胃癌是最常见的消化道肿瘤之一，其高发病率和致死率已严重危害人类身心健康。细胞凋亡是机体细胞维持自身稳态环境的一种自发性死亡方式，在胃癌的发生、发展过程中被广泛关注，始终影响着胃癌的转归和预后。中医药治疗胃癌在改善患者症状、提高生活质量、延长生存期等方面具有不可替代的优势。研究发现，中药活性成分如多糖类、皂苷类、黄酮类、生物碱类以及内酯类等可通过调控胃癌相关信号通路，提高促凋亡蛋白Bax、Bad、Bim的表达，降低抗凋亡蛋白Bcl-2、Bcl-xL、Bcl-W的表达，破坏胃癌细胞线粒体结构，降低线粒体膜电位水平，激活Caspase级联反应，最终诱导胃癌细胞线粒体凋亡，抑制胃癌的进展。通过对近年来中药活性成治疗胃癌的相关研究进行归纳总结，从中药活性成分调控线粒体凋亡抗胃癌的作用机制方面进行详细综述，以期为临床治疗胃癌新药研发提供思路和参考。

Gastric carcinoma (GC) is one of the most common malignant tumors of the digestive system with high incidence and mortality, posing a significant risk to human physical and mental health. Apoptosis is a spontaneous death mode of body cells to maintain their homeostasis environment, which is widely described in the occurrence and development of GC, and always affects the outcome and prognosis of GC. Traditional Chinese medicine (TCM) treatment of GC has irreplaceable advantages in improving symptoms, improving quality of life and prolonging survival. Research has demonstrated that the active constituents of traditional Chinese medicine, including polysaccharides, saponins, flavonoids, alkaloids, and lactones, can modulate the expression of pro-apoptotic proteins such as Bax, Bad, and Bim, while concurrently downregulating the expression of anti-apoptotic proteins Bcl-2, Bcl-xL, and Bcl-W. This modulation disrupts the mitochondrial architecture of GC cells by influencing GC-related signaling pathways. Additionally, these active ingredients decrease mitochondrial membrane potential, activate the caspase cascade, and ultimately induce mitochondrial apoptosis in GC cells, thereby inhibiting the progression of gastric cancer. This paper provides a comprehensive summary of recent studies on the treatment of GC using active components of TCM. Additionally, it offers an in-depth review of the anti-GC mechanisms, specifically focusing on the regulation of mitochondrial apoptosis by these active components. The objective is to furnish insights and references that could facilitate the development of novel therapeutic agents for the clinical management of GC.

R285.5

河南省重点研发与推广专项（科技攻关）项目（232102310280）；张仲景经方合方的临床应用及其作用机制研究项目（GZY-KJS-2022-041）；河南中医药学科领军人才项目（豫卫中医函[2021]8号）；河南省中医药科学研究专项课题（2023ZY2071）；河南省中医药科学研究专项课题（2021JDZX2003）