基于虚、痰、瘀、毒理论浅析射血分数保留的心力衰竭炎症状态与中医药干预策略

Inflammatory state of heart failure with preserved ejection fraction and intervention strategies of traditional Chinese medicine based on “deficiency，phlegm，blood stasis and toxin” theory

关键词:  射血分数保留的心力衰竭  炎症状态  中医药

Key words:  heart failure with preserved ejection fraction  inflammatory state  traditional Chinese medicine

摘要:

射血分数保留的心力衰竭（HFpEF）是常见的心力衰竭类型之一，约占全部心力衰竭的50%，具有较高的发病率、再住院率及病死率。HFpEF的发病机制较其他类型的心力衰竭更为复杂，具有高度异质性特点。近年来，关于其细胞分子学发病机制的相关研究越来越受到重视，大量研究显示HFpEF的发病及疾病进展与炎症密切相关，微血管炎症和内皮细胞炎症是HFpEF的关键分子机制，涉及一氧化氮（NO）-环磷酸鸟苷（cGMP）-蛋白激酶G（PKG）、转化生长因子-β1（TGF-β1）/Smads、血管紧张素Ⅱ（AngⅡ）/TGF-β1/Smad2/3、白细胞介素-33（IL-33）/跨膜型ST2（ST2L）等信号通路。HFpEF合并症通过全身炎症和氧化应激，进而导致冠状动脉微血管内皮炎症驱动心肌功能障碍及重塑。现代研究表明炎症与中医“虚、痰、瘀、毒”理论高度相似，结合HFpEF的致病因素、病理机制及病程不同阶段的临床表现采用中医药干预策略，注重补虚、化痰、祛瘀、解毒等治法的运用，结果显示中医药可以通过改善线粒体功能，调节能量代谢，从而抑制炎症反应，减轻心肌纤维化，逆转心肌肥厚，进而保护心肌细胞，抑制心室重构，延缓HFpEF病理进程，能够减轻患者临床症状，提高生活质量。文章试从虚、痰、瘀、毒理论浅析HFpEF病理变化，以期为临床防治HFpEF提供科学依据。

Abstract:

Heart failure with preserved ejection fraction（HFpEF） is a common type of heart failure，accounting for about 50% of all heart failure，with high morbidity，rehospitalization rate and mortality. The pathogenesis of HFpEF is more complex and highly heterogeneous than other types of heart failure. In recent years，more and more attention has been paid to the cellular and molecular pathogenesis of HFpEF. A large number of studies have shown that the pathogenesis and disease progression of HFpEF are closely related to inflammation. It involved NO-cGMP-PKG，TGF-β1/Smads，AngⅡ/TGF-β1/Smad2/3，IL-33/ST2L and other signaling pathways. In turn，coronary microvascular endothelial inflammation drives myocardial dysfunction and remodeling. Modern research shows that inflammation is highly similar to the theory of “deficiency，phlegm，blood stasis and poison” of traditional Chinese mediciｎｅ（ＴＣＭ）. Combined with the pathogenic factors，pathological mechanism and clinical manifestations of HFpEF at different stages of the disease，the intervention strategy of TCM is adopted，focusing on supplementing deficiency，dissipating phlegm，removing blood stasis and detoxification. Thus，it can inhibit inflammatory response，reduce myocardial fibrosis，reverse myocardial hypertrophy，protect myocardial cells，inhibit ventricular remodeling，delay the pathological process of HFpEF，alleviate clinical symptoms and improve the quality of life of patients. This article briefly analyzes the pathological changes of HFpEF from the aspects of deficiency，phlegm，blood stasis and toxin in the development of the disease，in order to provide a scientific basis for clinical prevention and treatment of HFpEF.