中医药防治糖尿病合并冠心病作用机制的研究进展

Research progress on the mechanism of traditional Chinese medicine in the prevention and treatment of diabetes mellitus complicated with coronary heart disease

关键词:  中医药  信号通路  糖尿病  冠心病  作用机制

Key words:  traditional Chinese medicine  signaling pathway  diabetes mellitus  coronary heart disease  mechanism

摘要:

糖尿病与冠心病作为全球范围内高发的慢性代谢性疾病和心血管疾病，其共病已成为中国公共卫生领域的重大挑战。据调查，中国两病共病发病率正逐年攀升，其高发病率与病死率对患者的健康造成了极大威胁。目前临床治疗糖尿病合并冠心病主要依赖药物和手术介入治疗，存在作用靶点单一、不良反应大以及高并发症等问题，这些问题在很大程度上影响了患者的生活质量和预后。近年来，中医药在糖尿病合并冠心病防治领域展现出独特优势。大量临床研究证实，中医药可以通过调控多种信号通路在改善临床症状、降低糖尿病并发症等方面疗效显著，且不良反应小。基于此，文章对中医药调控糖尿病合并冠心病相关信号通路进行系统综述，发现中药、中药单体、复方及中成药通过精准调控多条信号通路，抑制炎症反应、细胞凋亡、糖脂代谢紊乱、氧化应激、血管内皮功能障碍及心肌纤维化等机制来影响糖尿病合并冠心病的发生发展。文章旨在筛选具有明确通路调控效应的候选中药及活性成分，阐明中医方药的多靶点协同机制，以期推动中西医结合精准治疗方案的优化，为糖尿病合并冠心病临床治疗提供更可靠的科学依据和更优的治疗方案。

Abstract:

Diabetes mellitus (DM) and coronary heart disease (CHD) are highly prevalent chronic metabolic and cardiovascular diseases globally. Their comorbidity has emerged as a major public health challenge in China. Investigations indicate that the incidence of DM-CHD comorbidity in China is rising annually, posing a significant threat to patient health due to its high morbidity and mortality rates. Current clinical treatments for DM combined with CHD primarily rely on pharmacological and surgical interventions, which suffer from limitations such as single therapeutic targets, significant side effects, and high complication rates. These issues substantially impact patients'quality of life and prognosis.In recent years, traditional Chinese medicine (TCM) has demonstrated unique advantages in the prevention and treatment of DM combined with CHD. Extensive clinical research confirms that TCM can significantly improve clinical symptoms and reduce diabetic complications by modulating multiple signaling pathways, with minimal adverse reactions. Based on this evidence, this review systematically summarizes the TCM-mediated regulation of signaling pathways relevant to DM-CHD comorbidity. It reveals that Chinese herbal medicine, Chinese medicine monomer, Chinese herbal formula, and Chinese patent medicine influence the occurrence and progression of DM combined with CHD by precisely modulating multiple signaling pathways. These mechanisms involve inhibiting inflammatory responses, apoptosis, disorders of glucose and lipid metabolism, oxidative stress, vascular endothelial dysfunction, and myocardial fibrosis.This review aims to identify candidate Chinese herbs and active components with well-defined pathway regulatory effects and elucidate the multi-target synergistic mechanisms of TCM formulas. The goal is to promote the optimization of precision integrative Chinese and Western medicine treatment strategies, thereby providing more robust scientific evidence and superior therapeutic solutions for the clinical management of DM combined with CHD.