Insights of Chinese Medicine on Ventricular Remodeling: Multiple-Targets, Individualized-Treatment

Ventricular remodeling (VR) can be induced by myocardial injury, leading to progressive cardiac dysfunction and heart failure, and is associated with high morbidity and mortality. Despite being studied for more than 3 decades, current therapeutic strategies still remain unsatisfactory in effificacy, expensive, and with side effects and drug resistances. Chinese medicine (CM) has been used to treat heart diseases for thousands of years. This article reviews the published studies on the mechanisms and therapeutic applications of CM in VR. The major aspects include: mechanistic studies of VR, molecular biology and myocardial functional studies of CM therapies on VR, and mechanism of CM therapies on VR.     

高尿酸血症与房颤相关性及机制研究进展

心房颤动(atrial fibrillation)是临床上最常见的心律失常,显著增加了脑卒中、心衰和心源性死亡的风险.近年来,高尿酸血症与心血管疾病的相关性备受关注.高尿酸血症可通过炎症、氧化应激等途径促进高血压、冠心病等心血管疾病的发生.炎症和氧化应激是导致心脏电生理和结构重构的重要机制.流行病学研究表明高尿酸血症与房颤发生显著相关.然而,高尿酸是否通过炎症、氧化应激等途径导致房颤尚不清楚.本文结合国内外研究,对高尿酸血症与房颤的相关性以及高尿酸血症导致房颤的可能机制进行综述.     

血管扩张剂引起的肺水肿

血管扩张剂治疗急性左心衰竭已为许多临床医师所熟悉。但在心瓣膜狭窄的瓣膜病(二尖瓣狭窄、或兼有二尖瓣狭窄)心衰患者,扩血管药的扩张动脉效应可致左右心输出量急剧不平衡,使心衰迅速加重,甚至发生肺水肿。这一点常被人们忽视。本文报告4例均为风湿性心瓣膜病,在静滴血管扩张剂时发生急性肺水肿。而本院心内科5年来用同样疗法的非心瓣膜病心衰,并无1例发生肺水肿。     

Intracardiac thrombus formation in cardiac impairment: the role of anticoagulant therapy.

The presence of intracardiac thrombus has been associated with many diseases and clinical states, although cardiac impairment is commonly also present. Despite this, there continues to be a lack of consensus on which patients with cardiac impairment should have anticoagulant therapy. This review discusses the relationship between thromboembolism and cardiac impairment secondary to ischaemic heart disease, and suggests possible mechanisms, methods of diagnosis and therapeutic strategies for anticoagulation in such patients. In particular, warfarin has been established as thromboprophylaxis in certain subgroups of patients with cardiac impairment secondary to ischaemic heart disease. A large-scale randomised controlled trial in ambulant patients with cardiac impairment to evaluate the effectiveness of anticoagulant therapy and antiplatelet therapy is, however, long overdue.     

miRNA及DNA甲基化与中医药干预冠心病研究新进展

现代社会,心血管疾病已然成为人类健康的主要威胁之一,其中,冠心病作为最常见的类型,具有高发病率及致死致残率。越来越多研究证实,微小核糖核酸(miRNA)调节与脱氧核糖核酸(DNA)甲基化调控与冠心病的发生、发展关系密切,其可涉及调控冠心病的发病机理,且特殊的miRNA表达及特定基因的DNA甲基化状态可以作为冠心病预测及早期诊断的生物学标记以及治疗的潜在靶点。冠心病归属中医"胸痹""心痛"的范畴,研究表明,miRNA的及DNA甲基化的变化可以作为冠心病辨证分型的参考依据,且中医中药通过干预miRNA及DNA甲基化的相关靶点对冠心病起到防治作用。通过对miRNA及DNA甲基化参与冠心病的发病机制、检测,二者的相互调控以及中医药干预治疗等进行阐述,为相关研究提供参考。     

张锡纯学术思想对辨治心力衰竭相关病证的启示

心力衰竭是多种心脏疾病的严重转归。张锡纯《医学衷中参西录》 中“喘无善证”、“大气下陷”等论述与现代心力衰竭相关病证辨治具有相关性;其益气利水、兼顾汗证、注重“治未病”等治法理论对临床辨治心力衰竭相关病证具有重要启示。      

“心主神明”的内涵及现代科学依据

"心主神明"理论是中医学的重要基础理论,贯穿于中医的理法方药并指导临床实践。本文首先回顾了"心主神明"的渊源和内涵;重点阐述了"心主神明"的现代科学依据,认为心脏的泵血功能是大脑功能正常的重要基础,心脏的内分泌功能与脑的功能密切相关,心血管疾病常导致患者认知功能障碍和情绪的焦虑抑郁,并有现代物理学和心脏移植的佐证;最后说明"心主神明"理论在临床实践中运用的有效性。"心主神明"的理论和科学依据提示,西医学的心脏功能与大脑的功能密切相关,我们应努力挖掘并进行深入的科学研究,以全面阐明"心主神明"的科学内涵。     

冠心病血瘀证：从现代医学视角理解

The medical community as a whole is attempting to start preventive therapy for coronary heartdisease （CHD） patients earlier in life. However, the main limitations of such interventions are drug resistanceand adverse reactions. Additionally, traditional biomarker discovery methods for CHD focus on the behavior ofindividual biomarkers regardless of their relevance. These limitations have led to attempting novel approachesto multi-dimensionally investigate CHD and identify safe and efficacious therapies for preventing CHD. Recently,the benefit of Chinese medicine （CM） in CHD has been proven by increasing clinical evidence. More importantly,linking CM theory with modern biomedicine may lead to new scientific discoveries. According to CM theory,all treatments for patients should be based on patients＇ syndromes. A recent epidemiological investigation hasdemonstrated that blood stasis syndrome （BSS） is the major syndrome type of CHD. BSS is a type of complexpathophysiological state characterized by decreased or impeded blood flow. Common clinical features ofBSS include a darkish complexion, scaly dry skin, and cyanosis of the lips and nails, a purple or dark tonguewith purple spots, a thready and hesitant pulse, and stabbing or pricking pain fixed in location accompaniedby tenderness, mass formation and ecchymosis or petechiae. The severity of BSS is significantly correlatedwith the complexity of coronary lesions and the degree of stenosis, and is an important factor affecting theoccurrence of restenosis after percutaneous coronary intervention. The mechanisms of BSS of CHD patientsshould be investigated from a modern medicine perspective. Although many studies have attempted toexplore the biomedical mechanisms of BSS of CHD, from hemorheological disorders to inflammation andimmune responses, the global picture of BSS of CHD is still unclear. In this article, the current status of studiesinvestigating the biomedical mechanisms of BSS of CHD and future perspectives are discussed.     

The role of exercise testing in the evaluation and management of heart failure

The clinical syndrome of heart failure has been investigated so extensively that it may now almost be regarded as a metabolic disorder. Although an initial insult reduces cardiac pump efficacy, the resultant physiological response culminates in complex neurohormonal dysfunction. This has created confusion and prevented the acceptance of a universal definition of cardiac failure. With much current research concentrating on the pharmacological modification of neuroendocrine imbalance, it is easy to lose sight of the fundamental principles behind heart failure management, namely, to improve cardiac function. In attempting to achieve this, the issues of morbidity and mortality must be addressed jointly; they are not mutually exclusive entities. Discrepant results between mortality studies and changes in exercise capacity have undermined the value of exercise testing. Because a treatment enhances longevity we should not ignore its effect on symptomatic status, and likewise we should not discard a therapy, which improves function because adverse events result in occasional premature deaths. Informed patient choice must exist. Historically, exercise testing has been quintessential in our understanding and evaluation of heart failure. Peak oxygen consumption remains the best overall indicator of symptomatic status, exercise capacity, prognosis and hospitalisation. Unfortunately, muddling of surrogate and true end-points has confused many of these issues. Improved comprehension may be gained by applying the concept of cardiac reserve which has been described in a variety of heart conditions and used in cardiac failure patients to provide an indication of prognosis and functional capacity.     

植物雌激素的心血管效应

植物雌激素是一类天然存在于植物中,与雌激素结构近似的生物活性物质.本文主要介绍植物雌激素的分类和来源,从植物雌激素对心功能、心肌电生理效应阐述其对心脏的作用;通过对血脂代谢、动脉血管、细胞因子和凝血纤溶系统的调节,阐述其抗动脉粥样硬化的效应,为心血管疾病的预防和治疗提供新的思路.     

Viral myocarditis and dilated cardiomyopathy: mechanisms, manifestations, and management

Viral infection of the heart is relatively common and usually of little consequence. It can, however, lead to substantial cardiac damage and severe acute heart failure. It can also evolve into the progressive syndrome of chronic heart failure. Recent studies have gone some way towards unravelling the complex mechanisms underlying the heart muscle damage that occurs after viral infection. These studies have lent support to both immune and viral mediated (independent of an immune response) cardiac damage. Acute myocarditis can present in various ways, and it may be a cause of sudden death in an otherwise healthy young adult. New treatments for viral heart disease are awaited. In the meanwhile, the haemodynamic support of patients with acute left ventricular failure caused by myocarditis should be aggressive, to allow for the possibility of spontaneous recovery. Contemporary trials of treatment in chronic heart failure secondary to dilated cardiomyopathy support the use of angiotensin converting enzyme inhibitors, beta adrenoceptor blockers, and spironolactone in such patients.     

他汀类药物对慢性心力衰竭治疗作用的新认识

他汀类药物具有肯定的降血脂作用,已作为冠状动脉粥样硬化性心脏病的二级预防用药。大量研究显示,他汀类药物除降脂作用外,还有多效的非调脂作用如抗炎作用、改善内皮功能、改善心室重塑、恢复心脏自主神经功能、抗氧化作用。近年来很多研究表明,他汀类药物的多效性对慢性心力衰竭的治疗有益,可延缓慢性心力衰竭进展,改善心功能,降低慢性心力衰竭病死率、致残率。但同时也有一些潜在的不利影响,他汀类药物能否常规用于慢性心力衰竭的治疗还有待循证医学证实。     

运动锻炼疗法配合人参汤治疗慢性心力衰竭

目的：探讨运动锻炼疗法配合人参汤治疗对慢性心力衰竭的临床疗效。方法选取我院收治的慢性心力衰竭患者60例,随机分为2组,各30例,对照组予常规药物治疗,治疗组在常规药物治疗的基础上加以运动锻炼疗法,治疗结束后观察2组心功能分级和 Lee 心衰积分。结果治疗后2组心功能分级均有所改善,治疗组改善明显,与对照组比较差异有统计学意义（P ＜0.05）;治疗后2组 Lee 心衰积分均有所改善,治疗组较对照组改善明显,差异有统计学意义（P ＜0.05）。结论运动锻炼疗法配合人参汤治疗慢性心力衰竭,能有效提高心肌收缩力,改善临床症状,改善心功能。     

人参皂苷治疗阿尔茨海默病作用机制的研究进展

阿尔茨海默病(AD)是一种原因未明、以认知功能减退为主要临床表现的神经系统退行性疾病,已成为世界范围内危害人类健康最严重的疾病之一。中医药防治AD是近年来的研究热点,已发现人参根的提取物人参皂苷对AD具有良好的治疗作用。     

What Has Been Overlooked on Study of Chinese Materia Medica in the West?

Chinese materia medica (CMM), including Chinese herbal, animal, and mineral medicine, has been widely researched in the past century for their biological and pharmacological activities. However, their mechanism and clinical efficacy studies did not always give expected results. For example, the most commonly used Chinese herb for menstrual disorders, Radix Angelicae sinensis, showed neither estrogenic nor progesteronic activity in laboratory and clinical studies. Its efficacy should not be denied simply based on such results, because it is mostly used together with other herbs in formulae. Moreover, its regulation on menstruation may take effect through other mechanisms, such as regulation of blood circulation. The key difference of Chinese medicine (CM) from conventional medicine is its unique holistic view on human body and diseases. CMM is mostly applied in clinic in the form of formulae. Study on individual CMM, simply using methods for development of conventional drugs, is unable to thoroughly reveal the power of CMM formulae. The reason may partly result from improper design due to the lack understanding about application principle of CMMs in CM, and/or to current lack of knowledge about the causes of some symptoms and diseases. This paper will introduce the importance of qi and blood in CM etiology and pathology, Zheng differentiation, formulation of CMMs, and explain why one formula can treat different diseases and one disease can be treated with different formulae. Examples in the paper will demonstrate that proper studies on Zheng and its corresponding clinically proven formulae could help scientists find new direction to explain and treat symptoms and diseases that so far modern medicine has been unable to, provided that the designer properly understands CM theories, etiology and pathology of CM, as well as modern medicine. Strategy suggestions about research methods for CMM and its formulae will be given at the end.     

The recent advance in heart tissue engineering research

冠心病是现代社会危害公众健康的主要疾病之一,而现有的治疗手段并不能从根本上治愈冠心病所引起的心肌损害和心功能下降,心肌组织工程概念的提出有望为解决这一难题提供新途径。本文结合近年来的文献对心肌组织工程的国内外研究进展作一综述。     

The management of primary pulmonary hypertension

Primary pulmonary hypertension is a clinical syndrome characterized by pulmonary hypertension in the absence of sufficient underlying cardiac, parenchymal pulmonary, or systemic disease to account for it. The population of patients with primary pulmonary hypertension is a heterogeneous one, both clinically and histologically. As the etiologic mechanisms are unknown, therapy is directed toward the consequences of the pulmonary vascular process. Oxygen supplementation, the use of digoxin and diuretics for symptomatic heart failure, and anticoagulation all may have a role in treating primary pulmonary hypertension, although vasodilator therapy has been the main area of investigation. Screening for vasodilator responsiveness, defining a favorable vasodilator effect, predicting long-term effectiveness, and deciding who to treat have all been controversial. New approaches, such as use of high-dose calcium channel-blocking agents and continuous intravenous infusion of prostacyclin (an investigational agent), have recently been proposed. When medical therapies are exhausted, heart-lung or lung transplantation has increasingly become an option for selected patients.     

钠-葡萄糖协同转运蛋白2抑制剂：心力衰竭治疗领域的“跨界明星”

近年来钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在治疗心力衰竭（以下简称心衰）方面取得许多关键性进展，心血管结局研究开启了SGLT2i改善心血管预后的大门，DAPA-HF、EMPEROR-Reduced和SOLOIST-WHF等研究使其适应证扩展到射血分数减低的心衰；同时针对射血分数保留的心衰的临床研究也正在进行中。相信未来会有更多SGLT2i造福心衰患者的循证依据。     

心病气血辨证中证候本质探讨

中医心病气血辨证中,心气虚证、心血虚证和心脉瘀阻证是心血管系统疾病证候归属中常见的3个证候,从临床症状、现代医学研究进展及分子生物学前沿探讨3个证候外在表现和内在的物质变化基础及证候本质,实现中医心病气血辨证中证候的标准化、客观化和规范化,是循证心血管医学的根本要求和中医现代化的必由之路。     

The mobilization of autologous bone marrow stem cells in the treatment of heart failure with Chinese medicine

Heart failure(HF) is a severe heart disease.The use of autologous bone marrow stem cells (BMCs) mobilization in the treatment of HF has been a hot topic to research both in Western medicine and Chinese medicine(CM).There are many clinical trials and experiments on study of BMCs mobilization for HF therapy,including integrative medicine.The effect of BMCs mobilization is favorable for cardiac repair,while some advantages of CM support the advanced study of its application in BMCs mobilization to treat HF.In addition,with mechanisms of autologous BMCs mobilization for the treatment of HF that will be revealed in the future,especially stem cells niches,integrative medicine would play an important role in this clinical thought of therapy model gradually.Simultaneously,CM should adapt the new approaches of stem cells progresses on HF treatment as holding characteristics of itself.