Exploring the pathogenesis and treatment of vascular endothelial injury in coronary heart disease based on the toxic pathogen theory

ZHONG Senjie; LI Jing; CHEN Jie; WANG Lingjun; CHEN Zixin; WU Hui; FANG Hongcheng; XIAN Shaoxiang

doi:10.3969/j.issn.1006-2157.2023.07.016

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Exploring the pathogenesis and treatment of vascular endothelial injury in coronary heart disease based on the toxic pathogen theory

Clinical Studies | 更新时间：2023-08-07

- Exploring the pathogenesis and treatment of vascular endothelial injury in coronary heart disease based on the toxic pathogen theory
- Journal of Beijing University of Traditional Chinese Medicine Vol. 46, Issue 7, Pages: 985-991(2023)
- 作者机构：
  
  1.广州中医药大学第一附属医院　广州　510405
  2.广州中医药大学岭南医学研究中心
  3.广州中医药大学博士后科研流动站
  4.湖南中医药大学中医诊断研究所
  5.深圳市中西医结合医院
- 作者简介：
  
  Prof.XIAN Shaoxiang, Ph.D., Chief Physician, Doctoral supervisor. The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No 16, Airport Road, Baiyun District, Guangzhou 510405. E-mail: zhongyfy@126.com
- 基金信息：
  
  National Natural Science Foundation of China(82174316;82004293;81973777);Basic and Applied Research of Guangzhou Municipal University Joint Funding Project(202201020342);Guangzhou Science and Technology Bureau Key Project in 2022(2060404);Shenzhen Municipal Health Commission Project for Prestigious Doctors, Hospitals and Clinics(SZZYSM202106006)
- DOI：10.3969/j.issn.1006-2157.2023.07.016
  CLC： R259.414
- Received：03 February 2023，
  
  Published Online：25 May 2023，
  
  Published：30 July 2023
- 稿件说明：
移动端阅览
ZHONG Senjie, LI Jing, CHEN Jie, et al. Exploring the pathogenesis and treatment of vascular endothelial injury in coronary heart disease based on the toxic pathogen theory[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(7): 985-991.
DOI：

ZHONG Senjie, LI Jing, CHEN Jie, et al. Exploring the pathogenesis and treatment of vascular endothelial injury in coronary heart disease based on the toxic pathogen theory[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(7): 985-991. DOI： 10.3969/j.issn.1006-2157.2023.07.016.

摘要

多种危险因素导致的血管内皮损伤状态是冠心病发生发展的病理基础，持续存在于疾病的全过程。毒邪学说立足毒邪的致病特性，结合冠心病病理演变规律，认为毒邪为血管内皮损伤的关键因素，其中又蕴含着从潜毒至显毒的状态演变，是以心脉为病位的复杂动态过程。慢性稳定期以潜毒伏脉为核心病机，毒之因素逐渐积聚并潜藏于脉内，与危险因素及相关病理因子的异常表达相对应，慢性隐匿损伤血管内皮是疾病的启动因素；急性发作期以显毒损脉为核心病机，毒邪顽恶难解、腐脉伤络，代表以易损斑块为病理基础的发作性心血管事件，血管内皮急性损伤是疾病的恶化标志。依据毒邪的显现发作与否，冠心病不同阶段应侧重不同治法。冠心病稳定期治以扶正祛邪，清除血脉中的病理因子，消除毒邪形成之源；冠心病不稳定期治以攻邪解毒，祛除有形病邪，缓解病理实体对血脉的实质损伤。研究发现，毒邪学说指导下的中药治疗，展现出良好的血管内皮保护功效，从而改善冠心病相关症状。

Abstract

The state of vascular endothelial damage caused by multiple risk factors is the pathological basis for the development of coronary heart disease (CHD). It persists throughout the course of disease. Toxic pathogen theory

which is based on the pathogenic characteristics of toxic pathogen

combined with the pathological progress of CHD

states that toxic pathogen is the key factor of vascular endothelial injury

ranging from potential toxic pathogens to apparent toxic pathogens. This is a complex dynamic process in which the heart vessel is the location of disease. In the chronic stable phase

"potential toxic pathogen hiding in the blood vessel" is the core pathogenic factor. Specifically

toxic factors gradually accumulate and hide in the blood vessel

corresponding to the abnormal expression of risk factors and related pathological factors

which chronically and insidiously damage the vascular endothelium and are the initiating factors of the disease. In the acute attack phase

apparent toxic pathogen damaging the blood vessel is the core pathogenesis factor. Specifically

the toxic pathogen is persistent and difficult to resolve and will damage the blood vessel

representing an episodic cardiovascular event based on the pathology of vulnerable plaques

and acute toxic pathogen can damage the vascular endothelium

which is a sign of deterioration of the disease. According to the appearance of toxic pathogen

different treatments should be given in different stages of CHD. The treatment of CHD in the stable stage focuses on reinforcing healthy qi to eliminate pathogenic factors to help to eliminate the pathological factors in the blood vessels and eliminate the source of the formation of toxic pathogen. The treatment of CHD in the unstable stage focuses on attacking and removing toxins to eliminate the tangible pathological evil and relieve the substantial damage to the blood vessels by the pathological entity. It has been found that herbal treatments under the guidance of toxic pathogen theory have shown great endothelial protective effects

thus improving CHD.

关键词

Keywords

references

LLOYD-JONES DM , BRAUN LT , NDUMELE CE , et al . Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology [J/OL]. Circulation , 2019 , 139 ( 25 ): e1162 - e1177 [ 2023-01-20 ]. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000638 .

KHAFAJI H , CARR CS , SUWAIDI AJ . Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome [J]. Vasc Health Risk Manag , 2005 , 1 ( 3 ): 183 - 198 .

王聪霞，范雅洁 . 冠心病血管内皮损伤与血管重构的研究进展 [J]. 西安交通大学学报(医学版) , 2018 , 39 ( 4 ): 455 - 458 .

赵昌林 . 论毒邪病因学说 [J]. 中华中医药杂志， 2010 , 25 ( 1 ): 80 - 83 .

王新东 . 冠心病伏毒损脉病机理论与应用浅析 [J]. 南京中医药大学学报， 2015 , 31 ( 1 ): 8 - 12 .

黄淑敏，王梓仪，张倩，等 . 基于“毒邪学说”探讨炎症在慢性心力衰竭发展中的作用 [J]. 中国实验方剂学杂志， 2022 , 28 ( 18 ): 198 - 204 .

刘勇，姚斌，刘超峰 . 冠心病心绞痛痰瘀毒互结证病机研究进展 [J]. 中医杂志， 2019 , 60 ( 21 ): 1875 - 1879 .

胡芳，沈金峰，刘中勇 . 基于“伏毒学说”探讨冠心病的病因病机 [J]. 时珍国医国药， 2018 , 29 ( 6 ): 1409 - 1411 .

王小玲，张军平，许颖智 . 论毒邪理论在心系疾病中的运用 [J]. 中华中医药杂志， 2012 , 27 ( 8 ): 2090 - 2093 .

袁天慧，冼绍祥，杨忠奇，等 . “毒”邪致慢性心力衰竭理论依据初探 [J]. 中华中医药杂志， 2014 , 29 ( 6 ): 1785 - 1790 .

袁国强，吴以岭，贾振华，等 . 脉络病变病因与发病机制探讨 [J]. 中医杂志， 2012 , 53 ( 2 ): 91 - 94 .

李澎涛，王永炎，黄启福 . “毒损脑络”病机假说的形成及其理论与实践意义 [J]. 北京中医药大学学报， 2001 , 24 ( 1 ): 1 - 6 .

于敏，张波，史耀勋，等 . 南征教授“毒损肾络”理论学说探析及临床运用 [J]. 中华中医药学刊， 2010 , 28 ( 2 ): 243 - 246 .

王春，秦少博，李萍 . 炎症与血管内皮损伤研究进展 [J]. 心血管病学进展， 2015 , 36 ( 1 ): 89 - 92 .

SABE SA , FENG J , SELLKE FW , et al . Mechanisms and clinical implications of endothelium-dependent vasomotor dysfunction in coronary microvasculature [J]. Am J Physiol Heart Circ Physiol , 2022 , 322 ( 5 ): 819 - 841 .

LIU YX , TIAN T , ZHANG HJ , et al . The effect of homocysteine-lowering therapy with folic acid on flow-mediated vasodilation in patients with coronary artery disease: a meta-analysis of randomized controlled trials [J]. Atherosclerosis , 2014 , 235 ( 1 ): 31 - 35 .

MENG LB , CHEN K , ZHANG YM , et al . Common Injuries and Repair Mechanisms in the Endothelial Lining [J]. Chin Med J (Engl) , 2018 , 131 ( 19 ): 2338 - 2345 .

马欣，李运伦 . 从血管内皮细胞损伤研究冠心病血瘀证病理基础 [J]. 辽宁中医药大学学报， 2020 , 22 ( 1 ): 117 - 120 .

XUAN C , CHANG FJ , LIU XC , et al . Endothelial nitric oxide synthase enhancer for protection of endothelial function from asymmetric dimethylarginine-induced injury in human internal thoracic artery [J]. J Thorac Cardiovasc Surg , 2012 , 144 ( 3 ): 697 - 703 .

MEZAKI T , MATSUBARA T , HORI T , et al . Plasma levels of soluble thrombomodulin, C-reactive protein, and serum amyloid A protein in the atherosclerotic coronary circulation [J]. Jpn Heart J , 2003 , 44 ( 5 ): 601 - 612 .

ARBAB-ZADEH A , FUSTER V . The myth of the ”vulnerable plaque”：transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment [J]. J Am Coll Cardiol , 2015 , 65 ( 8 ): 846 - 855 .

HEUSCH G , LIBBY P , GERSH B , et al . Cardiovascular remodelling in coronary artery disease and heart failure [J]. Lancet , 2014 , 383 ( 9932 ): 1933 - 1943 .

芦瑞霞，朱晓星，张敏，等 . 毒邪学说与冠心病的证治探讨 [J]. 中医杂志， 2020 , 61 ( 1 ): 27 - 30 .

周仲瑛 . “伏毒”新识 [J]. 世界中医药， 2007 , 2 ( 2 ): 73 - 75 .

于宁，贾连群，宋囡，等 . 基于“痰瘀毒”病机探讨细胞焦亡与动脉粥样硬化的关系 [J]. 中华中医药学刊， 2019 , 37 ( 9 ): 2186 - 2188 .

方莉娜，张静 . 促炎－抗炎平衡在冠心病中作用研究进展 [J]. 中华实用诊断与治疗杂志， 2017 , 31 ( 4 ): 394 - 396 .

HANSSON GK . Inflammation and Atherosclerosis: The End of a Controversy [J]. Circulation , 2017 , 136 ( 20 ): 1875 - 1877 .

孟宇航，叶家虎，刘佳昊 . 基于“痰、瘀、毒”伏邪理论探析冠心病的防治 [J]. 中国中医急症， 2020 , 29 ( 2 ): 294 - 296 .

NI D , MO ZC , YI GH . Recent insights into atherosclerotic plaque cell autophagy [J]. Exp Biol Med , 2021 , 246 ( 24 ): 2553 - 2558 .

刘浩，何红霞，王晓峰 . 冠心病患者易损斑块中医药干预研究的探讨 [J]. 时珍国医国药， 2012 , 23 ( 8 ): 1985 - 1987 .

任丽，王阶，冯玲，等 . 冠脉易损斑块的中医病机治法探讨 [J]. 中华中医药学刊， 2011 , 29 ( 2 ): 279 - 281 .

李晓雅，王松子，孙卓，等 . 以“因瘀致毒，瘀毒互结致变”理论诊治冠心病经验 [J]. 中国中西医结合杂志， 2021 , 41 ( 10 ): 1248 - 1250 .

赵淑明，张文立，李昌，等 . 益气化痰祛瘀方对冠心病大鼠一氧化氮和内皮素的影响 [J]. 中国老年学杂志， 2011 , 31 ( 5 ): 814 - 815 .

刘如秀，周晟芳，李慧，等 . 滋肾活血方对冠心病心肌缺血肾虚血瘀型大鼠外周血浆中ET、NO及IL－18含量的影响 [J]. 中国中医基础医学杂志， 2016 , 22 ( 1 ): 54 - 56 .

ZHANG H , WANG WR , LIN R , et al . Buyang Huanwu decoction ameliorates coronary heart disease with Qi deficiency and blood stasis syndrome by reducing CRP and CD40 in rats [J]. J Ethnopharmacol , 2010 , 130 ( 1 ): 98 - 102 .

郑丽莉 . 芎归六君子汤对大鼠急性心肌梗死的治疗作用 [J]. 中国中医基础医学杂志， 2018 , 24 ( 6 ): 760 - 762 .

王永刚，钟伟，于远望，等 . 人参与丹参配伍对心肌梗塞模型大鼠血管内皮功能的影响 [J]. 时珍国医国药， 2013 , 24 ( 9 ): 2057 - 2058 .

黄烁，刘建勋，李磊，等 . 双参通冠方对冠心病气虚血瘀证大鼠的干预作用 [J]. 中华中医药杂志， 2017 , 32 ( 7 ): 3109 - 3116 .

李文龙，崔金涛，叶少剑，等 . 五参口服液对糖尿病合并冠心病大鼠血管内皮损伤的影响 [J]. 时珍国医国药， 2012 , 23 ( 5 ): 1081 - 1082 .

秦汉，胡志希，李琳，等 . 雪莲通脉丸对冠心病气虚血瘀证小鼠血管内皮细胞功能相关指标ET－1、NO、ACE的影响 [J]. 湖南中医药大学学报， 2016 , 36 ( 2 ): 25 - 28 .

马晓娟，郭春雨，张莹，等 . 活血及活血解毒配伍对急性心肌梗死大鼠心肌损伤的保护作用 [J]. 中华老年心脑血管病杂志， 2015 , 17 ( 9 ): 960 - 963 .

马晓娟，郭春雨，殷惠军，等 . 活血及活血解毒配伍中药对急性心肌梗死大鼠模型血小板活化、炎症反应及凝血状态的影响 [J]. 中国中西医结合杂志， 2014 , 34 ( 11 ): 1329 - 1334 .

张雯雯，金颂峰，赵国梁，等 . 复方中药稳斑汤减少同型半胱氨酸诱导大鼠心肌微血管内皮细胞凋亡的作用机制 [J]. 中国组织工程研究， 2021 , 25 ( 5 ): 723 - 728 .

朱祖成 . 清热解毒中药干预大鼠急性心肌缺血损伤的实验研究 [J]. 中国应用生理学杂志， 2011 , 27 ( 4 ): 443 - 444 .

张京春，陈可冀 . 瘀毒病机与动脉粥样硬化易损斑块相关的理论思考 [J]. 中国中西医结合杂志， 2008 , 28 ( 4 ): 366 - 368 .

李圣耀，冒慧敏，薛梅，等 . 刍议瘀毒内涵及其在冠心病事件发生中的意义 [J]. 中国中西医结合杂志， 2017 , 37 ( 9 ): 1126 - 1128 .

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