从脑心轴解析多靶点抗心律失常中西药物的治疗前景

Multi targeting anti-arrhythmic Chinese and western drugs: a therapeutic potential viewed from brain-heart axis

关键词:  脑心同治  多靶点抗心律失常  脑卒中

Key words:  Simultaneous treatment of brain and heart  multi-target anti-arrhythmia stroke

摘要:

心律失常是最普遍且病因较复杂的心脏疾病之一，现有抗心律失常药物多为单离子通道调节剂多数在抗心律失常的同时也有一定的致心律失常作用。因此多靶点抗心律失常药物已成为临床用药的最新需求，除离子通道异常可直接造成心律失常外，脑功能（皮质），脑干和自主神经亦会影响心脏电生理功能从而造成心律失常。越来越多的临床数据和实验数据表明以脑卒中为主的脑损伤和心功能损伤尤其是心律失常间存在着因果关系。脑损伤主要会经由下丘脑-垂体-肾上腺轴，交感副交感神经系统，免疫应答，电解质等相关途径影响心脏功能。因此明确心脑相互作用的机制有助于解释随机突发性心脏事件，并对心律失常的疗法提供新的见解。本综述将重点总结由卒中引发心律失常的病理生理途径，以发现对心律有调节作用的新靶点、并对对这些靶点有作用的药物及其临床应用前景做一展望。

Abstract:

Arrhythmia is one of the most common cardiac diseases with complicated etiology. The efficacy and side effects of various single-target antiarrhythmic drugs are highly variable. In addition to ion channel abnormalities in the heart,abnormal brain function (cortex),brainstem and autonomic nerve also can directly cause arrhythmia,can also affect cardiac electrophysiology and thus cause arrhythmia. The interactions between brain and heart mainly involve insular cortex,electrolyte and immune response related to autonomic nervous system. Clarifying the mechanism of cardio-cerebral interaction is helpful to explain random sudden cardiac events and may provide new insights into the treatment of arrhythmia. This review will focus on summarizing the pathophysiological pathways of arrhythmia caused by stroke,in order to find new targets that have regulatory effects on heart rhythm,and make a prospect of drugs that have effects on these targets and their clinical application prospects.