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老年心房颤动的代谢机制及干预策略

杨远青¹, 靳灵燕², 陈子溦³, 郑强荪², 秦兴华^1,*

¹西北工业大学生命学院，西安 710072；²西安交通大学第二附属医院心血管内科，西安 710004；³西安医学院临床医学院呼吸病预防与诊治工程研究中心，西安 710021

摘要

心房颤动(简称房颤)是心血管流行病，主要发生在有心血管基础疾病的老年人群中，易导致脑卒中、心力衰竭等严重后果。心脏是一个高耗能的器官，需要高度代谢灵活性(在生理和病理刺激下能够迅速转换能量代谢底物)来满足其能量需求。代谢与房颤发生息息相关，房颤患者存在胰岛素抵抗和有氧代谢向无氧糖酵解转变等代谢灵活性受损现象；此外，本研究组及他人研究表明代谢灵活性受损是房颤的重要病理学机制。能量代谢与衰老过程和衰老相关疾病息息相关，代谢灵活性受损被认为是衰老的重要驱动因素。因此，本综述重点阐述衰老时代谢灵活性的改变，并揭示代谢灵活性受损可能是老年房颤高发的重要原因，以期为老年房颤的防治提供干预策略。

关键词： 心房颤动; 衰老; 代谢紊乱; 代谢灵活性

Metabolic mechanism and intervention strategy of atrial fibrillation in the elderly

YANG Yuan-Qing¹, JIN Ling-Yan², CHEN Zi-Wei³, ZHENG Qiang-Sun², QIN Xing-Hua^1,*

¹School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China；²Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China；³Research Center for Prevention and Treatment of Respiratory Disease, School of Clinical Medicine, Xi’an Medical University, Xi’an 710021, China

Abstract

Atrial fibrillation (AF) is a cardiovascular epidemic that occurs primarily in the elderly with primary cardiovascular diseases, leading to severe consequences such as stroke and heart failure. The heart is an energy-consuming organ, which requires a high degree of metabolic flexibility to ensure a quick switch of metabolic substrates to meet its energy needs in response to physiological and pathological stimulation. Metabolism is closely related to the occurrence of AF, and AF patients manifest metabolic inflexibility, such as insulin resistance and the metabolic shift from aerobic metabolism to anaerobic glycolysis. Moreover, our research group and the others have shown that metabolic inflexibility is a crucial pathologic mechanism for AF. Energy metabolism is closely linked to the aging process and aging-related diseases, and impaired metabolic flexibility is considered as an essential driver of aging. Therefore, this review focuses on the alteration of metabolic flexibility in the elderly and reveals that impaired metabolic flexibility may be an important driver for the high prevalence of AF in the elderly, hoping to provide intervention strategies for the prevention and treatment of AF in the elderly.

Key words: atrial fibrillation; aging; metabolic disorder; metabolic flexibility

收稿日期：　　录用日期：

通讯作者：秦兴华　　E-mail: xinghuaqin@nwpu.edu.cn

DOI: 10.13294/j.aps.2023.0088

引用本文：

杨远青, 靳灵燕, 陈子溦, 郑强荪, 秦兴华. 老年心房颤动的代谢机制及干预策略[J]. 生理学报 2023; 75 (6): 779-787.

YANG Yuan-Qing, JIN Ling-Yan, CHEN Zi-Wei, ZHENG Qiang-Sun, QIN Xing-Hua. Metabolic mechanism and intervention strategy of atrial fibrillation in the elderly. Acta Physiol Sin 2023; 75 (6): 779-787 (in Chinese with English abstract).