摘要
近年随糖尿病发病率不断升高,其引发的心肌病变逐渐被重视,具有高隐匿性、高死亡率的特点。糖尿病心肌病(DCM)以线粒体结构紊乱、心肌代谢灵活性丧失为早期病理改变。而线粒体质量控制(MQC)失衡是导致损伤线粒体积累、心肌代谢灵活性丧失的关键机制,并伴随氧化应激与炎症水平升高,最终引发心肌结构与功能改变。虚气留滞系正气亏损,导致功能不足之虚气渐生,气化障碍而内生邪气留滞机体,引发一系列损伤变化的病理过程。中医认为DCM由消渴发展而来,以心脾肾虚气渐生为病之本,机体气化失常,内生浊瘀毒留滞营血、脉道,最终损及心体为病之标,故虚气留滞为DCM的基本病机变化。线粒体与气在物质与功能上相似,为气的微观体现之一,而MQC的作用与气的防御功能高度一致。当MQC失衡后,线粒体结构与功能受损,虚气渐生,引发一系列病理改变,致使留滞难除,复加重MQC失衡,最终发生DCM。靶向MQC来改善DCM已成为目前研究的重点方向,而中医药具有多途径、多靶点的治疗优势。故据DCM“虚气留滞”的病机变化,结合MQC的现代医学认识,确立以“扶正补虚为常,调气行滞为变”的基本治则,以期为中医药靶向MQC治疗DCM提供组方思路与临证参考。
With the increasing incidence of diabetes mellitus in recent years,cardiomyopathy caused by diabetes mellitus has aroused wide concern and this disease is characterized by high insidiousness and high mortality.The early pathological changes of diabetic cardiomyopathy(DCM)are mitochondrial structural disorders and loss of myocardial metabolic flexibility.The turbulence of mitochondrial quality control(MQC)is a key mechanism leading to the accumulation of damaged mitochondria and loss of myocardial metabolic flexibility,which,together with elevated levels of oxidative stress and inflammation,trigger changes in myocardial structure and function.Qi deficiency and stagnation is caused by the loss of healthy Qi,and the dysfunction of Qi transformation results in the accumulation of pathogenic Qi,which further triggers injuries.According to the theory of traditional Chinese medicine(TCM),DCM is rooted in Qi deficiency of the heart,spleen,and kidney.The dysfunction of Qi transformation leads to the generation and lingering of turbidity,stasis,and toxin in the nutrient-blood and vessels,ultimately damaging the heart.Therefore,Qi deficiency and stagnation is the basic pathologic mechanism of DCM.Mitochondria,similar to Qi in substance and function,are one of the microscopic manifestations of Qi.The role of MQC is consistent with the defense function of Qi.In the case of MQC turbulence,mitochondrial structure and function are impaired.As a result,Qi deficiency gradually emerges and triggers pathological changes,which make it difficult to remove the stagnant pathogenic factor and aggravates the MQC turbulence.Ultimately,DCM occurs.Targeting MQC to treat DCM has become the focus of current research,and TCM has the advantages of acting on multiple targets and pathways.According to the pathogenesis of Qi deficiency and stagnation in DCM and the modern medical understanding of MQC,the treatment should follow the principles of invigorating healthy Qi,tonifying deficiency,and regulating Qi movement.This paper aims to provide ideas for formulating prescriptions and clinical references for the TCM treatment of DCM by targeting MQC.
作者
李澳琳
廉璐
陈馨浓
谢盈彧
严志鹏
蔡文慧
张倩倩
张弛
张军平
LI Aolin;LIAN Lu;CHEN Xinnong;XIE Yingyu;YAN Zhipeng;CAI Wenhui;ZHANG QianQian;ZHANG Chi;ZHANG Junping(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine(TCM),National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China;Graduate School of Tianjin University of TCM,Tianjin 300193,China;Tianjin First Central Hospital,Tianjin 300190,China;College of TCM,Tianjin University of TCM,Tianjin 300193,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2024年第8期197-205,共9页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(81774232)
中医药传承与创新“百千万”人才工程(岐黄工程)岐黄学者专项(国中医药人教函[2021]203号)
天津市名中医传承工作室专项(津卫中[2020]732号)。
关键词
糖尿病心肌病
线粒体质量控制
线粒体
虚气留滞
中医药
diabetic cardiomyopathy
mitochondrial quality control
mitochondria
Qi deficiency and stagnation
traditional Chinese medicine
作者简介
第一作者:李澳琳,在读硕士,从事中医药防治心血管疾病的临床研究,E-mail:lijunzilal@163.com;通信作者:张军平,教授,主任医师,博士生导师,从事心脑血管病的中西医结合基础与临床研究,Tel:022-27432016,E-mail:tjzhtcm@163.com。
