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血管内皮是外周组织与血液循环之间的一层选择性的半透膜，不仅能调控血管内外物质交换，还能分泌多种活性物质，以调节血管张力、维持正常血运，对心脏内稳态具有重要调节作用，血管内皮功能障碍可损伤微循环灌注，加重心肌缺血，是冠状动脉微循环障碍（coronary microcirculation dysfunction,CMD）的关键病理机制。“虚气留滞”为CMD的核心病机，“虚气”指心、脾、肾脏气虚损，为发病之本；“留滞”指因虚生气滞、痰瘀，痹阻心络，为发病之标。若血管内皮屏障受损、舒缩失衡可导致血管通透性增加、血管过度收缩，与“虚气”引起的防御固摄、协调脉络功能失调相似；血管内皮凝血-纤溶功能失衡可导致微血栓生成增加，则与“虚气”引起的推动血运功能失常、实邪“留滞”相似，进而影响微血管结构与功能，引发CMD。文章探讨“虚气留滞”理论与CMD血管内皮功能障碍的相关性，以阐述CMD“虚气留滞”病机的科学内涵，并以补虚通滞为治则介绍了中医药靶向调节血管内皮功能干预CMD的相关进展，以期为中西医结合治疗CMD提供理论依据与临床用药参考。
Abstract：Vascular endothelium is a selective semi-permeable membrane between peripheral tissues and blood circulation,which can not only regulate the exchange of substances inside and outside the blood vessels,but also secrete a variety of active substances to regulate vascular tone and maintain normal blood vascularity,which has an important regulatory role in cardiac homeostasis.“Stagnation of virtual Qi”is the core pathogenesis of coronary microcirculation dysfunction(CMD),and“virtual Qi”refers to the virtual Qi in the heart,spleen,and kidney,which is the root cause of the pathogenesis.“Stagnation”refers to stagnation,phlegm and stasis due to hypoxia,which is the mark of the disease. If the vascular endothelial barrier is damaged and the diastolic imbalance can lead to increased vascular permeability and excessive vascular constriction,which is similar to the dysfunction of defense and coordination caused by“virtual Qi”. The imbalance of vascular endothelial coagulation-fibrinolysis can lead to an increase in microthrombosis,which is similar to the dysfunction of promoting blood circulation and the “stagnation” of real evil caused by “virtual Qi”,which in turn affects the structure and function of microvessels and causes CMD. This article attempts to explore the correlation between the theory of “stagnation of virtual Qi” and CMD vascular endothelial dysfunction,in order to elaborate the scientific connotation of the pathogenesis of “stagnation of virtual Qi” in CMD,and introduces the relevant progress of targeted regulation of vascular endothelial function intervention in CMD by traditional Chinese medicine with the principle of supplementing deficiency and stagnation,in order to provide a theoretical basis and clinical reference for the treatment of CMD with the combination of traditional Chinese and Western medicine.
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基本信息:
DOI：10.13194/j.issn.1673-842X.2025.07.008
中图分类号:R259
引用信息:
[1]黄克,左可可,顾宁.基于血管内皮功能探讨冠状动脉微循环障碍“虚气留滞”病机的科学内涵[J].辽宁中医药大学学报,2025,27(07):44-49.DOI:10.13194/j.issn.1673-842X.2025.07.008.
基金信息:
国家自然科学基金面上项目（81774229）; 第四批江苏省名老中医药专家传承工作室建设项目（苏中医科教[2021]7号）; 江苏省中医药科技发展计划面上项目（MS2023049）; 南京中医药大学自然科学基金项目（XZR2023063）; 南京市中医药青年人才培养计划项目（ZYQ20043）; 江苏省研究生科研与实践创新计划项目（SJCX＿1071）