心肌缺血再灌注损伤（MIRI）是心血管疾病死亡的重要病理机制，以心肌缺血恢复血流后心肌细胞损伤加剧为典型表现。MIRI具有治疗时间窗相关性，是决定患者短期生存结局和远期心脏功能的关键病理环节。内质网应激（ERS）是细胞维持稳态的适应性保护机制，可通过清除未折叠或错误折叠蛋白恢复内质网正常功能。在MIRI早期，ERS发挥保护作用，但持续应激会转而加剧心肌损伤，因此靶向调控ERS有望成为缓解MIRI的关键靶点。现有研究证实，多种中药活性成分及复方可通过调节ERS通路改善心肌结构与功能。将ERS作为中西医结合治疗MIRI的分子桥梁，探讨中药通过干预ERS调控MIRI的潜力具有重要研究价值。系统梳理ERS在MIRI中的双向调控作用及中药干预的关键靶点，为MIRI防治提供参考。

Myocardial ischemia-reperfusion injury (MIRI) is a critical pathological mechanism underlying cardiovascular disease mortality, characterized by exacerbated myocardial cell damage following the restoration of blood flow after ischemia. MIRI is time-sensitive and represents a key pathological link determining both short-term survival outcomes and long-term cardiac function in patients. Endoplasmic reticulum stress (ERS) is an adaptive protective mechanism that helps cells maintain homeostasis by eliminating misfolded or unfolded proteins to restore normal endoplasmic reticulum function. In the early phase of MIRI, ERS exerts protective effects; however, prolonged stress can shift toward worsening myocardial injury. Therefore, targeted modulation of ERS holds promise as a key therapeutic strategy for alleviating MIRI. Existing studies have demonstrated that various active components and herbal formulae from traditional Chinese medicine (TCM) can improve myocardial structure and function by regulating the ERS pathway. Utilizing ERS as a molecular bridge for integrative TCM and Western medicine approaches to treat MIRI offers significant research value. Systematically reviewing the dual regulatory role of ERS in MIRI and identifying key targets for TCM intervention may provide valuable insights for integrated prevention and treatment strategies against MIRI.

R285.5

甘肃省科技计划项目基金资助项目（21JR7RA584）；甘肃省科技厅自然科学基金项目（25JRRA974）；兰州市科技局科技发展指导性计划项目（2024-9-73）；敦煌医学与转化教育部重点实验室（DHYX24-26）；甘肃中医药大学研究生创新创业项目（2026CXCY-251）