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心力衰竭的生物钟调控机制研究进展

王琼¹, 张嘉阳², 邱乐佳¹, 陈丽红^1,*

¹华东师范大学医学与健康研究院，上海 200241；²上海健康医学院基础医学院，上海 201318

摘要

生物钟是机体内源性节律调控系统，通过整合环境和基因互作维持心血管稳态。心力衰竭(简称心衰)是以心脏结构和/或功能进行性恶化为特征的复杂临床综合征，近年研究发现，生物钟核心组分(如BMAL1、REV-ERBα 等)可通过调控心肌能量代谢、参与神经-体液调节、炎症及氧化应激反应等，影响心脏结构和代谢重构，进而参与心衰的发生和发展。流行病学证据表明，长期生物钟紊乱可显著增加心衰的发生风险，而许多心衰相关治疗药物的时间依赖性疗效也提示基于昼夜节律的给药策略有助于改善心衰预后。本文将系统阐述生物钟，尤其是核心生物钟基因，在心衰中的多维调控机制，并简要探讨时间疗法在心衰治疗中的应用，为开发心衰的时间生物学个体化治疗提供理论依据。

关键词： 生物钟; 心力衰竭; 时间生物学

Research advances in the mechanisms of circadian regulation in heart failure

WANG Qiong¹, ZHANG Jia-Yang², QIU Le-Jia¹, CHEN Li-Hong^1,*

¹Health Science Center, East China Normal University, Shanghai 200241, China；²School of Basic Medicine, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China

Abstract

The circadian clock is an endogenous time-keeping system that maintains physiological homeostasis by integrating environmental and genetic interactions. Heart failure is a complex clinical syndrome characterized by structural abnormalities and/or functional impairment of the heart. Growing evidence suggests that core circadian components, such as BMAL1 and REV-ERBα, play important roles in modulating myocardial energy metabolism, inflammatory responses, and oxidative stress, contributing to myocardial structural and metabolic remodeling during heart failure progression. Notably, circadian disruption is closely associated with heart failure, with aberrant blood pressure rhythms and disturbances in the sleep-wake cycle in patients. The time-dependent efficacy of heart failure medications further supports the potential of chronotherapy-based strategies to improve clinical outcomes. Here, we summarize the multifaceted regulatory roles of the circadian clock, particularly core clock genes, in heart failure pathogenesis, providing a theoretical framework for developing personalized chronotherapeutic strategies for heart failure management.

Key words: circadian clock; heart failure; chronobiology

收稿日期：　　录用日期：

通讯作者：陈丽红　　E-mail:

DOI: 10.13294/j.aps.2025.0063

引用本文：

王琼, 张嘉阳, 邱乐佳, 陈丽红. 心力衰竭的生物钟调控机制研究进展[J]. 生理学报 2025; 77 (4): 653-668.

WANG Qiong, ZHANG Jia-Yang, QIU Le-Jia, CHEN Li-Hong. Research advances in the mechanisms of circadian regulation in heart failure. Acta Physiol Sin 2025; 77 (4): 653-668 (in Chinese with English abstract).