近40年雷公藤生殖毒性研究概述

Overview of reproductive toxicity studies on Tripterygium wilfordii in recent 40 years

该文总结了近40年来雷公藤生殖毒性的研究进展,并针对毒性表征、损伤机制及减毒措施等方面进行归纳分析,发现:①雷公藤的生殖毒性涉及雷公藤多苷/甙、雷公藤甲素和雷醇内酯等成分以及雷公藤片和雷公藤多苷片等制剂;②雷公藤制剂对男性生殖系统不良反应主要表现为精子活力下降、少精或无精,生育能力下降或不育等,长期用药还可能导致睾丸萎缩、性欲减退;对女性的不良反应主要表现为月经紊乱、经量减少甚至闭经、性欲减退、不孕等;③雷公藤的生殖毒性与生殖细胞凋亡、精子或卵子生成障碍、生殖靶组织睾丸及卵巢损伤、性腺组织内环境改变(激素、激素合成限速酶及能量代谢)等因素有关;④药物配伍、激素替代、用药时间和剂型改变等措施有助减轻雷公藤对生殖系统的损伤。针对目前研究存在的问题,作者从临床、药理代谢机制,制剂质量标准及新的治疗作用等方面提出了有利于雷公藤临床合理用药的建议。

This paper summarizes the research progress of reproductive toxicity of Tripterygium wilfordii from 1979,and the toxicity characterization,damage mechanism,and attenuated measures are summarized.It was found that,the reproductive toxicity caused by T.wilfordii is mainly distributed on components of Tripterygium glycosides,triptolide,tripchlorolide,and clinically preparations,such as Leigongteng Tablets and Tripterygium Glycosides Tablets.Adverse reactions to male reproductive system caused by Tripterygium preparations mainly include decreased sperm motility,oligospermia or spermatozoa,decreased fertility or infertility,etc.Long-term drug use may also lead to testicular atrophy and decreased sexual desire.Adverse reactions to women are mainly manifested as menstru-al disorders,decreased menstrual volume or even amenorrhea,decreased sexual desire,infertility,etc.The reproductive toxicity of T.wilfordii is related to apoptosis of reproductive cells,disturbance of spermatogenesis or oogenesis,damage of testis and ovary in re-productive target tissues,and changes of internal environment in gonad tissues(hormones,hormone synthesis rate-limiting enzymes and energy metabolism).Drug compatibility,hormone replacement,medication duration and dosage form changes can help reduce the damage of T.wilfordii to the reproductive system.In addition,in view of the existing problems in the current study,the author proposes new directions in clinical studies,pharmacological metabolism mechanism,preparation quality standards and new therapeutic effects,etc.,to provide a basis for the safe and reasonable clinical application of T.wilfordii.