首页|内皮间质转化与心肌梗死后心室重构及中医药干预研究进展

内皮间质转化与心肌梗死后心室重构及中医药干预研究进展

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心肌梗死后心室重构(VRAMI)是指冠状动脉急性闭塞造成的心肌缺血缺氧，引起心室的物理形态(大小、组织构造、顺应性)发生变化的病理过程，是心肌细胞受损后产生病理生理反应和自我修复过程。VRAMI典型病理特征是心肌纤维化(MF)，纤维化的心脏组织失去主动收缩及舒张的功能，最终诱导心力衰竭(HF)，严重影响心肌梗死(MI)患者治疗预后。内皮间质转化(EndMT)是内皮细胞在胚胎发育期或缺血缺氧等多种病理因素刺激下造成自身物理形态变化和内皮功能缺失，并逐渐获得间充质细胞的典型特征，最终转化为间充质细胞的过程。当EndMT持续进展，将造成胶原过度累积而引发心肌结构受损，进一步加剧VRAMI和MF进程。新近研究显示，EndMT在VRAMI病理进展中扮演重要角色，靶向干预EndMT，可有效抑制VRAMI，从而保护心脏功能，有望成为VRAMI防治的新靶点。该文系统复习了新近国内外相关文献，详细梳理了EndMT在VRAMI中发挥的作用和病理生理学机制，以及中西医创新药物靶向干预的相关研究进展，以期为临床治疗该疾病提供新的思路和理论依据。
Endothelial-mesenchymal transition,ventricular remodeling after myocardial infarction,and research progress of Chinese medicine intervention
Ventricular remodeling after myocardial infarction(VRAMI)is a pathological phenomenon triggered by the abrupt occlu-sion of coronary arteries,leading to myocardial ischemia and hypoxia.This intricate process encompasses alterations in the dimensions,composition,and elasticity of the ventricular tissue and reflects pathophysiological reactions and self-repair after cardiomyocytes are damaged.The characteristic pathological manifestation of VRAMI is the presence of myocardial fibrosis(MF),wherein fibrotic cardiac tissue undergoes a loss of contractile and relaxation capacity,ultimately culminating in heart failure(HF)and significantly impacting the patient's prognosis.Endothelial-mesenchymal transition(EndMT)is a biological process in which endothelial cells,in response to diverse pathological stimuli such as ischemia and hypoxia in the embryonic development period,undergo morphological alterations and functional impairment,progressively acquiring mesenchymal cell properties and ultimately differentiating into mesenchymal cells.The ongoing advancement of the EndMT process will result in an excessive buildup of collagen,thereby inducing structural harm to the myo-cardium and exacerbating the processes of VRAMI and MF.Recent investigations have demonstrated the pivotal involvement of EndMT in the pathological advancement of VRAMI.Consequently,a targeted intervention aimed at effectively impeding VRAMI,safeguarding cardiac function,and potentially serving as a novel therapeutic target for the prevention and treatment of VRAMI.This article provides a comprehensive review of recent Chinese and international literature,focusing on the role and pathophysiological mechanisms of End-MT in VRAMI.Additionally,it discusses the research progress of innovative targeted interventions using both traditional Chinese and Western medicine,so as to offer new insights and a theoretical foundation for the clinical treatment of the disease.

ventricular remodeling after myocardial infarctionendothelial-mesenchymal transitionmyocardial fibrosisheart fai-lure

罗云菲、梅志刚、张文丽

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湖南中医药大学 中西医结合学院 中西医结合心脑疾病防治湖南省重点实验室,湖南 长沙 410208

重庆市荣昌区中医院 心血管内科,重庆 402460

三峡大学 健康医学院 国家中医药管理局中药药理三级实验室,湖北 宜昌 443002

湖南中医药大学 药学院,湖南 长沙 410208

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心肌梗死后心室重构 内皮间质转化 心肌纤维化 心力衰竭

国家自然科学基金湖南省自然科学基金面上项目国家中医药局中医药传承与创新"百千万"人才工程青年岐黄学者项目湖北省医学青年拔尖人才项目

821741672023JJ30464

2024

10.19540/j.cnki.cjcmm.20240204.701

中国中药杂志
中国药学会

中国中药杂志

CSTPCD北大核心
影响因子：1.718
ISSN：1001-5302
年,卷(期)：2024.49(12)
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