中药单体治疗急性心肌梗死后心脏纤维化的实验研究进展

李真 尹玉洁 刘依 韩宁馨 贾振华

摘要 急性心肌梗死（AMI）发生后，一系列复杂病理过程导致心脏结构和功能均发生改变，心脏纤维化（MF）形成后持续进展，导致心功能逐渐降低，预后不良。近年来中草药来源的活性成分因其结构稳定、药效确切逐步受到广泛关注，或许将为新药开发提供有价值的候选化合物。研究中药单体的作用和机制有利于寻找AMI后MF的有效治疗药物。目前已有多项实验研究发现，不同种中药单体均对AMI后MF的发生发展产生不同程度的阻抑作用且机制不同。根据中医理论对心肌梗死后心脏纤维化病机演变规律的认识，治疗药物可选取益气类、活血通络类、温阳类等，而对应的中药单体种类繁多、药效和作用机制不同，因此对于中药单体治疗AMI后MF的实验研究逐步广泛开展，并取得一定成果，日后仍需更多相关研究进行深入探索。

关键词 中药单体;急性心肌梗死;心脏纤维化;实验研究;益气;活血;通络;研究进展

Abstract After the occurrence of acute myocardial infarction（AMI），a series of complex pathological processes lead to the changes of cardiac structure and cardiac function.Cardiac fibrosis（Myocardial Fibrosis，MF） continues to progress after its formation，leading to a gradual decrease in heart function and a poor prognosis.In recent years，active ingredients derived from Chinese herbal medicine have gradually received widespread attention due to their stable structure and precise efficacy，and may provide valuable candidate compounds for the development of new drugs.The study of the functions and mechanisms of the monomers of traditional Chinese medicine is helpful to find effective treatment drugs for MF after AMI.At present，many experimental studies have found that different kinds of traditional Chinese medicine monomers have different degrees of inhibition on the occurrence and development of MF after AMI，and the mechanisms are different.According to the understanding of the pathogenesis of cardiac fibrosis after myocardial infarction in traditional Chinese medicine，the therapeutic drugs can be selected from qi-invigorating drugs，blood-activating and collateral-activating drugs，warming-yang drugs，etc.The corresponding traditional Chinese medicine monomers are diverse，with different efficacy and mechanism of action.Therefore，the experimental research on the treatment of MF after the treatment of AMI with traditional Chinese medicine is gradually and extensively carried out，and certain results have been obtained.In the future，more relevant researches are still needed for in-depth exploration.

Keywords Chinese medicine monomer; Acute myocardial infarction; Cardiac fibrosis; Experimental study; Yiqi; Promoting blood circulation; Dredging collaterals; Research progress

中圖分类号：R285.5文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.11.004

近年调查显示急性心肌梗死（Acute Myocardial Infarction，AMI）的发病率一路攀升，严重威胁了人类的健康。随着经皮冠状动脉介入技术在临床应用中的普及，在一定程度上降低了AMI死亡或再住院的发生率，并能延迟主要事件的平均时间。然而介入或溶栓虽可开通闭塞冠脉，但由于微血管结构功能完整性破坏导致心肌无再流及缺血再灌注损伤、释放氧自由基和蛋白酶，影响心肌有效再灌注，造成死亡率大幅增加。晚期纤维化持续激活，心室腔扩大、心肌收缩力和舒张功能下降，呈不可逆且进行性加重趋势，预后较差。……