中医药在新型冠状病毒肺炎炎症损伤中的作用研究进展

Progress on the role of Traditional Chinese Medicine in inflammatory injury of COVID-19

新型冠状病毒肺炎(NCP)是一种由COVID-19引起的感染性呼吸道疾病.炎性风暴(也称为细胞因子风暴)在COVID-19诱导的肺损伤中起重要作用,并且是导致NCP患者病情加重甚至死亡的核心病理因素.促炎性细胞因子的过度表达和释放将导致组织损伤.研究表明,对炎性损伤的干预可能是中医药治疗NCP的重要机制之一.临床研究发现,对NCP患者进行中医药早期干预可以显著缓解体征和症状,缩短病程,降低患者进入严重期的可能性,并降低病死率.通过对《新型冠状病毒肺炎诊疗方案(试行第八版)》及已发表文献的分析发现,中医药对NCP患者炎性损伤的调控通过多靶点实现.一方面,一些中药对病毒的增殖具有直接作用;另一方面,某些中药通过调节免疫细胞的功能,减少促炎细胞因子的产生,同时增加抗炎介质的分泌而重构机体免疫平衡.NCP的流行尚未结束,世界仍在遭受COVID-19病毒的攻击.本文旨在综述中医药对COVID-19诱导的炎症反应的作用及其机制,以期为临床和科研工作者提供资料帮助.

Novel coronavirus pneumonia is an infectious respiratory disease induced by a novel coronavirus,named COVID-19.At present,novel coronavirus pneumonia is widely spread around the world,with the characteristics of long incubation time,strong contagion,rapid progress,and high fatality rate.Inflammatory storm,also known as cytokine storm,has been found to play an important role in COVID-19 induced lung injury,and is believed to be one of the core pathological factors leading to exacerbation and even death of novel coronavirus pneumonia patients.It is found that over-expression and release of pro-inflammatory cytokines such as IL-6 will lead to self-attack and aggressive inflammatory response,and finally cause tissue damage.Studies have shown that the intervention of inflammatory injury may be one of the important mechanisms that contribute to therapeutic effect of Traditional Chinese Medicine against COVID-19.Clinical studies found that early intervention with Traditional Chinese Medicine in novel coronavirus pneumonia patients could significantly alleviate signs and symptoms,shorten course of the disease,decrease possibility of the patients progressing into severe stage,slow or even block the outbreak of inflammatory storm in the patient’s body,improve cure rate,reduce mortality,relieve sequelae,and promote the recovery of the patients in the recovery period.Through analyzing the representative prescription of Traditional Chinese Medicine in the Eighth Edition of the Diagnosis and Treatment Scheme for COVID-19,we found the regulation on the inflammatory injury by Traditional Chinese Medicine is realized in a multitarget manner.On the one hand,some Chinese Medicines are exhibited with direct effects against proliferation of the virus;on the other hand,some Chinese Medicines are shown with ability to re-balance the immune system via regulating function of immune cells,decreasing production of pro-inflammatory cytokines while increasing secretion of anti-inflammatory mediators.The epidemic of novel coronavirus pneumonia has not yet ended,and the world is still under the attack of COVID-19 virus.Although previous studies have found that certain ingredients in Traditional Chinese Medicine,such as astragalin,astragaloside IV,platycodin and wogonin,etc.,as well as Traditional Chinese Medicine prescription including Qingfei Paidu Decoction,Huashibaidu Decoction,etc.,can control inflammatory injury,their specific mechanism and the material basis still need to be studied in depth.On the other hand,the objective indicator of Traditional Chinese Medicine for patients with different syndromes still needs to be further clarified to facilitate its promotion in clinic.The integration of Traditional Chinese Medicine and western medicine has been proved to be more effective in inhibiting the development of novel coronavirus pneumonia,but the role of Traditional Chinese Medicine in the integrative therapy still needs to be further explored.Although there is still a lot of work to be carried out,the advantage of early intervention with Traditional Chinese Medicine against COVID-19 virus has been verified in both clinical and experimental studies.This paper aims to review mechanism and treatment strategy of Chinese Medicine on COVID-19 induced inflammation,and provide references for researchers in related area.