基于“虚气留滞”探讨铁死亡对慢性心力衰竭的调控机制及中医药防治进展  

Mechanism of Ferroptosis in Regulating Chronic Heart Failure and Traditional Chinese Medicine Prevention and Treatment Based on Qi Deficiency and Stagnation:A Review

作　　者：袁子阳 张艳[2] 张伟[3] 王雅琴 毛文君 杨过 王雪薇 YUAN Ziyang;ZHANG Yan;ZHANG Wei;WANG Yaqin;MAO Wenjun;YANG Guo;WANG Xuewei(Liaoning University of Traditional Chinese Medicine(TCM),Shenyang 110847,China;The Affiliated Hospital of Liaoning University of TCM,Shenyang 110000,China;Shenyang Pharmaceutical University,Shenyang 110016,China)

机构地区：[1]辽宁中医药大学,沈阳110847 [2]辽宁中医药大学附属医院,沈阳110000 [3]沈阳药科大学,沈阳110016

出　　处：《中国实验方剂学杂志》2025年第2期248-255,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81774157,82174241);全国名老中医药专家传承工作室建设项目(2022-304)。

摘　　要：慢性心力衰竭(CHF)为各种心血管疾病的终末阶段,是一种复杂的临床综合征,其临床表现为呼吸困难、水肿等征象,具有病情复杂、迁延难愈,死亡率高的特点。铁死亡是一种新型的细胞死亡方式,与其他细胞死亡方式不同,其具有铁依赖性,发生过程中会伴有脂质过氧化物堆积、线粒体皱缩等现象,是当前研究的热点。目前,已有研究证实铁死亡在CHF的发生发展中发挥重要作用,因此如何调控铁死亡可能成为未来治疗CHF的潜在靶点。“虚气留滞”理论是指元气亏虚,气血津液输布失常出现邪气留滞的病理状态,后世医家认为其对一些慢性疾病病机演化具有指导意义。笔者认为“虚气留滞”是CHF铁死亡病机的概括,“虚气”(心气亏虚)为发病之本,“留滞”(痰浊、瘀血)是疾病之标,二者相互影响,恶性循环,推动病情发展。中医药在治疗CHF、改善CHF患者预后、提高患者生活质量具有重要作用。因此,笔者试从“虚气留滞”理论出发,结合铁死亡对慢性CHF发生发展的影响机制,探讨二者相关性;并以“虚气留滞”理论为基础,以“补益虚气”“疏通留滞”为基本治则综述了中药及中药复方对调控铁死亡防治CHF的作用机制,以期为中医药治疗CHF提供新的思路和方法。Chronic heart failure(CHF)is the final stage of cardiovascular diseases.It is a complex syndrome,with dyspnea and edema as the main clinical manifestations,and it is characterized by complex disease conditions,difficult cure,and high mortality.Ferroptosis,a new type of programmed cell death,is different from other types of programmed cell death.Ferroptosis is iron-dependent,accompanied by lipid peroxide accumulation and mitochondrial shrinkage,becoming a hot research topic.Studies have confirmed that ferroptosis plays a key role in the occurrence and development of CHF.The regulation of ferroptosis may become a potential target for the treatment of CHF in the future.The theory of Qi deficiency and stagnation refers to the pathological state of original Qi deficiency and abnormal transportation and distribution of Qi,blood,and body fluid,which has guiding significance for revealing the pathogenesis evolution of some chronic diseases.We believe that Qi deficiency and stagnation is a summary of the pathogenesis of ferroptosis in CHF.Deficiency of Qi(heart Qi)is the root cause of CHF,and stagnation(phlegm turbidity and blood stasis)is the branch of this disease.The two influence each other in a vicious circle to promote the development of this disease.Traditional Chinese medicine(TCM)plays an important role in the treatment of CHF,improving the prognosis and quality of life of CHF patients.This paper explores the correlation between the theory of Qi deficiency and stagnation and the mechanism of ferroptosis in CHF.Furthermore,this paper reviews the mechanism of Chinese medicines and compound prescriptions in preventing and treating CHF by regulating ferroptosis according to the principles of replenishing Qi and dredging to remove stagnation,aiming to provide new ideas and methods for the treatment of CHF with TCM.

关 键 词：铁死亡 慢性心力衰竭 中医药 虚气留滞 中医治法 

分 类 号：R259[医药卫生—中西医结合] R541.6[医药卫生—中医内科学] R714.252[医药卫生—中医学]