从抑制炎症反应看中医药干预冠心病的新视角
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摘要
动脉粥样硬化(AS)是冠状动脉粥样硬化性心脏病(冠心病)的病理基础。冠心病强化药物治疗后仍有较高的心血管残存风险。随着CANTOS试验的发表,基于炎症理论干预冠心病取得突破性进展,炎症可能成为冠心病新的治疗靶点。近年来,中医药在抗炎干预冠心病方面进行了积极的探索。本文总结了相关中医药研究,旨在为从"干预炎症反应"角度发挥中西医优势互补效应治疗冠心病展示新的视角。
Atherosclerosis(AS) is the pathological basis of coronary atherosclerotic heart disease(CHD). Even with intensive drug therapy, the risk of cardiovascular residual is still high. With the publication of CANTOS trial, breakthroughs have been made in the intervention of CHD based on inflammation theory. Inflammation may become a new therapeutic target for CHD. In recent years, Chinese medicine has actively explored anti-inflammatory intervention in CHD treatment. This paper summarizes the relevant research of Chinese medicine, aiming at displaying a new perspective for the treatment of CHD from "intervention of inflammation response" and giving full play to the complementary effect of advantages of traditional Chinese and Western medicine.
Atherosclerosis(AS) is the pathological basis of coronary atherosclerotic heart disease(CHD). Even with intensive drug therapy, the risk of cardiovascular residual is still high. With the publication of CANTOS trial, breakthroughs have been made in the intervention of CHD based on inflammation theory. Inflammation may become a new therapeutic target for CHD. In recent years, Chinese medicine has actively explored anti-inflammatory intervention in CHD treatment. This paper summarizes the relevant research of Chinese medicine, aiming at displaying a new perspective for the treatment of CHD from "intervention of inflammation response" and giving full play to the complementary effect of advantages of traditional Chinese and Western medicine.
引文
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[12] 李建军.炎症与动脉粥样硬化[J].中国医学前沿杂志(电子版),2011,3(5):4-6.
[13] Nissen SE,Tuzcu EM,Schoenhagen P,et al.Statin therapy,LDL cholesterol,C-reactive protein,and coronary artery disease[J].N Engl J Med,2005,352(1):29-38.
[14] Ridker PM,Cannon CP,Morrow D,et al.C-reactive protein levels and outcomes after statin therapy[J].N Engl J Med,2005,352(1):20-28.
[15] Kaptoge S,Di Angelantonio E,Lowe G,et al.C-reactive protein concentration and risk of coronary heart disease,stroke,and mortality:an individual participant meta-analysis[J].Lancet,2010,375(9709):132-140.
[16] Musunuru K,Kral BG,Blumenthal RS,et al.The use of high sensitivity assays for C-reactive protein in clinical practice[J].Nat Clin Pract Cardiovasc Med,2008,5(10):621-635.
[17] Ridker PM,Rifai N,Rose L,et al.Comparison of C reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events[J].N Engl J Med,2002,347(20):1557-1565.
[18] Koenig W.High-sensitivity C-reactive protein and atherosclerotic disease:From improved risk prediction to risk-guided therapy[J].Int J Cardiol,2013,168(6):5126-5134.
[19] Kaptoge S,Seshasai SR,Gao P,et al.Inflammatory cytokines and risk of coronary heart disease:new prospective study and updated meta-analysis[J].Eur Heart J,2014,35(9):578-589.
[20] Ridker PM.Clinical application of C-reactive protein for cardiovascular disease detection and prevention[J].Circulation,2003,107(3):363-369.
[21] Ridker PM,Danielson E,Fonseca FA,et al.Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein[J].N Engl J Med,2008,359(21):2195-2207.
[22] Ridker PM,Everett BM,Thuren T,et al.Ant-iinflammatory therapy with canakinumab for atherosclerotic disease[J].N Engl J Med,2017,377(12):1119-1131.
[23] Libby P.Interleukin-1 Beta as a target for atherosclerosis therapy:biological basis of CANTOS and beyond[J].J Am Coll Cardiol,2017,70(18):2278-2289.
[24] 陈可冀,史大卓,徐浩,等.冠心病稳定期因毒致病的辨证诊断量化标准[J].中国中西医结合杂志,2011,31(3):313-314.
[25] 文川,徐浩,黄启福,等.活血中药对ApoE基因缺陷小鼠血脂及动脉粥样硬化斑块炎症反应的影响[J].中国中西医结合杂志,2005,25(4):345-349.
[26] 文川,徐浩,黄启福,等.几种活血中药对ApoE缺陷小鼠动脉粥样硬化斑块影响的形态学研究[J].中国病理生理杂志,2005,21(8)∶864-867.
[27] 李树生,赵华月,郭志凌.穿心莲有效成分API0134预防犬冠状动脉溶栓后再闭塞实验研究[J].中国循环杂志,1999,14(1):5-6.
[28] 任钧国,邱金瑛,郝钰,等.清解宁对白细胞-血管内皮细胞黏附的影响[J],中国免疫学杂志,2003,19(4):618.
[29] 刘建和,莫观海,唐路.丹红注射液治疗冠心病心绞痛瘀血证的临床研究[J].中国医师杂志,2006,8(12):1715-1716.
[30] 林萍,任谦.红花黄色素对老年冠心病患者血脂和炎症因子影响的临床观察[J].中国医院药学杂志,2009,29(8):652-653.
[31] 刘剑刚,徐浩,董国菊,等.血府逐瘀口服液对冠心病心绞痛血瘀证病人血管内皮功能及血液流变学的影响[J].中西医结合心脑血管病杂志,2006,4(8):659-661.
[32] 郑峰,周明学,徐浩,等.活血解毒中药对稳定期冠心病患者血清炎症标记物及血脂的影响[J].中华中医药杂志,2009,24(9):1153-1157.
[33] 周明学,徐浩,陈可冀,等.活血解毒中药有效部位对ApoE基因敲除小鼠动脉粥样硬化斑块炎症反应的影响[J].中西医结合心脑血管病杂志,2007,5(12)∶1202-1205.
[34] Gao S,Liu Z,Li H,et al.Cardiovascular actions and therapeutic potential of tanshinone ⅡA[J].Atherosclerosis,2012,220(1):3-10.
[35] Anne LR,Geoffrey RH,Aleksandra N,et al.A Zebrafish Compound screen reveals modulation of neutrophil reverse migration as an anti-inflammatory mechanism[J].Sci Transl Med,2014,6(225),doi:10.1126/scitranslmed.3007672.
[36] Shang QH,Wang H,Li SM,et al.The effect of sodium tanshinone ⅡA sulfate and simvastatin on elevated serum levels of inflammatory markers in patients with coronary heart disease:a study protocol for a randomized controlled trial.Evid.Based Complement[J].Evid Based Complement Alternat Med,2013,doi:10.1155/2013/756519.
[37] Buckley DI,Fu R,Freeman M,et al.C-reactive protein as a risk factor for coronary heart disease:a systematic review and meta-analyses for the U.S.Preventive Services Task Force[J].Ann Intern Med,2009,151(7):483-495.
[38] Siming Li,Yang Jiao,Hanjay Wang,et al.Sodium tanshinone IIA sulfate adjunct therapy reduces high-sensitivity C-reactive protein level in coronary artery disease patients:a randomized controlled trial[J].Sci Rep,2017,doi:10.1038/s41598-017-16980-4.
[39] Morton AC,Rothman AM,Greenwood JP,et al.The effect of interleukin-1 receptor antagonist therapy on markers of inflammation in non-ST elevation acute coronary syndromes:the MRC-ILA Heart Study[J].Eur Heart J,2015,36(6):377-384.
[40] Nicholls SJ,Kastelein JJ,Schwartz GG,et al.Varespladib and cardiovascular events in patients with an acute coronary syndrome:the VISTA-16 randomized clinical trial[J].JAMA,2014,311(3):252-262.
[41] Padfield GJ,Din JN,Koushiappi E,et al.Cardiovascular effects of tumour necrosis factor alpha antagonism in patients with acute myocardial infarction:a first in human study[J].Heart,2013,99(18):1330-1335.
[42] White HD,Held C,Stewart R.Darapladib for preventing ischemic events in stable coronary heart disease[J].N Engl J Med,2014,370(18):1702-1711.
[43] Newby LK,Marber MS,Melloni C,et al.Losmapimod,a novel p38 mitogen-activated protein kinase inhibitor,in non-ST-segment elevation myocardial infarction:a randomised phase 2 trial[J].Lancet,2014,384(9949):1187-1195.
[2] Reiner Z,Catapano AL,De Backer G,et al.ESC/EAS Guidelines for management of dyslipidaemias:the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS)[J].Eur Heart J,2011,32(14):1769-1818.
[3] Montalescot G,Sechtem U,Achenbach S,et al.2013 ESC guidelines on the management of stable coronary artery disease[J].Eur Heart J,2013,34(38):2949-3003.
[4] Jellinger PS,Handelsman Y,Rosenblit PD,et al.American association of clinical endocrinologists and American college of endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease[J].Endocr Pract,2017,23 (4):479-497.
[5] Cannon CP,Blazing MA,Giugliano RP,et al.Ezetimibe added to statin therapy after acute coronary syndromes[J].N Engl J Med,2015,372(25):2387-2397.
[6] Sabatine MS,Giugliano RP,Keech AC,et al.Evolocumb and clinical outcomes in patients with cardiovascular disease[J].N Engl J Med,2017,376(18):1713-1722.
[7] Li JJ,Fang CH.Atheroscleritis is a more rational term for the pathological entity currently known as atherosclerosis[J].Med Hypotheses,2004,63(1):100-102.
[8] Ross R.Atherosclerosis-an inflammatory disease[J].N Engl J Med,1999,340(2):115-126.
[9] Libby P,Ridker PM,Hansson GK.Progress and challenges in translating the biology of atherosclerosis[J].Nature,2011,473 (7347):317-325.
[10] Ridker PM,JUPITER Study Group.Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sensitive C-reactive protein:rationale and design of the JUPITOR trial[J].Circulation,2003,108(19):2292-2297.
[11] Li JJ,Li YS,Fang CH,et al.Effects of simvastatin within two weeks on anti-inflammatory cytokine interleukin-10 in patients with unstable angina[J].Heart,2006,92(4):529-530.
[12] 李建军.炎症与动脉粥样硬化[J].中国医学前沿杂志(电子版),2011,3(5):4-6.
[13] Nissen SE,Tuzcu EM,Schoenhagen P,et al.Statin therapy,LDL cholesterol,C-reactive protein,and coronary artery disease[J].N Engl J Med,2005,352(1):29-38.
[14] Ridker PM,Cannon CP,Morrow D,et al.C-reactive protein levels and outcomes after statin therapy[J].N Engl J Med,2005,352(1):20-28.
[15] Kaptoge S,Di Angelantonio E,Lowe G,et al.C-reactive protein concentration and risk of coronary heart disease,stroke,and mortality:an individual participant meta-analysis[J].Lancet,2010,375(9709):132-140.
[16] Musunuru K,Kral BG,Blumenthal RS,et al.The use of high sensitivity assays for C-reactive protein in clinical practice[J].Nat Clin Pract Cardiovasc Med,2008,5(10):621-635.
[17] Ridker PM,Rifai N,Rose L,et al.Comparison of C reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events[J].N Engl J Med,2002,347(20):1557-1565.
[18] Koenig W.High-sensitivity C-reactive protein and atherosclerotic disease:From improved risk prediction to risk-guided therapy[J].Int J Cardiol,2013,168(6):5126-5134.
[19] Kaptoge S,Seshasai SR,Gao P,et al.Inflammatory cytokines and risk of coronary heart disease:new prospective study and updated meta-analysis[J].Eur Heart J,2014,35(9):578-589.
[20] Ridker PM.Clinical application of C-reactive protein for cardiovascular disease detection and prevention[J].Circulation,2003,107(3):363-369.
[21] Ridker PM,Danielson E,Fonseca FA,et al.Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein[J].N Engl J Med,2008,359(21):2195-2207.
[22] Ridker PM,Everett BM,Thuren T,et al.Ant-iinflammatory therapy with canakinumab for atherosclerotic disease[J].N Engl J Med,2017,377(12):1119-1131.
[23] Libby P.Interleukin-1 Beta as a target for atherosclerosis therapy:biological basis of CANTOS and beyond[J].J Am Coll Cardiol,2017,70(18):2278-2289.
[24] 陈可冀,史大卓,徐浩,等.冠心病稳定期因毒致病的辨证诊断量化标准[J].中国中西医结合杂志,2011,31(3):313-314.
[25] 文川,徐浩,黄启福,等.活血中药对ApoE基因缺陷小鼠血脂及动脉粥样硬化斑块炎症反应的影响[J].中国中西医结合杂志,2005,25(4):345-349.
[26] 文川,徐浩,黄启福,等.几种活血中药对ApoE缺陷小鼠动脉粥样硬化斑块影响的形态学研究[J].中国病理生理杂志,2005,21(8)∶864-867.
[27] 李树生,赵华月,郭志凌.穿心莲有效成分API0134预防犬冠状动脉溶栓后再闭塞实验研究[J].中国循环杂志,1999,14(1):5-6.
[28] 任钧国,邱金瑛,郝钰,等.清解宁对白细胞-血管内皮细胞黏附的影响[J],中国免疫学杂志,2003,19(4):618.
[29] 刘建和,莫观海,唐路.丹红注射液治疗冠心病心绞痛瘀血证的临床研究[J].中国医师杂志,2006,8(12):1715-1716.
[30] 林萍,任谦.红花黄色素对老年冠心病患者血脂和炎症因子影响的临床观察[J].中国医院药学杂志,2009,29(8):652-653.
[31] 刘剑刚,徐浩,董国菊,等.血府逐瘀口服液对冠心病心绞痛血瘀证病人血管内皮功能及血液流变学的影响[J].中西医结合心脑血管病杂志,2006,4(8):659-661.
[32] 郑峰,周明学,徐浩,等.活血解毒中药对稳定期冠心病患者血清炎症标记物及血脂的影响[J].中华中医药杂志,2009,24(9):1153-1157.
[33] 周明学,徐浩,陈可冀,等.活血解毒中药有效部位对ApoE基因敲除小鼠动脉粥样硬化斑块炎症反应的影响[J].中西医结合心脑血管病杂志,2007,5(12)∶1202-1205.
[34] Gao S,Liu Z,Li H,et al.Cardiovascular actions and therapeutic potential of tanshinone ⅡA[J].Atherosclerosis,2012,220(1):3-10.
[35] Anne LR,Geoffrey RH,Aleksandra N,et al.A Zebrafish Compound screen reveals modulation of neutrophil reverse migration as an anti-inflammatory mechanism[J].Sci Transl Med,2014,6(225),doi:10.1126/scitranslmed.3007672.
[36] Shang QH,Wang H,Li SM,et al.The effect of sodium tanshinone ⅡA sulfate and simvastatin on elevated serum levels of inflammatory markers in patients with coronary heart disease:a study protocol for a randomized controlled trial.Evid.Based Complement[J].Evid Based Complement Alternat Med,2013,doi:10.1155/2013/756519.
[37] Buckley DI,Fu R,Freeman M,et al.C-reactive protein as a risk factor for coronary heart disease:a systematic review and meta-analyses for the U.S.Preventive Services Task Force[J].Ann Intern Med,2009,151(7):483-495.
[38] Siming Li,Yang Jiao,Hanjay Wang,et al.Sodium tanshinone IIA sulfate adjunct therapy reduces high-sensitivity C-reactive protein level in coronary artery disease patients:a randomized controlled trial[J].Sci Rep,2017,doi:10.1038/s41598-017-16980-4.
[39] Morton AC,Rothman AM,Greenwood JP,et al.The effect of interleukin-1 receptor antagonist therapy on markers of inflammation in non-ST elevation acute coronary syndromes:the MRC-ILA Heart Study[J].Eur Heart J,2015,36(6):377-384.
[40] Nicholls SJ,Kastelein JJ,Schwartz GG,et al.Varespladib and cardiovascular events in patients with an acute coronary syndrome:the VISTA-16 randomized clinical trial[J].JAMA,2014,311(3):252-262.
[41] Padfield GJ,Din JN,Koushiappi E,et al.Cardiovascular effects of tumour necrosis factor alpha antagonism in patients with acute myocardial infarction:a first in human study[J].Heart,2013,99(18):1330-1335.
[42] White HD,Held C,Stewart R.Darapladib for preventing ischemic events in stable coronary heart disease[J].N Engl J Med,2014,370(18):1702-1711.
[43] Newby LK,Marber MS,Melloni C,et al.Losmapimod,a novel p38 mitogen-activated protein kinase inhibitor,in non-ST-segment elevation myocardial infarction:a randomised phase 2 trial[J].Lancet,2014,384(9949):1187-1195.