钙超载与心肌缺血再灌注损伤及中药干预策略

据国家心血管病中心最近发布的报告显示,心血管病占居民疾病死亡构成的40%以上,为我国居民的首位死因,其中冠心病死亡率在逐年上升。血运重建能快速打开堵塞血管、恢复冠脉血供,成为治疗冠心病的重要手段。但是血运重建也只是一种局部治疗,并不能终止冠心病的病理发展进程,加之治疗后出现的一系列再灌注损伤,严重制约了冠心病的治疗效果。心肌缺血再灌注损伤是个复杂的病理过程,与氧自由基、钙超载、能量代谢障碍等密切相关。再灌注时可见心肌细胞内钙超载,而钙超载亦可通过多种机制造成心肌细胞进一步损伤。钙超载是心肌细胞损伤和死亡的共同通路,故防治钙超载是阻止I/R的重要举措。临床常用的钙通道阻滞剂防治钙超载取得很大进展,它们均能作用于血管平滑肌的L型Ca通道从而抑制钙超载,但也有因其作用靶点单一而副作用大的不足,故临床应用受到一定限制。中医药是个伟大的宝库,其中不少药物具有类似钙拮抗作用,开发应用此类药物弥补西药治疗的不足成为当代中医人的重要任务。

Relationship between calcium overload and myocardial ischemia reperfusion injury and intervention strategy of Chinese herbal medicine

The recent report from National Cardiovascular Center shows that cardiovascular diseases account for more than 40% of disease deaths among residents, so it has become the first cause of death among the residents in our country, and the mortality of coronary heart disease is increasing year by year. Revascularization can quickly open the clogged blood vessels and restore coronary blood supply, so it is an important approach for the treatment of coronary heart disease. However, the revascularization can not terminate the pathological development of coronary heart disease because it is just a local treatment method. In addition, a series of reperfusion injuries after revascularization would seriously restrict its treatment effect for coronary heart disease. Myocardial ischemia reperfusion injury is a complex pathological process, which is closely related to oxygen free radicals, calcium overload and energy metabolism disorder. The calcium overload can be seen during reperfusion in the myocardial cells, and it can cause further damages to the myocardial cells through various mechanisms. Calcium overload is a common pathway of myocardial necrosis and apoptosis, so prevention and treatment of calcium overload is an important method to prevent ischemia reperfusion. The commonly used calcium channel blockers for preventing calcium overload has made great progress, all of which can act on L-type calcium channel of vascular smooth muscle to inhibit calcium overload. However, their clinical application was restrained to a certain extent due to the single target and great side effects. Traditional Chinese medicine (TCM) is a great treasure, and many drugs in TCM have similar effects with calcium antagonists, so the development and application of such drugs would be an important task for contemporary TCM doctors to make up for the deficiency of Western medicine.