnormal ion channels,electrical activity disorders,myocardial fibrosis,inflammation,dysfunctional mitochondrial biogenesis,mitochondrial calcium overload,out-ofbalance energy metabolism,oxidative stress,sympathetic hyperactivity,and other pathological cardiac remodeling,and they are the main causes of sudden cardiac death.In traditional Chinese medicine,arrhythmias are considered to be palpitations,which are commonly caused by deficiency of Qi and Yin.It is often manifested as a deficiency of the spleen and stomach,resulting in malfunction of the Qi mechanism,followed by a particularly severe decline in cardiac function.Shengmaisan is a representative formula for nourishing Qi and Yin,consisting of Ginseng Radix et Rhizoma,Ophiopogonis Radix,and Schisandrae Chinensis Fructus.In recent years,clinical studies have shown that Shengmaisan and its additions and subtractions are commonly used in the treatment of arrhythmias.In this article,the mechanisms of the active ingredients of Shengmaisan in the electrophysiology,biochemistry,structure,autonomic nervous system,and subcellular fraction of the heart are reviewed,and the multi-target,multi-system,and integrality of Shengmaisan in the treatment of arrhythmias of Qi and Yin deficiency are described.In addition,energy metabolism disorder is tightly juxtaposed with Qi and Yin deficiency syndrome.Mitochondria,as the center of myocardial energy metabolism,play a paramount role in cardiac remodeling,indicating that Shengmaisan will be a salient part of future research to ameliorate cardiac pathologic remodeling through energy metabolism of mitochondria,so as to provide a theoretical basis for the clinical treatment of these arrhythmias.

关 键 词：生脉散 心律失常 心脏重构 气阴两虚 益气养阴 

分 类 号：R2-0[医药卫生—中医学] R22R285.5R284R33