基于PGC-1α/SIRT1通路探讨中医药治疗慢性心力衰竭的研究进展

Research Progress on the Treatment of Chronic Heart Failure with Traditional Chinese Medicine Based on the PGC-1α/SIRT1 Pathway

摘要: 慢性心力衰竭(CHF)的核心病理环节之一是心肌能量代谢障碍。过氧化物酶体增殖物激活受体γ共激活因子1α/沉默信息调节因子1 (PGC-1α/SIRT1)信号通路作为调控细胞能量稳态和线粒体功能的“中枢开关”，在该过程中扮演关键角色。该通路能感知心脏能量需求，并通过驱动线粒体生物合成、优化燃料代谢和增强抗氧化防御三大程序来精密调节能量供给。在CHF的病理状态下，持续的应激导致NAD⁺耗竭、SIRT1活性抑制及PGC-1α功能下调，进而引发线粒体功能障碍和“能量饥饿”的恶性循环。最新研究表明，恢复该通路功能是重要的治疗新靶点。中医药能够通过多靶点、多层次调控PGC-1α/SIRT1通路，改善线粒体功能，纠正心肌能量代谢紊乱，这为中西医结合防治CHF提供了创新的理论依据和潜在策略。

Abstract: One of the core pathological mechanisms in chronic heart failure (CHF) is myocardial energy metabolism disorder. The peroxisome proliferator-activated receptor gamma coactivator 1α/silent information regulator 1 (PGC-1α/SIRT1) signaling pathway, functioning as a “central switch” regulating cellular energy homeostasis and mitochondrial function, plays a key role in this process. This pathway senses cardiac energy demands and precisely regulates energy supply by driving three major programs: mitochondrial biogenesis, optimizing fuel metabolism, and enhancing antioxidant defenses. Under the pathological conditions of CHF, persistent stress leads to NAD⁺ depletion, inhibition of SIRT1 activity, and downregulation of PGC-1α function, thereby triggering a vicious cycle of mitochondrial dysfunction and “energy starvation”. Recent studies indicate that restoring the function of this pathway represents an important novel therapeutic target. Traditional Chinese Medicine (TCM) can regulate the PGC-1α/SIRT1 pathway through multi-target and multi-level approaches, improve mitochondrial function, and correct myocardial energy metabolism disturbances. This provides innovative theoretical foundations and potential strategies for the integrated Chinese and Western medicine approach to preventing and treating CHF.