中药调控巨噬细胞极化防治射血分数保留型心力衰竭研究进展OA

Heart failure with preserved ejection fraction(HFpEF)is a clinically prevalent form of heart failure,characterized by impaired ventricular diastolic function.Its high heterogeneity,progressive worsening,multiple comorbidities,and high mortality rate impose a heavy burden on patients.Its pathogenesis involves multiple mechanisms including myocardial inflammation,cardiac fibrosis,and mitochondrial dysfunction,with dysregulated macrophage polarization serving as a key driver.Macrophages exhibit two phenotypes:classically activated macrophages(M1 type)and alternatively activated macrophages(M2 type).In HFpEF,M1/M2 imbalance induces myocardial inflammation,promotes fibrosis and cardiac remodeling,and disrupts electrical conduction homeostasis,thereby exacerbating the pathological progression of HFpEF.Research indicates that traditional Chinese medicine(TCM)can modulate macrophage polarization balance through multi-component,multi-target mechanisms.This article summarizes the mechanisms of macrophage polarization in the pathogenesis of HFpEF.It systematically outlines how TCM exerts its core anti-inflammatory,anti-fibrotic,and cardiac function-improving effects by regulating macrophage polarization and balancing M1/M2 phenotypes via the transforming growth factor-β1/Smad(TGF-β1/Smads)signaling pathway and the phosphoinositide 3-kinase/protein kinase B(PI3K/Akt)signaling pathway.This provides novel insights and theoretical support for the application of TCM in the prevention and treatment of HFpEF.