高血压左心室肥厚逆转的研究进展

【作者】 邓翠东；

【导师】 戴万亨；

【作者基本信息】 成都中医药大学 ， 中西医结合临床， 2004， 硕士

【摘要】 高血压引起的左心室肥厚(LVH)是发生各种心血管并发症的独立危险因素。LVH与心脏舒缩功能的下降，冠脉储备力的减少和各种心律失常的易发生性密切相关。目前认为：左心室肥厚病理改变主要是心肌细胞肥大和心肌间质纤维化。关于左心室肥厚发生机制的重要原因是血流动力学异常和神经内分泌激活两大方面。比较共识的观点认为LVH是高血压病心肌细胞和其间质成分对生长因子和某些激素的一种应答反应。LVH的中医基本病机是痰浊、血瘀、阳亢。由于高血压与左心室肥厚处于同一机体环境，因而辨证具有同一性。 中药逆转左心室肥厚的机制研究有了较深入的发展，尤其是在分子生物学、基因、神经内分泌、细胞信号转导、炎性介质等方面有了一定的进展。为中药的推广应用提供了有力的证据。高血压合并左心室肥厚使用药物(中药和西药)及非药物疗法是可以逆转的。不论用什么方法逆转左心室肥厚，降压治疗是首要条件，但单纯降压并不是逆转左心室肥厚的唯一因素。其他因素如神经、体液、内分泌激素等，对心肌细胞及其间质成分内信息传递基因表达的影响，可能是形成或消退心肌肥厚的重要途径。由于中药的非特定靶向性，研究难度较大。对中药研究要求相对较高，因此对中药多角度多层面的研究相对涉及较少，以后尚需加大研究力度。临床实验方面目前缺乏大样本前瞻性研究，缺乏循证医学证据，这是以后应探索的方向。更多还原

【Abstract】 Left ventricular hypertrophy (LVH) caused by essential hypertension was considered as an independent risk factor causing various kinds of cardiovascular complications. LVH nearly correlates with degression of cardiac diastolic and systolic function, loss of coronary artery reserve potential and susceptibility to all kinds of arrhythmia. At present, it is regarded that the main pathologic changes of LVH are the hypertrophy of cardiac myocytes and the interstitial fibrosis of myocardium. The main cause of pathophysiological mechanisms of LVH are the abnormity in hemodynamics and the activity in neuroendocrine. There is the common view that LVH is the response of cardiac myocytes and interstitial components of them to growth factors and some hormones. The basic pathogenesis of Traditional Chinese Medicine to LVH is Turbid Phlegm, Blood stasis and Yang hyperactivity. There is congeniality of differentiation of symptoms and signs, for hypertension and LVH lies in congenial environment.There was an enormous progress in the study of the mechanisms of the traditional Chinese medicine reversing LVH, especially in molecular biology, the study of gene, neuroendocrine, cellular signal transduction and inflammatory medium. These studies had provided a few powerful evidences for the application of Chinese medicine. Hypertension complicated with LVH can be reversed by the treatment of drugs (including Chinese medicine) and non-drugs. Whatever methods were applied to reverse LVH, anti-hypertension is the first step, but merely anti-hypertension is not the sole factor of reversingLVH. Other factors, such as nerves, body fluid and endocrine hormone, have influence on the gene expression of signal transduction between cardiac myocytes and their interstitial components-an important pathway by which LVH was caused or regressed. Due to non-definite tropism of target of Chinese herbs, it is very difficult to study Chinese herbs. The request to the studies of Chinese herbs is relatively high, while the present studies less involved in the studies of multiple sights and layers. These studies should be reinforced in the future. There are short of large-scale prospective studies and evidence of evidence-based medicine in clinic trial, which are the direction to be explored in the future.更多还原