注重新型冠状病毒肺炎(COVID-19)治疗中药物性肝损伤的预警与保护

Pharmacovigilance and protective medication for drug-induced liver injury in treatment of COVID-19

2019年12月爆发的新型冠状病毒肺炎(COVID-19)疫情引发世界关注,现有数据基本证实,此病毒可经呼吸道飞沫和接触传播,且有传染性,临床表现多样,病情反复多变,有的起病时无明显发热、咽拭子病毒培养阴性,但可快速恶化,给科学救治和精准施治带来困难。目前临床常用西医治疗以抗病毒药物为主,激素等其他药物对症处理,重症予以体外膜肺氧合(ECMO)治疗为主,重要脏器功能支持和常规急救措施;中医药根据辨证论治在本次疫情中获得了较好的疗效。为了更好地提高中西药物治疗的有效性和安全性,运用文献挖掘、网络药理学等技术,在系统总结中西药物治疗有效性的基础上,从药物预警入手,总结了化学药应用过程中潜在的肝损伤作用,探讨了中药复方或中成药中有潜在肝损伤药味的肝毒作用网络和潜在路径靶点,以期为临床应用或联合应用时的规范使用、监测指标等警戒信息和必要的保肝治疗等方面提供用药安全与合理用药的参考。

The outbreak of COVID-19 coronavirus pneumonia in December 2019 has aroused great concern worldwide. At present, the COVID-19 coronavirus pneumonia is highly contagious, rapid and widespread. It has been reported that COVID-19 virus is spread by respiratory droplets and direct contact transmission, and it has various clinical manifestations and recurrent is common. Some patients do not even appear obvious fever and have negative results for throat swab virus culture at the onset of the disease, but the rapid deterioration in their clinical condition usually occurred, which bring difficulties to scientific diagnosis and treatment. At present, western medicine treats most patients with anti-viral drugs, hormones and other drugs, or treats critically ill patients with ECMO oxygenation, important organ function support and other emergency treatments. Traditional Chinese medicine(TCM) based on syndrome differentiation and treatment has obtained curative effects in this outbreak. In order to improve the effects and safety of Chinese and western drug therapy, we applied literature-mining method and network pharmacology, summarized the potential liver injury during the application of western medicine and discussed hepatotoxicity networks and potential pathway targets of ingredients in Chinese patent medicine and Chinese herbal compound. This study not only summarizes essential information regarding potential drug-induced liver injury and biomarkers for pharmacovigilance, but also provides insights for liver protection by TCM or TCM in combination with western medicine in the treatment of novel coronavirus.