基于心肌能量代谢干预的心力衰竭治疗策略优化的研究进展  

Research progress on optimizing treatment strategies for heart failure based on myocardial energy metabolism intervention

作　　者：赵利娟 唐娇 黄璞珏 邓雪 王涛 Zhao Lijuan;Tang Jiao;Huang Pujue;Deng Xue;Wang Tao(Department of Pediatrics,Western Theater General Hospital,Chengdu 610036,China;Department of Pediatrics,West China Second Hospital,Sichuan University,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Key Laboratory of Obstetric&Gynecologic and Pediatric Diseases of Sichuan Province,Chengdu 610041,China;Department of Pediatrics,the First People′s Hospital of Longquanyi District,Chengdu,Chengdu 610100,China)

机构地区：[1]西部战区总医院儿科,成都610036 [2]四川大学华西第二医院儿科,四川大学出生缺陷与相关妇儿疾病教育部重点实验室,发育与妇儿疾病四川省重点实验室,成都610041 [3]成都市龙泉驿区第一人民医院儿科,成都610100

出　　处：《中华实用儿科临床杂志》2024年第12期946-950,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金青年基金(81701888);四川省科技厅重点研发项目(2023YFS0206)。

摘　　要：近年来,心力衰竭(HF)的管理(包括药物治疗和非药物治疗)取得了诸多进展,但HF患病率和死亡率仍居高不下,长期预后差,亟须开发新的治疗途径和干预靶点,探索新的药物和方法来进一步改善预后。心肌能量代谢的特征性转换是HF发生发展的重要标志,且与衰竭心脏中的心肌能量缺乏的发生机制密切相关。心肌细胞葡萄糖与脂肪酸的利用度失衡,心肌线粒体氧化磷酸化向糖酵解的代谢转换,糖酵解和葡萄糖氧化途径之间解偶联,以及胎儿基因程序再表达等在心肌功能障碍和HF发生发展中均有重要作用。因此,优化心肌能量底物代谢,增强线粒体氧化代谢能力,提高心肌线粒体产能效率,从而改善心脏做功,将是降低HF严重程度的潜在治疗方法。现就HF过程中的心肌能量代谢特征和分子调控机制进行综述,探讨以心肌能量代谢调控为基础的HF治疗策略优化的研究方向。In recent years,the management of heart failure(HF)(including drug therapy and non-drug therapy)has made many advances,but its prevalence and mortality are still high,and the long-term prognosis is poor.It is urgent to develop new therapeutic approaches and intervention targets and explore new drugs and methods to improve the prognosis.The characteristic transformation of myocardial energy metabolism is an important marker of HF development,closely related to the mechanism of myocardial energy deficiency in the failing heart.The imbalance of glucose and fatty acid availability in cardiomyocytes,metabolic conversion from oxidative phosphorylation to glycolysis of myocardial mitochondria,uncoupling between glycolysis and glucose oxidation pathway,and fetal gene reexpression all play important roles in myocardial dysfunction and HF development.Potential therapeutic methods to reduce the severity of HF include optimizing myocardial energy substrate metabolism,enhancing mitochondrial oxidative metabolism capacity,improving myocardial mitochondrial productivity efficiency,and thereby increasing cardiac work.This paper summarizes the characteristics and molecular regulation mechanism of myocardial energy metabolism during HF and discusses the research direction of optimizing HF treatment strategy based on myocardial energy metabolism regulation.

关 键 词：心力衰竭 能量代谢 线粒体 靶向 策略优化 

分 类 号：R541.6[医药卫生—心血管疾病]