首页|心肌缺血再灌注损伤氧化应激机制及中药的保护作用

心肌缺血再灌注损伤氧化应激机制及中药的保护作用

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心肌缺血是一种发病率和病死率较高的疾病,通过再灌注恢复缺血区域的血液供应是目前较为有效的干预手段。然而大量的研究表明再灌注可能会导致进一步的心肌损伤,造成心肌收缩、舒张功能不全,严重影响心肌功能。这种现象被称为心肌缺血再灌注损伤(myocardial ischemia reperfusion injury,MIRI)。MIRI的生理病理机制包括氧化应激、钙超载、细胞自噬、焦亡、内质网应激、细胞凋亡等,其中氧化应激在MIRI相关的细胞死亡中发挥着重要作用,被认为是心肌缺血再灌注损伤的主要机制。氧化应激的发生主要是由活性氧(reactive oxygen species,ROS)的过度产生导致机体或组织的氧化还原系统平衡被打破,大量具有高反应活性的ROS超出心肌细胞抗氧化防御能力,从而对DNA和蛋白等生物大分子进行修饰,造成DNA受损、蛋白功能紊乱、细胞损伤乃至死亡和局部炎症反应等严重反应,通过多种途径介导细胞发生凋亡、自噬以及炎症的损伤,从而造成不可逆的心肌细胞损伤和心肌功能障碍,给临床治疗及预后带来了很大的困难。近年来,对氧化应激在各种器官组织的缺血再灌注(ischemia reperfusion,I/R)损伤的研究取得了很大的进展,但针对恢复心肌缺血区域血流供应时发生氧化应激造成的损伤机制以及中药的保护作用鲜见报道。该文综述了氧化应激在心肌缺血再灌注损伤中的作用、ROS的主要产生途径以及中药对缺血心肌再灌注时发生氧化应激损伤的保护作用,以期为今后的研究和临床治疗提供参考。
Mechanisms of oxidative stress in myocardial ischemia-reperfusion injury and protective effects of traditional Chinese medicines
Myocardial ischemia is a disease characterized by high morbidity and mortality rates,restoring blood supply to the ischemic area through reperfusion is an effective intervention method.However,numerous studies have shown that reperfusion may cause severe myocardial damage,resulting in myocardial systolic and diastolic dysfunction and seriously affecting myocardial function.This phenomenon is called myocardial ischemia reperfusion injury(MIRI).The physiological and pathological mechanisms of MIRI include oxidative stress,calcium overload,autophagy,pyrolysis,endoplasmic reticulum stress,apoptosis,etc.Oxidative stress plays an important role in MIRI-related cell death and is considered to be the main mechanism of MIRI.The occurrence of oxidative stress is mainly due to the excessive production of reactive oxygen species(ROS),which disrupts the balance of the redox system of the body or tissue.A large number of highly reactive ROS exceed the antioxidant defense capacity of cardiomyocytes,causing modifications in biological macromolecules such as DNA and proteins and resulting in severe reactions like DNA damage,protein dysfunction,cell damage or death,and local inflammation.Oxidative stress mediates apoptosis,autophagy,and inflammatory injury through various pathways,resulting in irreversible cardiomyocyte injury and myocardial dysfunction,which brings significant challenges for clinical treatment and prognosis.In recent years,remarkable progress has been made in understanding oxidative stress in ischemia reperfusion(I/R)injury of different organs and tissue.However,the injury mechanism caused by oxidative stress in restoring blood supply to the ischemic area and the protective effect of TCM remain largely unexplored.This article reviewed the role of oxidative stress in MIRI,the main production pathways of ROS,and the protective effects of TCM on oxidative stress injury during ischemic myocardial reperfusion,so as to provide a reference for future research and clinical treatment in this field.

oxidative stressischemia-reperfusion injuryprotective effects of traditional Chinese medicines

宋鉴书、曹策、李浩然、李磊、刘建勋

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广东药科大学中医药研究院,广东广州 510006

中国中医科学院西苑医院中药药理北京市重点实验室国家中医心血管疾病临床医学研究中心,北京 100091

氧化应激 缺血再灌注损伤 中药保护作用

国家自然科学基金重点项目国家自然科学基金面上项目国家中医药管理局中医药传承与创新"百千万"人才工程(岐黄工程)岐黄学者项目中国中医科学院科技创新工程项目

8203012482174015CI2021A04609

2024

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(13)