基于心与小肠相表里探讨生脉冠心方调节肠道菌群治疗冠心病的机制浅析
Exploring the Mechanism of Shengmai Guanxin Formula Regulating Intestinal Microbiota in the Treatment of Coronary Heart Disease Based on the Relationship between Heart and Small Intestine
摘要: 冠心病是患病率高、危害性强、对人类健康造成极大威胁的临床最常见的心血管疾病之一。近年来，肠道菌群及其代谢产物与冠心病的研究逐渐深入。本文基于心与小肠相表里的中医基础理论，从心与小肠的关系对冠心病进行辩证。通过发掘云南罗氏调气理血学术流派治疗冠心病的经验方——生脉冠心方的药物单体、药对、合方对肠道菌群及其代谢产物的研究进展，为本方通过影响肠道菌群治疗冠心病提供理论依据，为继承发展名医经验提供一份助力。
Abstract: Coronary heart disease is one of the most common clinical cardiovascular diseases with high incidence, strong harm, and great threat to human health. In recent years, research on the relationship between gut microbiota and its metabolites with coronary heart disease has gradually deepened. This article is based on the basic theory of traditional Chinese medicine that the heart and small intestine are interrelated, and dialectically treats coronary heart disease from the relationship between the heart and small intestine. By exploring the experience of the Yunnan Roche Qi regulating and Blood regulating academic school in treating coronary heart disease—the research progress of the drug monomers, drug pairs, and combination formulas of Shengmai Guanxin Formula on gut microbiota and its metabolites, this study provides a theoretical basis for our formula to treat coronary heart disease by influencing gut microbiota, and provides assistance for inheriting and developing the experience of famous doctors.
文章引用：张志琴. 基于心与小肠相表里探讨生脉冠心方调节肠道菌群治疗冠心病的机制浅析[J]. 临床医学进展, 2025, 15(4): 2362-2369. https://doi.org/10.12677/acm.2025.1541189

参考文献

[1] 中国心血管健康与疾病报告2023概要[J]. 中国循环杂志, 2024, 39(7): 625-660.
[2] 国家卫生健康委员会. 中国卫生健康统计年鉴[M]. 北京: 中国协和医科大学出版社, 2022.
[3] 舒妍妍, 林旭红. 肠道微生物在心血管疾病中的作用及机制[J/OL]. 中山大学学报(医学科学版), 2024, 45(6): 994-1005.
[4] Kamo, T., Akazawa, H., Suzuki, J. and Komuro, I. (2017) Novel Concept of a Heart-Gut Axis in the Pathophysiology of Heart Failure. Korean Circulation Journal, 47, 663-669. [Google Scholar] [CrossRef] [PubMed]
[5] 河北医学院. 灵枢经校译[M]. 北京: 人民卫生出版社, 1982.
[6] 素问[M]. 穆俊霞, 王平, 校. 北京: 中国医药科技出版社, 2011.
[7] (汉)张仲景. 金匮要略[M]. 于志贤, 张智基, 校. 北京: 中医古籍出版社, 1997.
[8] 张玲, 陈雪梅. 应用瑞舒伐他汀降血脂后的不同疗效人群肠道微生态菌群差异分析[J]. 心脑血管病防治, 2019, 19(5): 408-410+414.
[9] 牟菲, 赵娟娟, 纪泽敏, 等. 基于16SrDNA高通量测序技术挖掘影响高脂血症的核心菌群[J]. 中国药物与临床, 2020, 20(5): 701-704.
[10] Kitai, T. and Tang, W.H.W. (2018) Gut microbiota in Cardiovascular Disease and Heart Failure. Clinical Science, 132, 85-91. [Google Scholar] [CrossRef] [PubMed]
[11] Tang, W.H.W., Kitai, T. and Hazen, S.L. (2017) Gut Microbiota in Cardiovascular Health and Disease. Circulation Research, 120, 1183-1196. [Google Scholar] [CrossRef] [PubMed]
[12] Spychala, M.S., Venna, V.R., Jandzinski, M., Doran, S.J., Durgan, D.J., Ganesh, B.P., et al. (2018) Age-Related Changes in the Gut Microbiota Influence Systemic Inflammation and Stroke Outcome. Annals of Neurology, 84, 23-36. [Google Scholar] [CrossRef] [PubMed]
[13] Luedde, M., Winkler, T., Heinsen, F., Rühlemann, M.C., Spehlmann, M.E., Bajrovic, A., et al. (2017) Heart Failure Is Associated with Depletion of Core Intestinal Microbiota. ESC Heart Failure, 4, 282-290. [Google Scholar] [CrossRef] [PubMed]
[14] Shimizu, M., Hashiguchi, M., Shiga, T., Tamura, H. and Mochizuki, M. (2015) Meta-Analysis: Effects of Probiotic Supplementation on Lipid Profiles in Normal to Mildly Hypercholesterolemic Individuals. PLOS ONE, 10, e0139795. [Google Scholar] [CrossRef] [PubMed]
[15] Tsai, C., Lu, H., Chou, Y., Liu, P., Chen, H., Huang, M., et al. (2022) Gut Microbial Signatures for Glycemic Responses of GLP-1 Receptor Agonists in Type 2 Diabetic Patients: A Pilot Study. Frontiers in Endocrinology, 12, Article 814770. [Google Scholar] [CrossRef] [PubMed]
[16] Le Chatelier, E., Nielsen, T., Qin, J., Prifti, E., Hildebrand, F., Falony, G., et al. (2013) Richness of Human Gut Microbiome Correlates with Metabolic Markers. Nature, 500, 541-546. [Google Scholar] [CrossRef] [PubMed]
[17] Dentin, R., Tomas-Cobos, L., Foufelle, F., Leopold, J., Girard, J., Postic, C., et al. (2012) Glucose 6-Phosphate, Rather than Xylulose 5-Phosphate, Is Required for the Activation of Chrebp in Response to Glucose in the Liver. Journal of Hepatology, 56, 199-209. [Google Scholar] [CrossRef] [PubMed]
[18] 吴红. 血浆TMAO水平与冠心病严重程度相关性分析及依折麦布对血浆TMAO水平影响的研究[D]: [硕士学位论文]. 上海: 上海交通大学, 2016.
[19] Yao, M., Liao, P., Zhao, X. and Wang, L. (2020) Trimethylamine-n-Oxide Has Prognostic Value in Coronary Heart Disease: A Meta-Analysis and Dose-Response Analysis. BMC Cardiovascular Disorders, 20, Article No. 7. [Google Scholar] [CrossRef] [PubMed]
[20] Ma, G., Pan, B., Chen, Y., Guo, C., Zhao, M., Zheng, L., et al. (2017) Trimethylamine N-Oxide in Atherogenesis: Impairing Endothelial Self-Repair Capacity and Enhancing Monocyte Adhesion. Bioscience Reports, 37, BSR20160244. [Google Scholar] [CrossRef] [PubMed]
[21] Spirig, R., Tsui, J. and Shaw, S. (2012) The Emerging Role of TLR and Innate Immunity in Cardiovascular Disease. Cardiology Research and Practice, 2012, 1-12. [Google Scholar] [CrossRef] [PubMed]
[22] Tang, W.H.W., Li, D.Y. and Hazen, S.L. (2018) Dietary Metabolism, the Gut Microbiome, and Heart Failure. Nature Reviews Cardiology, 16, 137-154. [Google Scholar] [CrossRef] [PubMed]
[23] 王玫, 杜小琴, 侯静雯, 等. 心力衰竭患者血清SCFA、MAO表达与肠道菌群及代谢综合征的相关性研究[J]. 标记免疫分析与临床, 2022, 29(4): 595-603.
[24] Zhu, W., Gregory, J.C., Org, E., Buffa, J.A., Gupta, N., Wang, Z., et al. (2016) Gut Microbial Metabolite TMAO Enhances Platelet Hyperreactivity and Thrombosis Risk. Cell, 165, 111-124. [Google Scholar] [CrossRef] [PubMed]
[25] Altmann, S.W., Davis, H.R., Zhu, L., Yao, X., Hoos, L.M., Tetzloff, G., et al. (2004) Niemann-Pick C1 Like 1 Protein Is Critical for Intestinal Cholesterol Absorption. Science, 303, 1201-1204. [Google Scholar] [CrossRef] [PubMed]
[26] Wang, Z., Klipfell, E., Bennett, B.J., Koeth, R., Levison, B.S., DuGar, B., et al. (2011) Gut Flora Metabolism of Phosphatidylcholine Promotes Cardiovascular Disease. Nature, 472, 57-63. [Google Scholar] [CrossRef] [PubMed]
[27] Zhang, Y., Wang, Y., Ke, B. and Du, J. (2021) TMAO: How Gut Microbiota Contributes to Heart Failure. Translational Research, 228, 109-125. [Google Scholar] [CrossRef] [PubMed]
[28] 罗铨, 李晓. 罗氏调气理血学术流派临床经验荟萃[M]. 昆明: 云南科技出版社, 2019.
[29] 阎洪臣, 张焱. 内难经选释[M]. 北京: 中国中医药出版社, 2019.
[30] 杨光, 何浩强, 陈光, 等. 中药调节肠道菌群干预冠心病及其危险因素的研究进展[J]. 中国中药杂志, 2020, 45(1): 29-36.
[31] 张春丽, 徐国波, 刘俊, 等. 太子参化学成分研究[J]. 天然产物研究与开发, 2017, 29(7): 1132-1135+1164.
[32] 褚书豪, 汪小彩, 冯良. 太子参化学成分及其药理作用研究进展[J]. 光明中医, 2016, 31(7): 1047-1048.
[33] 汪剑飞. 太子参药理研究新进展[J]. 实用药物与临床, 2013, 16(4): 333-334.
[34] 黎明. 太子参的药理研究及临床应用[J]. 亚太传统医药, 2010, 6(6): 35-36.
[35] 毕倩. 基于肠道微生态调节的制何首乌干预胰岛素抵抗作用及机制研究[D]: [硕士学位论文]. 昆明: 云南中医学院, 2018.
[36] 林红强, 杨娜, 王涵, 等. 黄芪的化学成分、药理活性及临床应用研究进展[J]. 世界最新医学信息文摘, 2018, 18(38): 45-49.
[37] 张瑜. 中药黄芪的心血管药理作用及临床应用研究[J]. 世界最新医学信息文摘, 2017, 17(74): 47.
[38] 何旭云, 贺姣姣, 郑宁宁, 等. 黄芪多糖对肥胖小鼠的减肥作用与调节肠道菌群的关系研究[J]. 世界中医药, 2016, 11(11): 2379-2384.
[39] 刘明, 宋凤媛, 李方彤, 等. 天然产物与肠道微生物相互作用的研究进展[J]. 应用化学, 2021, 38(4): 367-375.
[40] 赵文莉, 赵晔, Tseng, Y. 黄精药理作用研究进展[J]. 中草药, 2018, 49(18): 4439-4445.
[41] 张智, 包智影, 孙家佳, 等. 发酵黄精多糖对肥胖小鼠肠道菌群的影响[J]. 华南理工大学学报(自然科学版), 2021, 49(3): 95-105+113.
[42] Gu, W., Wang, Y., Zeng, L., Dong, J., Bi, Q., Yang, X., et al. (2020) Polysaccharides from Polygonatum Kingianum Improve Glucose and Lipid Metabolism in Rats Fed a High Fat Diet. Biomedicine & Pharmacotherapy, 125, Article 109910. [Google Scholar] [CrossRef] [PubMed]
[43] 韩炜. 川芎的化学成分与药理作用研究进展[J]. 中国现代中药, 2017, 19(9): 1341-1349.
[44] 罗仁书, 何治勇. 川芎有效成分药理作用的研究进展[J]. 中国医院用药评价与分析, 2018, 18(9): 1294-1296.
[45] 茅丹, 李芳, 马群, 等. 盐酸川芎嗪经眼部给药后大鼠体内药物动力学研究[J]. 辽宁中医药大学学报, 2018, 20(12 ): 55-58.
[46] Lv, X., Chen, M., Huang, Z., Guo, W., Ai, L., Bai, W., et al. (2021) Potential Mechanisms Underlying the Ameliorative Effect of Lactobacillus Paracasei FZU103 on the Lipid Metabolism in Hyperlipidemic Mice Fed a High-Fat Diet. Food Research International, 139, Article 109956. [Google Scholar] [CrossRef] [PubMed]
[47] 陆小华, 马骁, 王建, 等. 赤芍的化学成分和药理作用研究进展[J]. 中草药, 2015, 46(4): 595-602.
[48] 莫玉兰. 赤芍总苷药理作用研究概况[J]. 光明中医, 2009, 24(4): 782-784.
[49] 郭双, 蔡小利, 胡宗福, 等. 赤芍黄柏制剂对致病性大肠杆菌人工感染雏鸡的肠道菌群多样性的影响[J]. 畜牧兽医学报, 2021, 52(8): 2265-2274.
[50] 代晓光, 苏长兰. 丹参化学成分及药理研究进展[J]. 中医药信息, 2018, 35(4): 126-129.
[51] 朱淑珍. 丹参素的药理活性与药物动力学研究进展[J]. 中西医结合心血管病电子杂志, 2018, 6(11): 60-61.
[52] Hu, Y., Sun, J., Wang, T., Wang, H., Zhao, C., Wang, W., et al. (2021) Compound Danshen Dripping Pill Inhibits High Altitude-Induced Hypoxic Damage by Suppressing Oxidative Stress and Inflammatory Responses. Pharmaceutical Biology, 59, 1583-1591. [Google Scholar] [CrossRef] [PubMed]
[53] Zhang, Y., Wang, J., Liu, Y., Chen, Y., Yang, X. and Duan, L. (2021) The Synergistic Effects of Astragalus Mongholicus and Salvia Miltiorrhiza on Coronary Heart Disease Identified by Network Pharmacology and Experiment. Drug Design, Development and Therapy, 15, 4053-4069. [Google Scholar] [CrossRef] [PubMed]
[54] Ai, Z., Zhang, X., Ge, W., Zhong, Y., Wang, H., Zuo, Z., et al. (2022) Salvia miltiorrhiza Extract May Exert an Anti-Obesity Effect in Rats with High-Fat Diet-Induced Obesity by Modulating Gut Microbiome and Lipid Metabolism. World Journal of Gastroenterology, 28, 6131-6156. [Google Scholar] [CrossRef] [PubMed]
[55] 史志远. 三七用于冠心病治疗的药理分析[J]. 世界最新医学信息文摘, 2018(18): 146+155.
[56] 谭梦晨, 刘文娥, 马露, 等. 三七复方成分通过调节炎症反应和肠道菌群减轻宫腔粘连大鼠子宫内膜纤维化[J]. 中国病理生理杂志, 2024, 40(11): 2135-2144.
[57] 曲彤, 耿飞飞, 李宁, 等. 酸枣仁的化学成分、药理作用和临床应用研究进展[J]. 药学前沿, 2024, 28(9): 98-108.
[58] 崔小芳. 酸枣仁总皂苷的肠道菌群体外代谢转化研究[D]: [硕士学位论文]. 晋中: 山西中医药大学, 2020.
[59] 国家卫生计生委合理用药专家委员会, 中国药师协会. 冠心病合理用药指南(第2版)[J]. 中国医学前沿杂志, 2018, 10(6): 1-130.
[60] 苗兰, 彭勍, 孙明谦, 等. 祛瘀化痰通脉方对高脂血症金黄地鼠肠道菌群的调节作用[J]. 中国实验方剂学杂志, 2022, 28 (1): 109-120.
[61] 张雅心, 江伟豪, 陈奕澔, 等. 从心论治方对Apo E-/-小鼠血脂和肠道菌群的影响[J]. 中药新药与临床药理, 2020, 31(8): 892-899.
[62] Liang, Y., Zhang, Y., Deng, Y., Liang, S., He, Y., Chen, Y., et al. (2018) Chaihu‐Shugan‐San Decoction Modulates Intestinal Microbe Dysbiosis and Alleviates Chronic Metabolic Inflammation in NAFLD Rats via the NLRP3 Inflammasome Pathway. Evidence-Based Complementary and Alternative Medicine, 8, Article 27820. [Google Scholar] [CrossRef] [PubMed]
[63] 张雨婷, 杨宇峰. 基于“阴火理论”探讨肠道内环境稳态对2型糖尿病影响机制[J]. 辽宁中医药大学学报, 2022, 24(2): 209-213.
[64] 冯文林, 伍海涛. 基于《黄帝内经》“甘入脾”理论指导下健脾中药的多糖成分调控IBSD肠道菌群的机制研究[J]. 辽宁中医杂志, 2019, 46(1): 127-129.
[65] 卢冬雪, 陈昺伃, 刘峰, 等. 基于肠道菌群论苦寒药的临床应用[J]. 南京中医药大学学报, 2020, 36(4): 567-572.
[66] 袁一顺, 刘中勇, 刘言薇, 等. 中药调节肠道菌群的物质基础及用药规律研究[J]. 中西医结合心脑血管病杂志, 2024, 22(16): 2889-2895.
[67] 生脉冠心方治疗冠心病[J]. 医学文选, 1990(4): 13-15.
[68] 丘瑞香, 罗致强. 生脉冠心方治疗冠心病临床探讨——附213例病例报告[J]. 新中医, 1989, 21(7): 16-18.
[69] 余海英. 生脉冠心方治疗气虚血瘀型慢性稳定性心绞痛的临床观察[D]: [硕士学位论文]. 昆明: 云南中医药大学, 2019.

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