心房颤动是临床实践中常见的心律失常,其发病机理错综复杂。心肌纤维化作为房颤的主要病理基础,与房颤可互相促进,进而导致疾病的加重。基于房颤心肌纤维化的临症表现,中医可将其归于“心悸”范畴来诊治。本文从气血理论出发,结合现代药理学及临床研究,讨论气血失和与房颤心肌纤维化的相关性,探讨炙甘草汤对房颤心肌纤维化的治疗作用。研究发现,炙甘草汤诸药合用,益气养阴,补血复脉,具有保护心肌、延缓心肌重构等多重功效,能有效改善心肌纤维化状况,从而防治心房颤动。Atrial fibrillation (AF) is a common arrhythmia in clinical practice, characterized by a complex pathogenesis. Myocardial fibrosis, serving as a primary pathological substrate of AF, can mutually exacerbate AF, leading to disease progression. Based on the clinical manifestations of AF-related myocardial fibrosis, traditional Chinese medicine categorizes it under the diagnosis and treatment framework of “palpitations”. This paper, grounded in the theory of qi and blood, integrates modern pharmacology and clinical research to discuss the correlation between qi-blood disharmony and AF-related myocardial fibrosis, as well as to explore the therapeutic effects of Zhigancao Decoction on AF-related myocardial fibrosis. The study reveals that Zhigancao Decoction, through the combined actions of its constituents, tonifies qi and nourishes yin, replenishes blood, and restores the pulse. It exhibits multiple benefits including myocardial protection and delay of myocardial remodeling, thereby effectively ameliorating myocardial fibrosis and preventing AF.
目的观察吡非尼酮对大鼠心肌纤维化的作用,并探讨其机制。方法选取8周龄SPF级雄性SD大鼠24只,构建大鼠心房纤维化模型,随机分为假手术组、模型组、吡非尼酮低剂量组和吡非尼酮高剂量组,每组6只。假手术组和模型组分别经尾静脉注射生理盐水和异丙肾上腺素,吡非尼酮低剂量组和吡非尼酮高剂量组在注射异丙肾上腺素的基础上分别灌胃不同剂量的吡非尼酮。Masson染色检测心肌纤维化程度,免疫组织化学染色检测胶原组织Ⅰ型(Collogen-1)、核苷酸结合寡聚化结构域样受体蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)炎性小体、半胱氨酸天冬氨酸蛋白酶1(cysteinyl aspartate-specific proteinase-1,Caspase-1)的表达,Western blot检测Collogen-1和心房消皮素D(gasdermin D,GSDMD)的表达。结果与假手术组比较,模型组心肌纤维化改变显著,Collogen-1、NLRP3、Caspase-1和GSDMD表达显著升高,差异有统计学意义(P<0.05);与模型组比较,吡非尼酮低剂量组和吡非尼酮高剂量组心肌纤维化程度显著减轻,Collogen-1、NLRP3、Caspase-1和GSDMD表达显著降低,差异有统计学意义[(8.14±1.40)%,(6.56±0.75)%vs(22.15±2.57)%,P<0.05;0.14±0.03 vs 0.33±0.05,0.42±0.13,P<0.05;(10.34±1.40)%,(10.33±3.40)%vs(23.22±1.99)%,P<0.05;(15.67±0.56)%,(17.33±0.78)%vs(22.87±1.92)%,P<0.05;0.43±0.06,0.46±0.11 vs 0.65±0.03,P<0.05]。结论吡非尼酮通过NLRP3/Caspase-1/GSDMD信号轴抑制心肌细胞焦亡,减轻心肌纤维化。
