中药抗幽门螺杆菌作用机制研究进展

Anti-Helicobacter pylori Mechanism of Chinese Medicine:A Review

幽门螺杆菌(Hp)是一种螺旋形、微需氧革兰氏阴性菌,已被世界卫生组织列为Ⅰ类致癌物,与多种消化系统疾病密切相关。随着抗生素治疗的普遍化,Hp耐药成为Hp根除治疗失败的主要原因。目前已发现多种中药具有抗Hp的作用,有望成为根除Hp的新选择。结合近年来国内外相关文献,总结归纳中医对Hp感染的认识,从直接杀灭和间接抑杀两个方面阐述中药抗Hp作用机制。通过抑制Hp生长、呼吸及代谢过程,破坏Hp形态结构,抑制Hp生物膜形成直接杀灭Hp;通过降低Hp黏附与定植,调节Hp相关免疫反应,抑制Hp相关炎症作用,抑制Hp氧化应激与胃黏膜损伤间接抑杀Hp。其中,间接抑杀Hp通过降低Hp运动活力,抑制脲酶活性及相关基因的表达,抑制黏附蛋白生成从而降低Hp黏附与定植;通过增强机体产生的免疫保护反应,调节溶酶体功能,调节免疫细胞因子,避免Hp引起的免疫逃避机制及调节免疫与炎症之间的平衡调节Hp相关免疫反应;通过抑制炎性细胞因子释放,抑制毒力因子表达,调节炎症治疗靶点与信号通路而抑制Hp相关炎症反应;通过诱导抗氧化酶和氧化酶活性,调节活性氧和活性氮的生成,抑制炎性介质途径避免机体氧化损伤。文章系统整理中药抗Hp的作用机制,旨在为中医药抗Hp研究及临床合理应用提供理论基础和科学依据。

Helicobacter pylori(Hp),a spiral-shaped microaerophilic Gram-negative bacterium that has been classified as a class Ⅰ carcinogen by the World Health Organization,is associated with a variety of digestive system diseases. With the popularization of antibiotic therapy,Hp resistance has become the main reason for the failure of the eradication treatment of Hp. A variety of Chinese medicines have been proved to have anti-Hp effects,which are expected to serve as new options for the eradication of Hp. By reviewing the recent literature in China and abroad,we summarized the understanding of Chinese medicines in the treatment of Hp infection and elaborated on the mechanisms from two aspects:direct killing and indirect inhibition. On the one hand,Chinese medicines can directly kill Hp by inhibiting the growth,respiration,and metabolism of Hp,destroying the morphological structure of Hp,and inhibiting the formation of Hp biofilm. On the other hand,Chinese medicines can inhibit Hp by reducing Hp adhesion and colonization,regulating Hp-caused immune response,inhibiting Hp-caused inflammation,and alleviating the Hp-caused oxidative stress and gastric mucosal injury. Specifically,the indirect inhibition of Hp can be achieved via the following ways. Chinese medicines can reduce Hp adhesion and colonization by reducing Hp motility,inhibiting urease activity and the expression of related genes,and decreasing the production of adhesion proteins. They can regulate the Hp-caused immune responses by enhancing the immune protective response,modulating lysosomal function and immune cytokines,avoiding the immune evasion of Hp,and maintaining the balance between immunity and inflammation. Chinese medicines can inhibit Hp-caused inflammatory responses by inhibiting the release of inflammatory cytokines,down-regulating the expression of virulence factors,and regulating the targets and signaling pathways in the treatment of inflammation. In addition,Chinese medicines can alleviate the Hp-caused oxidative stress and gastric mucosal injury by improving the activities of antioxidant enzymes and oxidases,regulating the generation of reactive oxygen species and reactive nitrogen, and inhibiting inflammatory mediators. This article systematically introduces the mechanisms of Chinese medicines against Hp,aiming to provide a theoretical and scientific basis for the research and clinical application of Chinese medicines against Hp.