重构造血平衡防治心肌梗死的中西医干预策略

Rebalancing hematopoiesis against myocardial infarction with integrating Chinese and Western medical strategies

关键词:  心肌梗死  造血失衡  中西医结合  干预策略

Key words:  myocardial infarction  hematopoietic imbalance  integrated Chinese and Western medicine  intervention strategy

摘要:

心肌梗死急性期免疫炎症反应诱发造血失衡，表现为包括中性粒细胞和单核细胞在内的髓系细胞显著上升而淋巴细胞如B细胞显著下降，而中性粒细胞和淋巴细胞的比值在临床上可预测心血管风险。造血失衡的可能原因在于心肌梗死通过GSDMD介导自噬调控机制，引起中性粒细胞升高从而导致心肌损伤，而NHE1介导心肌梗死诱发的B淋巴细胞的降低。其中，骨髓Nave B细胞是发挥心脏保护作用的关键亚群。据此，在理论上提出心髓同治、中西药靶向中性粒细胞活化与B细胞亚群防治心肌梗死的策略；在诊断上采用中西医病证结合发现了心肌梗死预后的创新生物标志物；在治疗上采用中西药和细胞治疗综合干预，实现了在心肌梗死动物模型上死亡率降低、梗死面积减小、心功能改善的目标。

Abstract:

Inflammation in the acute phase of myocardial infarction(MI) results in hematopoietic imbalance, manifesting as a significant enhance of myeloid cells, including neutrophils and monocytes, with decreased lymphocytes, especially B cells. The neutrophil-lymphocyte ratio is a readily obtained inflammatory biomarker to predict the cardiovascular risk. The author has revealed the causality of hematopoietic imbalance post MI, particularly, the increased neutrophils via an autophagy-dependent mechanism thereafter exacerbating myocardium injury. In addition, NHE1 activation induces the decline of B cells after MI, while the bone marrow Nave B cells exhibits cardioprotective effect. Based on the above findings, the author proposes the preventive and therapeutic strategies for MI, integrating management of heart and bone marrow, and targeting neutrophil and B cell subsets with both Chinese and Western medicine. Additionally, the author has identified novel MI biomarkers via integrating Traditional Chinese and Western medicine in a “disease-pattern” research model. Furthermore, the comprehensive intervention with combined Chinese and Western medicine and cell therapy has achieved the goal of decreased mortality, reduced infarct area, and improved cardiac function in MI animal models.