丹参水溶性成分抗心肌缺血再灌注的研究进展

心肌缺血指心肌的供血量减少或心肌对氧的需求量增加超过其最大供血量,从而引起心肌代谢、功能和结构改变。缺血后恢复血液灌注即再灌注会引起心脏功能性损伤、心律失常,加速心肌细胞坏死,称为缺血/再灌注损伤。其病理生理机制较复杂,涉及冠脉狭窄,内皮损伤,血小板聚集,能量代谢障碍,氧化应激,炎症反应,细胞凋亡和钙超载及自噬,形成了复杂的调节网络。目前临床用于防治心肌缺血及再灌的药物按作用机制主要包括抗血小板药物,β受体阻断剂,钙通道拮抗剂,他汀类,RAS系统阻断剂,硝酸酯类和溶栓治疗等。虽然前述药物种类众多,但是由于现代西药靶点单一、不良反应多等因素限制了其防治效果。传统中药丹参作为活血化瘀的主药,对缺血性心脏病的预防和治疗具有显著的疗效,且具有多靶点、生物活性成分丰富的治疗优势,其水溶性成分被公认为是防治心血管疾病的重要活性成分。本文通过CNKI,Pub Med,Sciencedirect等数据库,综述丹参水溶性成分通过舒张冠脉、保护内皮、抗血小板聚集、调节能量代谢、活性氧代谢、抑制炎性反应、细胞凋亡、钙超载和调控自噬抗心肌缺血及再灌注损伤,对主要水溶性单体成分(丹参素、丹酚酸A和丹酚酸B)的作用及其机制进行比较,为丹参在心血管疾病的临床运用提供理论依据。

Research Advances in Protective Effect of Water-soluble Ingredients in Salviae Miltiorrhizae Radix et Rhizoma on Myocardial Ischemia and Reperfusion Injury

Myocardial ischemia occurs when blood flow to heart is reduced or the myocardial oxygen demand is more than the maximum blood supply, resulting in changes in myocardial metabolism, function, and structure. Reperfusion after ischemia leads to cardiac functional damage, arrhythmias, and myocardial cell necrosis, known as ischemia/reperfusion injury. Its pathophysiology is complex, involving coronary artery stenosis, endothelial injury, platelet aggregation, energy metabolism disorder, oxidative stress, inflammation response, apoptosis, calcium overload and autophagy, forming a complex regulatory network. The current clinical medicines for myocardial ischemia and reperfusion mainly include antiplatelet drugs, beta blockers, calcium channel blockers, statins, RAS blockers, nitrates and thrombolytic therapy etc.Although there are many kinds of drugs mentioned above, the control effect is limited because of the single target of modern western medicine and many adverse reactions. With multiple targets and components, Salviae Miltiorrhizae Radix et Rhizoma, the main medicine for activating blood circulation and removing blood stasis, has been widely used in the treatment of cardiovascular disease, especially for the prevention and treatment of myocardial ischemic diseases. The water-soluble ingredient is acknowledged as the important active ingredient in treating cardiovascular diseases. The effect and mechanism of main water-soluble components (tanshinol, salvianolic acid A and salvianolic acid B) were compared in this paper to provide a theoretical basis for the clinical application of Salviae Miltiorrhizae Radix et Rhizoma.