青蒿琥酯的药代动力学以及相关药理作用研究进展

Research progress on pharmacokinetics and pharmacological activities of artesunate

青蒿琥酯(artesunate, AS),是一种青蒿素的衍生物,作为全新结构抗疟药,具有高效、速效、低毒、不易产生耐受等特点,当前全球用于轻微到严重的疟疾感染的基础治疗。越来越多的研究报告显示AS与其活性代谢产物二氢青蒿素(dihydroartemisinin,DHA)除抗疟以外具有多种生物活性,吸引研究者对其新药理作用的进一步研究以期老药新用。然而对于AS的药物动力学特征的全面了解,将有利于AS的新药理作用的深度开发以及临床应用。因此,该文综述了AS的吸收、分布、代谢、排泄的体内过程,以及目前临床应用AS经静脉给药、肌肉注射、口服以及直肠给药等不同给药途径后AS和活性代谢物DHA的药代动力学特征;比较了AS在健康志愿者、疟疾患者、特殊人群(儿童、妇女)等不同人群中的AS和DHA的体内过程和药代动力学参数。同时,也综述了AS和活性代谢物DHA在抗肿瘤、抗炎、抗脓毒症、抗血管生成、抗纤维化以及免疫调节等方面的药理作用新进展,旨在为进一步合理开发利用AS及其代谢产物提供一定的理论依据。

Artesunate(AS), a famous derivative of the artemisinin, is the basic treatment globally for mild to severe malaria infection due to the prominent advantages such as high efficiency, fast effect, low toxicity and not easy to produce resistance. More and more research reports have shown that AS and its active metabolites dihydroartemisinin(DHA) had various bioactivities in addition to antimalarial activity, attracting researchers to further study its new pharmacological effects in order to explore new use of the old drug. A comprehensive understanding of the pharmacokinetic characteristics of AS will be conducive to the further development of new pharmacological actions and clinical application of AS. Therefore, this paper would review the absorption, distribution, metabolism and excretion of AS in vivo, as well as the pharmacokinetics characteristics of AS and DHA after clinical administration of AS by intravenous(IV), intramuscular(IM), oral or rectal routes. The in vivo process and pharmacokinetic parameters of AS and DHA were compared between healthy volunteers, malaria patients, and special populations(children, women). Meanwhile, the research progress on pharmacological effects of AS and active metabolite DHA such as anti-tumor, anti-inflammatory, anti septic, antiangiogenic, anti-fibrosis and immunoregulation activities would be also reviewed, hoping to provide a theoretical basis for the further development and utilization of AS and its metabolites.