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中华诊断学电子杂志 ›› 2024, Vol. 12 ›› Issue (01) : 25 -30. doi: 10.3877/cma.j.issn.2095-655X.2024.01.004

心血管疾病诊治

胶原在心肌梗死后心脏重构中的研究进展
姜晓宇1, 付迪1, 陈雪英2, 申程2, 甘立军2,†()   
  1. 1. 272067　济宁医学院临床医学院
    2. 272029　济宁医学院附属医院心内科；济宁市心血管疾病诊疗重点实验室
  • 收稿日期:2023-07-27 出版日期:2024-02-26
  • 通信作者: 甘立军
  • 基金资助:
    国家自然科学基金(82000269); 山东省中医药科技项目重点项目(Z-2022081)

Research progress of collagen in cardiac remodeling after myocardial infarction

Xiaoyu Jiang1, Di Fu1, Xueying Chen2, Cheng Shen2, Lijun Gan2,†()   

  1. 1. College of Clinical Medicine, Jining Medical University, Jining 272067, China
    2. Department of Cardiology,; Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2023-07-27 Published:2024-02-26
  • Corresponding author: Lijun Gan
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姜晓宇, 付迪, 陈雪英, 申程, 甘立军. 胶原在心肌梗死后心脏重构中的研究进展[J]. 中华诊断学电子杂志, 2024, 12(01): 25-30.

Xiaoyu Jiang, Di Fu, Xueying Chen, Cheng Shen, Lijun Gan. Research progress of collagen in cardiac remodeling after myocardial infarction[J]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(01): 25-30.

心肌胶原是构成心肌细胞外基质的主要成分，维持心脏结构和心肌细胞功能的完整性，并在心肌梗死后心脏功能的变化和心脏重构中起着重要作用。心肌梗死是常见的心血管疾病，因此探讨胶原蛋白成分在心肌梗死后承担的功能十分必要。心肌胶原受转化生长因子-β1/Smads信号通路、神经内分泌以及多种调控分子影响，不同类型胶原在心脏中承担着不同的作用以维持心脏正常功能，在心肌梗死后大部分心肌胶原表达升高，也有部分胶原，比如Ⅴ型胶原因消耗比例下降，进而导致瘢痕面积增大，因此，适合的胶原比例是维持心脏正常功能的前提。笔者就心肌胶原的功能、心肌梗死后心肌胶原的变化、调控心肌胶原变化的机制以及对心肌胶原可产生影响的药物研究进行综述。

关键词: 胶原, 心肌梗死, 心室重构, 心肌纤维化, 信号通路

Myocardial collagen is the primary component of the extracellular matrix in the cardiomyocardium. It is responsible for maintaining the integrity of the heart structure and cardiomyocyte function and plays an important role in the change of cardiac function and cardiac remodeling after myocardial infarction. Myocardial infarction is a common cardiovascular disease, so it is essential to explore the function of collagen components after myocardial infarction. Myocardial collagen is affected by transforming growth factor-β1/Smads signaling pathway, neuroendocrine and a variety of regulatory molecules. Different types of collagen in the heart serve distinct functions to maintain the normal function of the heart. After myocardial infarction, most of the myocardial collagen exhibits increased expression. However, some collagen, specifically type V collagen, can contribute to an increase in scar area due to its decreasing consumption proportion. Therefore, maintaining an appropriate ratio of collagen is the precondition of maintaining normal heart function. The author reviews the functions of myocardial collagen, the alterations in myocardial collagen after myocardial infarction, the mechanisms of regulating changes in myocardial collagen, and the pharmaceutical interventions that can affect myocardial collagen.

Key words: Collagen, Myocardial infarction, Ventricular remodeling, Myocardial fibrosis, Signaling pathway
图1 心脏TGF-β1/Smads信号通路注：TGF-β1为转化生长因子β1; TβR为细胞膜上的丝氨酸/苏氨酸激酶型受体形成的功能性复合物；cardial fibroblast为心肌成纤维细胞；fibrosis-relate gene α-SMA COL为纤维化相关基因α-SMA、胶原；fibrosis为纤维化；Smad2、Smad3、Smad7为受体活化型Smad，Smad2、Smad3能被TβRⅠ受体激活促进胶原基因和平滑肌肌动蛋白(α-SMA)的表达，促进纤维化及心室重塑，Smad7能抑制Smad2/3的磷酸化达到抑制纤维化和心室重塑的作用
表1 改善胶原沉积的药物
药物种类 药物名称 调节的胶原类型 调节相关的因子 参考文献
心血管常用药物 阿托伐他汀 Ⅰ型胶原水平下调 抑制IL-1表达 [39]
  阿司匹林 Ⅰ型胶原水平下调 抑制TGF-β1的表达 [40]
  达格列净 抑制胶原沉积 负性调节TGF-β1/Smad信号通路 [41]
中成药及天然药物提取物 参松养心胶囊 抑制Ⅰ、Ⅲ型胶原表达 下调TGF-β1、MMP-9、TIMP-Ⅰ [42]
  通冠胶囊 抑制Ⅰ、Ⅲ型胶原表达 降低TGF-β1、MMP-9表达 [43]
  金丝桃苷 减轻纤维蛋白原沉积 IL-1β的表达下降 [44]
  桃红四物汤 抑制Ⅰ、Ⅲ型胶原表达 降低TGF-βR1、Smad2/3磷酸化 [45]
  Zerumbone 降低Ⅰ、Ⅲ型胶原的水平 TGF-β1、P-Smad2、P-Smad3表达下调，Smad7表达上调 [14]
  人参皂苷Rg2 降低Ⅰ、Ⅲ型胶原的水平 心肌梗死后AKT通路被显著抑制 [46]
  达马烷型皂苷元I 减轻胶原沉积 抑制IL-1β和IL-18 [47]
  丹参红花提取物 降低Ⅰ、Ⅲ型胶原的表达水平 降低Smad3 [48]
  二水石蒜碱 Ⅰ型胶原下调 TGF-β和P-Smad3下调 [49]
抗病毒药 阿扎那韦 降低Ⅰ、Ⅲ型胶原 下调HMGB1、TLR9和抑制核因子κB磷酸化 [50]
血尿酸抑制剂 培米宁 抑制Ⅰ、Ⅲ型胶原表达 抑制IL-1β、IL-6和TNF-α水平升高 [51]
其他类型药物 心肌球来源细胞外泌体 瘢痕明显减小 － [52]
  IL-10 Ⅰ、Ⅲ型胶原分泌减少 降低透明质酸酶3 [53]
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