巨噬细胞糖代谢重编程在心肌纤维化中的作用机制及中医药干预研究进展

Research Progress on the Mechanism of Macrophage Glycometabolic Reprogramming in Myocardial Fibrosis and the Intervention of Traditional Chinese Medicine

中文关键词:心肌纤维化  中药  糖代谢  代谢重编程  巨噬细胞极化

keywords:Myocardial fibrosis  Traditional Chinese medicine  Glucose metabolism  Metabolic reprogramming  Macrophage polarization

中文摘要:心肌纤维化是多种心血管疾病的共同病理过程，其特征是心脏成纤维细胞过度活化、细胞外基质大量沉积，导致心脏僵硬度增加、收缩和舒张功能障碍。巨噬细胞在心肌纤维化的发生、进展和修复中起着重要作用。巨噬细胞具有高度异质性，其极化状态受细胞糖代谢重编程影响。通过免疫疗法靶向巨噬细胞可能是减缓或阻止心脏病纤维化进展的有益治疗途径。中医药越来越被认可为具有免疫调节活性的化合物来源。本文从免疫代谢的角度阐明了巨噬细胞活化与糖代谢重编程之间的关系,综述了几种中药复方及中药衍生的化合物，包括真武汤、丹参酮 IIA和黄芪甲苷IV等可通过磷脂酰肌醇3-激酶/蛋白激酶B(PI3K/Akt)、哺乳动物雷帕霉素受体（mTOR）/缺氧诱导因子-1α(HIF-1α)、核转录因子-κB(NF-κB)和腺苷酸活化蛋白激酶(AMPK)信号通路等关键通路来调节巨噬细胞糖代谢重编程发挥抗心肌纤维化的作用。

Abstract:Myocardial fibrosis is a common pathological process of various cardiovascular diseases, which is characterized by the excessive activation of cardiac fibroblasts and massive deposition of extracellular matrix, leading to increased cardiac stiffness and systolic and diastolic dysfunction. Macrophages play an important role in the occurrence, progression and repair of myocardial fibrosis. Macrophages have a high degree of heterogeneity, and their polarization status is affected by cellular glucose metabolic reprogramming. Targeting macrophages through immunotherapy may serve as a promising therapeutic approach to slow down or prevent the progression of cardiac fibrosis. Traditional Chinese medicine (TCM) is increasingly recognized as a source of compounds with immunomodulatory activity. From the perspective of immunometabolism, this paper clarifies the relationship between macrophage activation and glucose metabolic reprogramming, and reviews that several TCM compound prescriptions and TCM-derived compounds, including Zhenwu Decoction, Tanshinone ⅡA and Astragaloside Ⅳ, can regulate macrophage Glycometabolic Reprogramming through key signaling pathways such as PI3K/AKT, mTOR/ HIF-1α, NF-κB and AMPK, thereby exerting anti-myocardial fibrosis effects.