升降散治疗全身炎症反应综合征的研究进展

Research Progress of Shengjiangsan in Treating Systemic Inflammatory Response Syndrome

升降散记载于清代医著《伤寒瘟疫条辨》。该方由僵蚕、蝉蜕、姜黄、大黄4味药组成,药简功繁,既可理气,又能透邪。近些年来,围绕此方的作用机制研究不断扩展与深化。根据收集的资料显示,升降散被广泛应用于临床多种疾病的治疗。全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的概念在20世纪90年代首次被提出,是指感染或非感染因素引起机体内自我放大的级联炎症反应与炎症因子风暴所造成的的病理生理状态。近年来,SIRS的治疗逐渐成为时下的重点与热点。严重急性呼吸道综合征(severe acute respiratory syndrome,SARS),新型冠状病毒肺炎(novel coronavirus pneumonia,COVID-19)重症患者常因SIRS进展成多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)乃至多器官功能衰竭(multiple organ failure,MOF)而死亡。白细胞介素-1受体拮抗剂、抗缓激肽、血小板活化因子受体拮抗剂等治疗SIRS的临床常用药物均未取得令人满意的效果,故寻找改善SIRS状态的药物迫在眉睫。在SARS,COVID-19的中医诊疗方案中,升降散作为初期用药被推荐使用,其抗病毒作用可能与阻止SIRS向MODS转化有关。药理学研究表明,升降散可以对SIRS免疫失衡的调控平衡,是通过干预多种炎症因子及其信号传导通路来实现的。时下有关升降散治疗SIRS的研究报道较少,故对升降散的理论梳理及其治疗SIRS的临床研究与药理学机制进行探讨,以期为临床实践与实验研究开阔思路。

Shengjiangsan was recorded in a medical book Treatise on Cold-induced Disorders and Plague written in the Qing Dynasty. This prescription,consisting of four drugs:Bombyx,cicada slough,Turmeric and Rhubarb,is simple but effective in regulating Qi and eliminating pathogenic factors. In recent years,the researches on the mechanism of this prescription have been continuously expanded and deepened.According to the collected data,Shengjiangsan is widely used in the treatment of various clinical diseases. The concept of systemic inflammatory response syndrome(SIRS)was first proposed in the 1990s,and it refers to the pathophysiological state caused by self-amplified cascade inflammatory response and inflammatory factor storm arising from infectious or non-infectious factors. In recent years,the treatment of SIRS has gradually become the current focus and hotspot. Patients with severe acute respiratory syndrome(SARS)and novel coronavirus pneumonia(COVID-19)often die from SIRS progression to multiple organ dysfunction syndrome(MODS)or even multiple organ failure(MOF). Interleukin-1 receptor antagonist,anti-bradykinin,platelet activating factor receptor antagonist and other commonly used drugs in clinical treatment of SIRS have not achieved satisfactory results,so it is urgent to find drugs to improve SIRS status. Shengjiangsan is recommended as an initial prescription in traditional Chinese medicine diagnosis and treatment plan for SARS and COVID-19,and its antiviral effect may be related to preventing SIRS from transforming into MODS. Pharmacological studies have shown that Shengjiangsan can regulate the immune imbalance of SIRS to achieve a balance by intervening various inflammatory factors and their signaling pathways. At present,there are few reports on the treatment of SIRS with Shengjiangsan. Therefore,the theoretical analysis of Shengjiangsan and its clinical research and pharmacological mechanism in the treatment of SIRS are discussed here to broaden the thinking for clinical practice and experimental research.