1.北京中医药大学,北京市朝阳区北三环东路11号,100029
2.北京中医药大学东直门医院
3.陕西中医药大学附属医院
4.北京中医药大学东方医院
erzitaba@163.com
收稿:2023-12-18,
修回:2024-01-27,
纸质出版:2024-07-02
移动端阅览
李宇轩,汪吴娇,李鹏等.基于线粒体功能探讨从“玄府-络脉-脏腑”论治心力衰竭[J].中医杂志,2024,65(13):1346-1352.
LI Yuxuan,WANG Wujiao,LI Peng,et al.Discussion on the Treatment of Heart Failure from the Theory of "Sweat Pore-Collaterals-Zang and Fu Organs" Based on Mitochondrial Function[J].Journal of Traditional Chinese Medicine,2024,65(13):1346-1352.
李宇轩,汪吴娇,李鹏等.基于线粒体功能探讨从“玄府-络脉-脏腑”论治心力衰竭[J].中医杂志,2024,65(13):1346-1352. DOI: 10.13288/j.11-2166/r.2024.13.008.
LI Yuxuan,WANG Wujiao,LI Peng,et al.Discussion on the Treatment of Heart Failure from the Theory of "Sweat Pore-Collaterals-Zang and Fu Organs" Based on Mitochondrial Function[J].Journal of Traditional Chinese Medicine,2024,65(13):1346-1352. DOI: 10.13288/j.11-2166/r.2024.13.008.
线粒体是心肌细胞能量代谢的主要场所,同时介导细胞凋亡及免疫反应,线粒体功能障碍与心力衰竭的发生发展密切相关。结合线粒体功能障碍在心力衰竭发病中的作用机制,提出线粒体功能与“玄府-络脉-脏腑”类似,据此从“玄府-络脉-脏腑”论治心力衰竭,认为心力衰竭的核心病机为气虚,气虚则玄府开阖无力,甚至玄府闭密,致气虚血瘀,络脉瘀滞不荣,气血津液则无法渗灌充养脏腑,心失所养,发为本病。治疗应以益气开玄、辛以通络、活血利水为法,用药以益气、活血、利水类药物为主。
Mitochondria are the main site of energy metabolism in cardiomyocytes, and at the same time mediate apoptosis and immune response, so mitochondrial dysfunction is closely related to the development of heart failure. Combined with the pathogenesis of mitochondrial dysfunction and heart failure, it is proposed that the mitochondrial function is similar to "sweat pore - collaterals -
zang
and
fu
organs", according to which the treatment of heart failure is based on the theory of "sweat pore - collaterals -
zang
and
fu
organs". It is believed that the core mechanism of heart failure is
qi
deficiency, and
qi
deficiency leads to the weakness of the sweat pore opening and closing, or even the sweat pore closure, then resulting in
qi
deficiency and blood stasis, collaterals stagnation fail to flourish, and
qi
, blood, and body fluids can not infiltrate and nourish
zang
-
fu
organs, so that the heart f
ail to be nourished, and the disease will develop. The treatment should be based on the method of boosting
qi
and opening sweat pore, using acridity to unblock the collaterals, and invigorating blood and draining water, with medicinal of boosting
qi
, invigorating blood, and draining water as treatment.
中华医学会心血管病学分会心力衰竭学组 , 中国医师协会心力衰竭专业委员会 , 中华心血管病杂志编辑委员会 . 中国心力衰竭诊断和治疗指南2018 [J]. 中华心血管病杂志 , 2018 , 46 ( 10 ): 760 - 789 .
王华 , 刘宇佳 , 杨杰孚 . 心力衰竭流行病学 [J]. 临床心血管病杂志 , 2023 , 39 ( 4 ): 243 - 247 .
MCMURRAY JJV , PACKER M . How should we sequence the treatments for heart failure and a reduced ejection fraction?A redefinition of evidence-based medicine [J]. Circulation , 2021 , 143 ( 9 ): 875 - 877 .
CORREALE M , TRICARICO L , CROELLA F , et al . Novelties in the pharmacological approaches for chronic heart failure: new drugs and cardiovascular targets [J]. Front Cardiovasc Med , 2023 , 10 : 1157472 . doi: 10. 3389/fcvm.2023 http://dx.doi.org/10.3389/fcvm.2023 .
MARÍN-GARCÍA J , AKHMEDOV AT . Mitochondrial dynamics and cell death in heart failure [J]. Heart Fail Rev , 2016 , 21 ( 2 ): 123 - 136 .
夏冉 , 王茎 , 戴小华 , 等 . 益气活血类中药干预线粒体质量控制治疗心力衰竭的实验研究进展 [J]. 中国实验方剂学杂志 , 2021 , 27 ( 5 ): 206 - 213 .
朱明军 . 中医药治疗慢性心力衰竭临床疗效评价与思考 [J]. 北京中医药大学学报 , 2023 , 46 ( 7 ): 902 - 907 .
江玉 , 江花 , 王倩 , 等 . 玄府理论研究现状 [J]. 中医杂志 , 2016 , 57 ( 20 ): 1790 - 1794 .
周水平 , 仝小林 , 徐远 . 络病的基本概念与病理特点探析 [J]. 中医药学刊 , 2002 , 20 ( 6 ): 724 - 726 .
郑国庆 , 王艳 , 王小同 . 玄府理论的建立与发展 [J]. 中华医史杂志 , 2005 , 35 ( 4 ): 19 - 23 .
陆鹏 , 胡幼平 . 从“开玄充络”谈热证用灸法 [J]. 针灸临床杂志 , 2012 , 28 ( 9 ): 7 - 9 .
杨帆 , 张伟 . 基于玄府-肺络新视点探讨干燥综合征相关性间质性肺疾病的中医病机演变 [J]. 中华中医药杂志 , 2019 , 34 ( 7 ): 2935 - 2938 .
邹旭 , 潘光明 , 盛小刚 , 等 . 慢性心力衰竭中医证候规律的临床流行病学调查研究 [J]. 中国中西医结合杂志 , 2011 , 31 ( 7 ): 903 - 908 .
罗良涛 , 赵慧辉 , 王娟 , 等 . 中医医院冠心病慢性心力衰竭患者中医证候要素分布特点分析 [J]. 北京中医药大学学报 , 2014 , 37 ( 2 ): 130 - 134 .
郑玲玲 , 杜武勋 , 朱明丹 , 等 . 刘完素“玄府气液说”浅析:津液代谢之微观探索 [J]. 中医杂志 , 2013 , 54 ( 22 ): 1971 - 1973 .
连妍洁 , 李明轩 , 刘红旭 , 等 . 基于“玄府-气液-络脉”探讨心力衰竭的中医证治 [J]. 中医杂志 , 2023 , 64 ( 6 ): 641 - 645 .
向圣锦 , 段俊国 . 基于玄府和络脉学说探讨气血津液运行交换的结构体系 [J]. 中国中医药现代远程教育 , 2022 , 20 ( 17 ): 57 - 61 .
王硕 , 赵云罡 . 心衰进程中非编码RNA对线粒体功能的调控作用 [J]. 生物化学与生物物理进展 , 2023 , 50 ( 7 ): 1538 - 1552 .
SMITH RL , SOETERS MR , WUST RCI , et al . Metabolic flexibility as an adaptation to energy resources and requirements in health and disease [J]. Endocr Rev , 2018 , 39 ( 4 ): 489 - 517 .
MUOIO DM . Metabolic inflexibility: when mitochondrial indecision leads to metabolic gridlock [J]. Cell , 2014 , 159 ( 6 ): 1253 - 1262 .
LOZHKIN A , VENDROV AE , RAMOS-MONDRAGÓN R , et al . Mitochondrial oxidative stress contributes to diastolic dysfunction through impaired mitochondrial dynamics [J]. Redox Biol , 2022 , 57 : 102474 . doi: 10. 1016/j.redox.2022.102474 http://dx.doi.org/10.1016/j.redox.2022.102474 .
VERVLIET T , PARYS JB , BULTYNCK G . Bcl-2 proteins and calcium signaling: complexity beneath the surface [J]. Oncogene , 2016 , 35 ( 39 ): 5079 - 5092 .
王丽艳 , 徐哲龙 . 线粒体功能障碍在心血管疾病中作用机制的研究进展 [J]. 天津医药 , 2020 , 48 ( 2 ): 146 - 151 .
CHEN W , ZHAO H , LI Y . Mitochondrial dynamics in health and disease: mechanisms and potential targets [J]. Signal Transduct Target Ther , 2023 , 8 ( 1 ): 333 .
方文熙 , 谢赛阳 , 邓伟 . 线粒体质量控制在心力衰竭中的研究进展 [J]. 中华老年心脑血管病杂志 , 2023 , 25 ( 6 ): 655 - 657 .
ISHIHARA N , MIZUSHIMA N . A receptor for eating mitochondria [J]. Dev Cell , 2009 , 17 ( 1 ): 1 - 2 .
王旭 . 优化心肌能量代谢治疗心衰是主角还是配角? [D]. 长春 : 吉林大学 , 2014 .
BHANDARI P , SONG M , CHEN Y , et al . Mitochondrial contagion induced by Parkin deficiency in Drosophila hearts and its containment by suppressing mitofusin [J]. Circ Res , 2014 , 114 ( 2 ): 257 - 265 .
HUANG CY , LAI CH , KUO CH , et al . Inhibition of ERK-Drp1 signaling and mitochondria fragmentation alleviates IGF-IIR-induced mitochondria dysfunction during heart failure [J]. J Mol Cell Cardiol , 2018 , 122 : 58 - 68 . doi: 10.1016/j.yjmcc.2018.08.006 http://dx.doi.org/10.1016/j.yjmcc.2018.08.006 .
TANG Y , XU W , LIU Y , et al . Autophagy protects mitochondrial health in heart failure [J]. Heart Fail Rev , 2024 , 29 ( 1 ): 113 - 123 .
BRAVO-SAN PEDRO JM , KROEMER G , GALLUZZI L . Autophagy and mitophagy in cardiovascular disease [J]. Circ Res , 2017 , 120 ( 11 ): 1812 - 1824 .
DORN GW , KITSIS RN . The mitochondrial dynamism-mitophagy-cell death interactome: multiple roles performed by members of a mitochondrial molecular ensemble [J]. Circ Res , 2015 , 116 ( 1 ): 167 - 182 .
WANG B , NIE J , WU L , et al . AMPKα2 protects against the development of heart failure by enhancing mitophagy via PINK1 phosphorylation [J]. Circ Res , 2018 , 122 ( 5 ): 712 - 729 .
ZHAN H , HUANG F , NIU Q , et al . Downregulation of miR-128 ameliorates Ang Ⅱ-induced cardiac remodeling via SIRT1/PIK3R1 multiple targets [J]. Oxid Med Cell Longev , 2021 , 2021 : 8889195 . doi: 10.1155/2021/8889195 http://dx.doi.org/10.1155/2021/8889195 .
SONG J , HERRMANN JM , BECKER T . Quality control of the mitochondrial proteome [J]. Nat Rev Mol Cell Biol , 2021 , 22 ( 1 ): 54 - 70 .
JADIYA P , TOMAR D . Mitochondrial protein quality control mechanisms [J]. Genes (Basel) , 2020 , 11 ( 5 ): 563 .
VENKATESH S , LI M , SAITO T , et al . Mitochondrial LonP1 protects cardiomyocytes from ischemia/reperfusion injury in vivo [J]. J Mol Cell Cardiol , 2019 , 128 : 38 - 50 . doi: 10.1016/j.yjmcc.2018.12.017 http://dx.doi.org/10.1016/j.yjmcc.2018.12.017 .
MONDAL P , TOWERS C . Beyond mitophagy: mitochondrial-derived vesicles can get the job done! [J]. Autophagy , 2022 , 18 ( 2 ): 449 - 451 .
LI B , ZHAO H , WU Y , et al . Mitochondrial-derived vesicles protect cardiomyocytes against hypoxic damage [J]. Front Cell Dev Biol , 2020 , 8 : 214 . doi: 10.3389/fcell.2020.00214 http://dx.doi.org/10.3389/fcell.2020.00214 .
CADETE VJ , DESCHENES S , CUILLERIER A , et al . Formation of mitochondrial-derived vesicles is an active and physiologically relevant mitochondrial quality control process in the cardiac system [J]. J Physiol , 2016 , 594 ( 18 ): 5343 - 5362 .
DEL RE DP , AMGALAN D , LINKERMANN A , et al . Fundamental mechanisms of regulated cell death and implications for heart disease [J]. Physiol Rev , 2019 , 99 ( 4 ): 1765 - 1817 .
MCARTHUR K , WHITEHEAD LW , HEDDLESTON JM , et al . BAK/BAX macropores facilitate mitochondrial herniation and mtDNA efflux during apoptosis [J]. Science , 2018 , 359 ( 6378 ): eaao6047 .
ROGERS C , ERKES DA , NARDONE A , et al . Gasdermin pores permeabilize mitochondria to augment caspase-3 activation during apoptosis and inflammasome activation [J]. Nat Commun , 2019 , 10 ( 1 ): 1689 .
SHOSHAN-BARMATZ V , DE PINTO V , ZWECKSTETTER M , et al . VDAC, a multi-functional mitochondrial protein regulating cell life and death [J]. Mol Aspects Med , 2010 , 31 ( 3 ): 227 - 285 .
PAZARENTZOS E . Cell demise inhibited: unexpected liaisons between mitochondria and IκΒα [J]. Mol Cell Oncol , 2021 , 8 ( 6 ): 995020 .
WU NN , BI Y , AJOOLABADY A , et al . Parkin insufficiency accentuates high-fat diet-induced cardiac remodeling and contractile dysfunction through VDAC1-mediated mitochondrial Ca 2+ overload [J]. JACC Basic Transl Sci , 2022 , 7 ( 8 ): 779 - 796 .
WANG Q , WU J , ZENG Y , et al . Pyroptosis: a pro-inflammatory type of cell death in cardiovascular disease [J]. Clin Chim Acta , 2020 , 510 : 62 - 72 . doi: org/10. 1016/j.cca.2020.06.044 http://dx.doi.org/org/10.1016/j.cca.2020.06.044 .
BOCK FJ , TAIT SWG . Mitochondria as multifaceted regulators of cell death [J]. Nat Rev Mol Cell Biol , 2020 , 21 ( 2 ): 85 - 100 .
郭冰 , 贺璇 , 余意 , 等 . 心康冲剂对慢性心力衰竭大鼠心肌细胞焦亡的影响 [J]. 中华中医药学刊 , 2024 , 42 ( 4 ):108-112, 280 - 282 .
SCHENK B , FULDA S . Reactive oxygen species regulate Smac mimetic/TNFα-induced necroptotic signaling and cell death [J]. Oncogene , 2015 , 34 ( 47 ): 5796 - 5806 .
ZHANG Y , SU SS , ZHAO S , et al . RIP1 autophosphorylation is promoted by mitochondrial ROS and is essential for RIP3 recruitment into necrosome [J]. Nat Commun , 2017 , 8 : 14329 . doi: 10.1038/ncomms14329 http://dx.doi.org/10.1038/ncomms14329 .
李唯嘉 , 荣书玲 , 李保 . 坏死性凋亡经典通路在心血管疾病中的研究进展 [J]. 中西医结合心脑血管病杂志 , 2023 , 21 ( 19 ): 3562 - 3566 .
吴昱杰 , 刘建勋 . 益气活血中药改善慢性心衰心气虚证作用机制研究进展 [J]. 中药药理与临床 , 2021 , 37 ( 1 ): 234 - 239 .
何远利 , 安祯祥 , 杨蕊琳 , 等 . 心衰宁合剂对慢性心力衰竭大鼠心肌AMPK和PPARα的影响 [J]. 中药新药与临床药理 , 2020 , 31 ( 3 ): 287 - 293 .
KONG HL , HOU AJ , LIU NN , et al . The effects of ginsenoside Rb1 on fatty acid β-oxidation, mediated by AMPK, in the failing heart [J]. Iran J Basic Med Sci , 2018 , 21 ( 7 ): 731 - 737 .
杨旭 , 王琦越 , 黄秀深 , 等 . 基于水协同转运蛋白KCC1、KCC3、KCC4、NKCC1含量及Na + -K + -ATP酶活性变化研究湿阻中焦证的水液代谢机制 [J]. 辽宁中医杂志 , 2018 , 45 ( 3 ): 627 - 630,673 .
刘惠 , 王陵军 , 王俊岩 , 等 . 心阴片对慢性心力衰竭模型小鼠线粒体能量代谢的影响 [J]. 中医杂志 , 2021 , 62 ( 12 ): 1073 - 1079 .
廖家桢 , 王硕仁 , 吕希莹 , 等 . 参芪治疗心气虚证临床疗效和作用原理 [J]. 中医杂志 , 1990 , 31 ( 2 ): 51 - 54 .
郝怿隆 , 汪引芳 , 黄亦童 , 等 . 中药提取物对细胞线粒体功能的影响及研究进展 [J]. 医学综述 , 2019 , 25 ( 9 ): 1672 - 1676 .
李岩 . 益气药对慢性心力衰竭心气虚证模型大鼠心肌能量代谢重构的干预作用 [D]. 北京 : 北京中医药大学 , 2012 .
黄平 , 袁美玲 , 王磊 , 等 . 麝香酮抑制mPTP开放减轻OGD/R所致HT22细胞损伤的作用机制 [J]. 中国中药杂志 , 2023 , 48 ( 22 ): 6154 - 6163 .
潘美崧 , 王知斌 , 孙延平 , 等 . 双苯吡酮类化合物抗心肌缺血作用机制的研究进展 [J]. 中国药房 , 2021 , 32 ( 24 ): 3049 - 3053 .
阎晓悦 , 刘炜 . 中药对线粒体能量代谢的影响 [J]. 中国实用医药 , 2019 , 14 ( 9 ): 192 - 193 .
胡志伟 . 红花提取物对大鼠肝硬化的抑制作用及其机制研究 [D]. 武汉 : 武汉大学 , 2016 .
易永丽 , 雷娅 , 王坤 , 等 . 大黄-桃仁药对调控子宫腺肌病在位内膜线粒体稳态的机制研究 [J]. 中草药 , 2022 , 53 ( 15 ): 4709 - 4718 .
陈智华 . 朝药泽兰对大鼠心肌缺血再灌注损伤的保护作用 [D]. 延吉 : 延边大学 , 2019 .
李焱 , 刘阳 , 石霄宇 , 等 . 药对黄芪葶苈子对心力衰竭大鼠心肌组织线粒体动力学的影响 [J]. 时珍国医国药 , 2021 , 32 ( 3 ): 520 - 523 .
高群 , 蔡芸 , 李岩 , 等 . 林谦教授益气活血利水法治疗慢性心功能衰竭的思路与实践探索 [J]. 中西医结合心脑血管病杂志 , 2022 , 20 ( 23 ): 4395 - 4397 .
0
浏览量
0
下载量
6
CSCD
关联资源
相关文章
相关作者
相关机构
京公网安备11010102007558号