中药治疗糖尿病心肌病研究进展

doi:10.12092/j.issn.1009-2501.2026.06.005

摘要/Abstract

摘要：

糖尿病心肌病（DCM）是糖尿病的严重并发症之一，发病机制复杂，目前西医缺乏特异性治疗药物。中药以其多靶点、多途径的优势在DCM防治中展现出良好前景。本文系统梳理近五年中药干预DCM的实验研究进展，从中药单体、传统复方及现代成方制剂三个层面总结其作用靶点与信号通路。结果显示，中药单体（如姜黄素、黄芪多糖、小檗碱、黄芪甲苷、白藜芦醇）主要通过激活PI3K/AKT/mTOR、AMPK/mTOR、SIRT3/FOXO3a、Nrf2/HO-1/GPX4等信号通路，抑制氧化应激、细胞凋亡、铁死亡及焦亡，改善心肌结构与功能；传统复方（如补阳还五汤、炙甘草汤、生脉饮、抵挡汤）可调控胰岛素信号通路、TLR4/NF-κB、miR-181a-5p/SPHK2及线粒体动力学相关蛋白，减轻炎症与纤维化；现代成方制剂（如通心络胶囊、左归降糖舒心方、蛭龙活血通瘀胶囊、麝香通心滴丸、滋膵通脉饮）则通过AMPK-mTOR、TGF-β1/Smads、AGE-RAGE等通路促进自噬、改善血管内皮功能及微循环障碍。各类中药均能降低DCM模型血糖血脂水平，减少心肌损伤标志物（CK-MB、MDA）表达，升高抗氧化指标（SOD、GSH-Px）活性。中药治疗DCM具有多靶点协同作用优势，但其分子网络解析及临床转化仍需深入探索。

关键词: 糖尿病心肌病, 中药, 作用机制, 信号通路, 研究进展

Abstract:

Diabetic cardiomyopathy (DCM) is one of the severe complications of diabetes mellitus with complex pathogenesis. Currently, there are no specific therapeutic drugs for DCM in Western medicine. Traditional Chinese medicine (TCM) exhibits promising prospects in the prevention and treatment of DCM due to its multi-target and multi-pathway characteristics. This article systematically reviews the advances in experimental research on TCM intervention for DCM over the past five years, and summarizes the functional targets and signaling pathways of TCM from three categories: TCM monomers, classical compound prescriptions and modern proprietary Chinese medicines. The results demonstrate that TCM monomers (e.g., curcumin, astragalus polysaccharide, berberine, astragaloside IV and resveratrol) mainly activate signaling pathways including PI3K/AKT/mTOR, AMPK/mTOR, SIRT3/FOXO3a and Nrf2/HO-1/GPX4, thereby inhibiting oxidative stress, apoptosis, ferroptosis and pyroptosis, and improving myocardial structure and cardiac function. Classical compound prescriptions such as Buyang Huanwu Decoction, Zhigancao Decoction, Shengmai Yin and Didang Decoction can regulate insulin signaling pathway, TLR4/NF-κB axis, miR-181a-5p/SPHK2 and proteins related to mitochondrial dynamics, and alleviate myocardial inflammation and fibrosis. Modern proprietary Chinese medicines, including Tongxinluo Capsule, Zuojiang Jiangtang Shuxin Formula, Zhilong Huoxue Tongyu Capsule, Shexiang Tongxin Dropping Pills and Ziquan Tongmai Decoction, regulate AMPK-mTOR, TGF-β1/Smads and AGE-RAGE pathways to promote autophagy and ameliorate vascular endothelial dysfunction and microcirculatory disorders. All types of TCM can reduce blood glucose and blood lipid levels in DCM models, downregulate the expression of myocardial injury markers (CK-MB, MDA), and enhance the activities of antioxidant indicators (SOD, GSH-Px). TCM exerts synergistic therapeutic effects on DCM via multiple targets. Nevertheless, further in-depth studies are still required to elucidate its molecular network and promote clinical transformation.

Key words: diabetic cardiomyopathy, traditional Chinese medicine, mechanism of action, signaling pathway, research progress

中图分类号:

R285.5

许潇, 王帅霖, 钱欣, 姚逸, 王彰禹, 朱晓奕, 毛庆, 郭齐. 中药治疗糖尿病心肌病研究进展[J]. 中国临床药理学与治疗学, 2026, 31(6): 764-773.

Xiao XU, Shuailin WANG, Xin QIAN, Yi YAO, Zhangyu WANG, Xiaoyi ZHU, Qing MAO, Qi GUO. Research progress on the treatment of diabetic cardiomyopathy with traditional Chinese medicine[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(6): 764-773.

图/表 3

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Drug	Model	n (minimal)	Target	Mechanism	Reference
Curcumin	DCM rats	6	PI3K/AKT/mTOR signaling pathway	↓MDA ↑SOD, PI3K, mTOR, p-AKT	[4]
	DCM mice	5	SIRT3/FOXO3a signaling pathway	↓MDA, ROS, Bax, Cleaved caspase-3 ↑SOD, GSH-Px, SIRT3, FOXO3a, Bcl-2	[5]
	DCM rats	10	CYP2J2/PPARs signaling pathway	↑PPARα, PPARβ, PPARγ, CYP2J2	[6]
	DCM mice	6	Nrf2/HO-1/GPX4 signaling pathway	↓CK-MB, cTNT, LDH, MDA, ROS, Fe2? ↑SOD, GSH-Px, Nrf2, HO-1, GPX4	[7]
	DCM rats	20	AMPK/mTOR signaling pathway	↓Cleaved caspase-3, C-PARP, p62, p-mTOR ↑LC3, Beclin-1, p-AMPK	[8]
Astragalus polysaccharide	DCM rats	10	AMPK/mTOR signaling pathway	↓LVEDD, LVESD, mTOR, p-mTOR ↑LVEF, LVFS, AMPK, p-AMPK	[10]
	DCM rats	10	LC3, p62	↓p62 ↑LC3	[11]
	SOD2?/KO mice	6	Nitrosine, 8-OH-dG, SOD2	↓ROS, Nitrosine, 8-OH-dG ↑SOD2	[12]
Berberine	H9c2 cells	—	CCNA2, PLK1, RRM2	↓ROS, CCL2, CCL7, NRBP2, SOX9 ↑BIRC5, CCNA2, CCNB1, CDC20, MYBL2, PLK1, RRM2	[14]
	DCM mice, H9c2 cells	6	SIRT3/lipophagy axis	↓CK, CK-MB, Plin5 ↑Beclin1, Sirt3, LC3Ⅱ/LC3Ⅰ, Opa1, Drp1, Mfn2, Mff	[15]
	DCM mice, H9c2 cells	6	mTOR/mtROS signaling pathway	↓CollagenⅠ, CollagenⅢ, NLRP3, Caspase-1, IL-1β, IL-18, GSDMD, p-mTOR, TGF-β	[16]
	DCM mice, H9c2 cells	6	AMPK/mTOR signaling pathway	↓ROS, MFF, p-Drp1Ser616, Parkin, p-mTORSer2481/mTOR ↑ATP, MMP, Mfn2, p-Drp1Ser637, LC3-Ⅱ, PGC-1α, Nrf1, Nrf2, Tfam, Tfb1m, Tfb2m	[17]
Astragaloside IV	DCM mice	10	IL-17 signaling pathway	↓CK-MB, TG, LDL-C, IL-1β, IL-6, CXCL-10, IL-17, IL-17R, TRAF6, MAPKs, c-Jun, NF-κB p65 ↑HDL-C	[19]
Astragaloside IV	DCM mice, H9c2 cells	6	NLRP3/Caspase-1/GSDMD signaling pathway	↓TC, TG, IL-1β, IL-18, IL-6, TNF-α, NLRP3, ASC, Caspase-1, GSDMD, GSDMD-N, pro-IL-1β, IL-1β ↑LDH, CK-MB	[20]
	DCM mice	6	AMPK/ULK1 signaling pathway	↓TG, LDL-C, p62 ↑Beclin-1, LC3, p-AMPK	[21]
	DCM mice	15	PI3K/Akt signaling pathway	↓LDH, CK-MB, cTnT, MDA, TNF-α, IL-1β, IL-6, MCP-1 mRNA ↑GSH, GSH-Px, p-PI3K/PI3K, p-Akt/Akt	[22]
Resveratrol	DCM mice	8	SIRT3	↓TC, TG, LDL-C, Bax, Cleaved caspase-3 ↑HDL-C, Bcl-2, p-AMPK, PGC-1α, p-FOXO-1, SIRT3	[24]
	DCM mice	10	Mst1/SIRT3	↓Bax, Bax/Bcl-2, p62, p-Mst1 ↑Bcl-2 mRNA, Sirt3, LC3Ⅱ/LC3Ⅰ	[25]
	DCM mice	6	AMPK-P53	↓P62, P53 ↑Parkin, p-AMPK	[26]

Drug	Model	n (minimal)	Target	Mechanism	Reference
Curcumin	DCM rats	6	PI3K/AKT/mTOR signaling pathway	↓MDA ↑SOD, PI3K, mTOR, p-AKT	[4]
	DCM mice	5	SIRT3/FOXO3a signaling pathway	↓MDA, ROS, Bax, Cleaved caspase-3 ↑SOD, GSH-Px, SIRT3, FOXO3a, Bcl-2	[5]
	DCM rats	10	CYP2J2/PPARs signaling pathway	↑PPARα, PPARβ, PPARγ, CYP2J2	[6]
	DCM mice	6	Nrf2/HO-1/GPX4 signaling pathway	↓CK-MB, cTNT, LDH, MDA, ROS, Fe2? ↑SOD, GSH-Px, Nrf2, HO-1, GPX4	[7]
	DCM rats	20	AMPK/mTOR signaling pathway	↓Cleaved caspase-3, C-PARP, p62, p-mTOR ↑LC3, Beclin-1, p-AMPK	[8]
Astragalus polysaccharide	DCM rats	10	AMPK/mTOR signaling pathway	↓LVEDD, LVESD, mTOR, p-mTOR ↑LVEF, LVFS, AMPK, p-AMPK	[10]
	DCM rats	10	LC3, p62	↓p62 ↑LC3	[11]
	SOD2?/KO mice	6	Nitrosine, 8-OH-dG, SOD2	↓ROS, Nitrosine, 8-OH-dG ↑SOD2	[12]
Berberine	H9c2 cells	—	CCNA2, PLK1, RRM2	↓ROS, CCL2, CCL7, NRBP2, SOX9 ↑BIRC5, CCNA2, CCNB1, CDC20, MYBL2, PLK1, RRM2	[14]
	DCM mice, H9c2 cells	6	SIRT3/lipophagy axis	↓CK, CK-MB, Plin5 ↑Beclin1, Sirt3, LC3Ⅱ/LC3Ⅰ, Opa1, Drp1, Mfn2, Mff	[15]
	DCM mice, H9c2 cells	6	mTOR/mtROS signaling pathway	↓CollagenⅠ, CollagenⅢ, NLRP3, Caspase-1, IL-1β, IL-18, GSDMD, p-mTOR, TGF-β	[16]
	DCM mice, H9c2 cells	6	AMPK/mTOR signaling pathway	↓ROS, MFF, p-Drp1Ser616, Parkin, p-mTORSer2481/mTOR ↑ATP, MMP, Mfn2, p-Drp1Ser637, LC3-Ⅱ, PGC-1α, Nrf1, Nrf2, Tfam, Tfb1m, Tfb2m	[17]
Astragaloside IV	DCM mice	10	IL-17 signaling pathway	↓CK-MB, TG, LDL-C, IL-1β, IL-6, CXCL-10, IL-17, IL-17R, TRAF6, MAPKs, c-Jun, NF-κB p65 ↑HDL-C	[19]
Astragaloside IV	DCM mice, H9c2 cells	6	NLRP3/Caspase-1/GSDMD signaling pathway	↓TC, TG, IL-1β, IL-18, IL-6, TNF-α, NLRP3, ASC, Caspase-1, GSDMD, GSDMD-N, pro-IL-1β, IL-1β ↑LDH, CK-MB	[20]
	DCM mice	6	AMPK/ULK1 signaling pathway	↓TG, LDL-C, p62 ↑Beclin-1, LC3, p-AMPK	[21]
	DCM mice	15	PI3K/Akt signaling pathway	↓LDH, CK-MB, cTnT, MDA, TNF-α, IL-1β, IL-6, MCP-1 mRNA ↑GSH, GSH-Px, p-PI3K/PI3K, p-Akt/Akt	[22]
Resveratrol	DCM mice	8	SIRT3	↓TC, TG, LDL-C, Bax, Cleaved caspase-3 ↑HDL-C, Bcl-2, p-AMPK, PGC-1α, p-FOXO-1, SIRT3	[24]
	DCM mice	10	Mst1/SIRT3	↓Bax, Bax/Bcl-2, p62, p-Mst1 ↑Bcl-2 mRNA, Sirt3, LC3Ⅱ/LC3Ⅰ	[25]
	DCM mice	6	AMPK-P53	↓P62, P53 ↑Parkin, p-AMPK	[26]

Drug	Model	n (minimal)	Target	Mechanism	Reference
Buyang Huanwu Decoction	DCM mice	10	AKT, GSK3β	↓GSK3β, p-GSK3β ↑INSR, p-PI3K, p-AKT	[27]
	DCM mice	8	TNF-α, DRP1, MFN2	↓LDH, CK-MB, IL-2, TNF-α, MDA, DRP1, MFF ↑SOD, MFN2	[28]
	DCM mice	10	TLR4/NF-κB	↓CK-MB, IL-6, MCP-1, TNF-α, TG, LDL-C, TLR4, NF-κB p65, Cleaved caspase-3, Cleaved PARP, CollagenⅠ, Collagen Ⅲ ↑HDL-C	[29]
Zhigancao Decoction	DCM rats	10	miR-181a-5p, SPHK2	↓α-SMA, CollagenⅠ, CollagenⅢ, SPHK2 ↑miR-181a-5p	[30]
Zhigancao Decoction	DCM rats	10	LC3-Ⅰ, LC3-Ⅱ, Beclin-1, P62	↓BNP, Bax, P62 ↑Bcl-2, Beclin-1, LC3-Ⅱ/LC3-Ⅰ	[31]
Shengmai Decoction	DCM mice	10	Alkbh5-Atg7	↓LDH, CK-MB, cTN1 ↑ANP mRNA, BNP mRNA, Alkbh5, Lc3, Atg7	[32]
	DCM rats	10	CaMKII/PLB/p-PLB/SERCA2a	↓PLB, CaMKII ↑p-PLB, SERCA2a, NCX1, PPAR-α, SERCA2a/PLB, PLBSer16+Thr17/PLB	[33]
	DCM rats	10	PPARα/CD36	↓MDA, PPARα, CD36 ↑SOD, GSH-Px, miR-19a	[34]
Didang Decoction	DCM mice	12	Mfn2, Opal, Drp1, Fis-1	↓Mfn2, Opa1, ROS ↑Drp1, Fis-1	[35]
Didang Decoction	DCM mice	8	NLRP3	↓TC, TG, ROS, NLRP3, TXNIP, Caspase-1, IL-1β	[36]

Drug	Model	n (minimal)	Target	Mechanism	Reference
Buyang Huanwu Decoction	DCM mice	10	AKT, GSK3β	↓GSK3β, p-GSK3β ↑INSR, p-PI3K, p-AKT	[27]
	DCM mice	8	TNF-α, DRP1, MFN2	↓LDH, CK-MB, IL-2, TNF-α, MDA, DRP1, MFF ↑SOD, MFN2	[28]
	DCM mice	10	TLR4/NF-κB	↓CK-MB, IL-6, MCP-1, TNF-α, TG, LDL-C, TLR4, NF-κB p65, Cleaved caspase-3, Cleaved PARP, CollagenⅠ, Collagen Ⅲ ↑HDL-C	[29]
Zhigancao Decoction	DCM rats	10	miR-181a-5p, SPHK2	↓α-SMA, CollagenⅠ, CollagenⅢ, SPHK2 ↑miR-181a-5p	[30]
Zhigancao Decoction	DCM rats	10	LC3-Ⅰ, LC3-Ⅱ, Beclin-1, P62	↓BNP, Bax, P62 ↑Bcl-2, Beclin-1, LC3-Ⅱ/LC3-Ⅰ	[31]
Shengmai Decoction	DCM mice	10	Alkbh5-Atg7	↓LDH, CK-MB, cTN1 ↑ANP mRNA, BNP mRNA, Alkbh5, Lc3, Atg7	[32]
	DCM rats	10	CaMKII/PLB/p-PLB/SERCA2a	↓PLB, CaMKII ↑p-PLB, SERCA2a, NCX1, PPAR-α, SERCA2a/PLB, PLBSer16+Thr17/PLB	[33]
	DCM rats	10	PPARα/CD36	↓MDA, PPARα, CD36 ↑SOD, GSH-Px, miR-19a	[34]
Didang Decoction	DCM mice	12	Mfn2, Opal, Drp1, Fis-1	↓Mfn2, Opa1, ROS ↑Drp1, Fis-1	[35]
Didang Decoction	DCM mice	8	NLRP3	↓TC, TG, ROS, NLRP3, TXNIP, Caspase-1, IL-1β	[36]

Drug	Model	n (minimal)	Target	Mechanism	Reference
Tongxinluo Capsule	H9c2 cells	—	AMPK-mTOR signaling pathway	↓ROS, LDH, MDA, P62, p-mTOR ↑Beclin-1, LC3Ⅱ/Ⅰ, p-AMPK	[37]
Tongxinluo Capsule	DCM rats	8	TGF-β1-p38MAPK-CREB signaling pathway	↓TGF-β1, p-p38MAPK, Caspase-3 ↑Bcl-2, p-CREB	[38]
Zuogui Jiangtang Shuxin Formula	DCM mice	6	Foxo1-ANP-β-MHC signaling pathway	↓Foxo1, ANP, β-MHC	[39]
Zuogui Jiangtang Shuxin Formula	DCM mice	10	TLR4/NF-κB signaling pathway	↓TNF-α, IL-1β, TLR4, NF-κB p56, p-NF-κB p56/NF-κB p56, CollagenⅠ, CollagenⅢ, α-SMA	[40]
Zhilong Huoxue Tongyu Capsule	DCM mice	8	P38MAPK signaling pathway	↓TG, TC, p-P38MAPK, TNF-α, α-SMA, Collagen-Ⅰ	[41]
	DCM rats	10	PI3K, AKT1, FoxO3a	↓GHb, TC, TG, LDL-C ↑HDL-C, PI3K, AKT1, FoxO3a, p-PI3K, p-AKT1, p-FoxO3a	[42]
	DCM rats	9	Adiponectin	↓ICAM-1, VCAM-1 ↑Adiponectin	[43]
Shexiang Tongxin Dropping Pill	DCM rats	6	AGE-RAGE	↓p-p38, p-JNK, Cleaved caspase-3	[44]
Shexiang Tongxin Dropping Pill	DCM mice	6	VEGF, ZO-1, Occludin, VE-Cadherin, Claudin-5, JAM-A	↓TC, TG, LDL-C ↑VEGF, VEGFR2, PI3K, AKT, eNOS, ZO-1, Occludin, VE-Cadherin, Claudin-5, JAM-A	[45]
Zicui Tongmai Decoction	DCM rats	9	TGF-β1/Smads signaling pathway	↓TGF-β1, Smads3 ↑Smads7	[46]
Zicui Tongmai Decoction	DCM rats	9	PKC-βⅡ	↓FPG, FINS, HOMA-IR, TG, T-CHO, LDL-C, HbAlc, MDA, PKC-βⅡ, VEGF ↑SOD, VE-cadherin, VEGFR2	[47-48]