文献类型：期刊文献

中文题名：缺血性心肌病的病理生理机制及中西医治疗研究进展

英文题名：Pathophysiological mechanisms of ischemic cardiomyopathy and its research progress in the traditional Chinese medicine and Western medicine

作者：李菊红[1];李伟霞[1];蒙占权[1]

第一作者：李菊红

机构：[1]甘肃中医药大学附属医院,甘肃兰州730000

第一机构：甘肃中医药大学第二附属医院

年份：2026

卷号：18

期号：8

起止页码：133

中文期刊名：中医临床研究

外文期刊名：Clinical Journal Of Chinese Medicine

语种：中文

中文关键词：缺血性心肌病;病理生理机制;中西医治疗;研究进展

外文关键词：Ischemic cardiomyopathy;Pathophysiological mechanisms;Integrated traditional Chinese and Western medicine therapy;Research progress

摘要：近年来,缺血性心肌病所致心力衰竭的发病率与病死率持续攀升,已成为全球范围内严重威胁人类生命安全与生活质量的心血管疾病,给临床诊疗带来巨大挑战,深入阐明缺血性心肌病的病理生理机制并探索有效治疗策略对改善患者预后具有重要意义。文章系统梳理了缺血性心肌病以心肌重塑为核心的病理生理机制。心肌重塑作为疾病进展的关键环节,涉及多种复杂机制,包括冬眠心肌、心肌细胞凋亡、神经内分泌激活及炎性反应等关键环节,这些机制相互交织,形成恶性循环,共同促使缺血性心肌病向心力衰竭进展。在治疗方面,文章全面综述了中西医治疗的最新进展。中医强调辨证论治,立足“本虚标实”病机,以益气温阳、活血通络、利水消肿为主要治则,根据不同证型灵活施治,在改善症状、提高生活质量方面体现出独到优势。西医治疗则呈现多元化趋势,包括神经内分泌抑制药物;经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)与冠状动脉旁路移植术(coronary artery bypass grafting,CABG)等血运重建手段;心脏再同步治疗、心室辅助装置等器械治疗;以及干细胞移植、心肌能量代谢调节等新兴生物与代谢疗法。此外,无创机械通气(non-invasive positive pressure ventilation,NIPPV)在急性左心衰竭救治中也发挥重要作用。文章系统总结缺血性心肌病的病理机制与治疗进展,旨在为临床诊断与治疗提供更全面的理论依据与实践参考。中西医结合、个体化综合治疗是当前的重要方向,未来仍需进一步探索疾病机制、优化治疗策略,以改善缺血性心肌病患者的长期预后与生活质量。
In recent years,the incidence rate and mortality rate of heart failure caused by ischemic cardiomyopathy(ICM)have continued to rise,making it a cardiovascular disease that seriously threatens human life safety and quality of life globally.This has posed signiffcant challenges to clinical diagnosis and treatment.Elucidating the pathophysiological mechanisms of ICM and exploring effective treatment strategies are crucial for improving patient outcomes.The article systematically reviews the pathophysiological mechanisms of ICM,with myocardial remodeling as the core.Myocardial remodeling,as a key link in disease progression,involves multiple complex mechanisms:including hibernating myocardium,cardiomyocyte apoptosis,neuroendocrine activation,and inffammatory response.These mechanisms are intertwined,forming a vicious cycle that collectively drives the progression of ICM to heart failure.In terms of treatment,this article comprehensively summarizes the latest advancements in both traditional Chinese medicine(TCM)and Western medicine.TCM emphasizes syndrome differentiation and treatment based on the pathogenesis of“deffciency in root cause and excess in branch”.The main therapeutic principles include nourishing Qi(气)and warming Yang(阳),promoting blood circulation and removing collateral obstruction,and promoting diuresis and reducing swelling.Flexible treatment according to different syndrome types demonstrates unique advantages in improving symptoms and enhancing quality of life.Western medicine treatment exhibits a diversiffed trend,including neuroendocrine suppression drugs;revascularization methods such as percutaneous coronary intervention and coronary artery bypass grafting;device therapies such as cardiac resynchronization therapy and ventricular assist devices;and emerging biological and metabolic therapies such as stem cell transplantation and myocardial energy metabolism regulation.Additionally,noninvasive mechanical ventilation plays a signiffcant role in the treatment of acute left heart failure.By systematically summarizing the pathological mechanisms and treatment advancements of ICM,the article aims to provide a more comprehensive theoretical basis and practical reference for clinical diagnosis and treatment.The integration of TCM and Western medicine,along with individualized comprehensive treatment,is an important direction at present.Further exploration of disease mechanisms and optimization of treatment strategies are still needed in the future,with the ultimate goal of improving the long-term prognosis and quality of life for ICM patients.