从“气血理论”探讨铁代谢紊乱与心肌缺血再灌注损伤的关系

Exploration of the relationship between iron metabolism disorder and myocardial ischemia-reperfusion injury from “qi-blood theory”

关键词:  气血理论  心肌缺血再灌注  铁死亡  中医药

Key words:  theory of qi and blood  MI/R  ferroptosis  traditional Chinese medicine

摘要:

心肌缺血再灌注损伤是一种继发的心脏损伤，中医认为其病理性质属于虚实夹杂，其发生发展与痰浊、血瘀、气虚多种病理因素相关。铁死亡是铁代谢紊乱所致的铁依赖性细胞死亡形式，其发生机制主要包括铁代谢、氨基酸代谢、脂代谢和铁自噬4种途径。中医药在调节心肌缺血再灌注损伤铁代谢紊乱方面具有疗效，采用益气活血、化瘀通络之法，可减轻铁离子累积和脂质过氧化水平，恢复机体气血平衡状态，从而减轻心肌缺血。文章对铁代谢特征及作用机制进行总结，探讨铁死亡与气血理论的相似之处及中医药干预作用，以期进一步认识铁死亡的机制，理解气血理论的内涵。

Abstract:

Myocardial ischemia-reperfusion injury (MI/RI) is a kind of secondary heart injury,which is regarded as a mixture of deficiency and excess in traditional Chinese medicine (TCM) theory,and its occurrence and development are related to many pathological factors such as phlegm,blood stasis and qi deficiency. Ferroptosis is a form of iron-dependent cell death caused by iron metabolic disorder. Its mechanism mainly includes four pathways which are iron metabolism pathway,amino acid metabolism pathway,lipid metabolism pathway and ferritinophagy pathway. TCM is effective in regulating iron metabolism disorder in MI/RI. The method of supplementing qi and activating blood circulation,removing blood stasis and dredging collateral can reduce the accumulation of iron ions and the level of lipid peroxidation,and restore the balance of qi and blood in the body,thus alleviate myocardial ischemia. In this paper,the characteristics and mechanism of iron metabolism were summarized,the similarities between ferroptosis and qi-blood theory and the TCM methods are discussed in order to understand the mechanism of ferroptosis and the connotation of qi-blood theory.