基于心肌纤维化探讨慢性心力衰竭的中医药干预研究进展

Research Progress in Traditional Chinese Medicine Interventions for Chronic Heart Failure: Focus on Myocardial Fibrosis

摘要: 慢性心力衰竭(CHF)是多种心血管疾病进展至终末阶段所形成的复杂临床综合征，具有发病率高、病死率高及预后差等特点。心肌纤维化(MF)是心脏重构的重要病理基础，其主要表现为细胞外基质异常沉积及胶原代谢失衡，可导致心肌顺应性下降、心室重构加重及心功能持续恶化，是推动CHF发生发展的关键病理环节。虽然现代医学通过神经内分泌调控、抗炎及抗重构等策略在改善CHF患者症状和预后方面取得了显著进展，但对于已形成的心肌纤维化逆转作用仍相对有限。因此，探索安全、有效的抗心肌纤维化干预策略已成为CHF防治领域的重要研究方向。中医药基于整体观念和辨证论治理论，具有多成分、多靶点、多通路协同调控优势，可通过调节炎症反应、氧化应激、细胞凋亡、能量代谢及信号转导等多个环节抑制心肌纤维化进程，在改善心功能、延缓心室重构及提高患者生活质量方面展现出较大的应用潜力。大量研究表明，中药活性成分、经典经方及现代复方均能够通过调控TGF-β/Smad、PI3K/Akt、NF-κB、MAPK等信号通路发挥抗心肌纤维化作用。本文围绕CHF心肌纤维化的发病机制，系统综述中药单体及中药复方干预心肌纤维化的研究进展，以期为CHF的基础研究及临床防治提供参考。

Abstract: Chronic heart failure (CHF) is a complex clinical syndrome resulting from the progression of various cardiovascular diseases to their end-stage, characterized by high incidence, high mortality, and poor prognosis. Myocardial fibrosis (MF) is a major pathological basis of cardiac remodeling. It is primarily characterized by abnormal deposition of extracellular matrix and an imbalance in collagen metabolism, which can lead to reduced myocardial compliance, worsening ventricular remodeling, and progressive deterioration of cardiac function. It is a key pathological mechanism driving the onset and progression of CHF. Although modern medicine has made significant progress in improving the symptoms and prognosis of patients with CHF through strategies such as neuroendocrine modulation, anti-inflammatory therapy, and antiremodeling therapy, the ability to reverse established myocardial fibrosis remains relatively limited. Therefore, exploring safe and effective anti-myocardial fibrosis intervention strategies has become an important research direction in the field of CHF prevention and treatment. Based on the holistic concept and the theory of syndrome differentiation and treatment, traditional Chinese medicine (TCM) offers the advantage of synergistic regulation through multiple components, targets, and pathways. By modulating various processes—including inflammatory responses, oxidative stress, apoptosis, energy metabolism, and signal transduction—it can inhibit the progression of myocardial fibrosis and has demonstrated significant potential for improving cardiac function, delaying ventricular remodeling, and enhancing patients’ quality of life. Numerous studies have shown that the active ingredients of traditional Chinese medicine (TCM), classical TCM formulas, and modern TCM formulations can all exert anti-myocardial fibrosis effects by regulating signaling pathways such as TGF-β/Smad, PI3K/Akt, NF-κB, and MAPK. This article provides a systematic review of research progress on the use of TCM monomers and formulations to intervene in myocardial fibrosis in the context of chronic heart failure (CHF), with the aim of offering guidance for basic research and clinical prevention and treatment of CHF.