雷公藤消化系统损伤及其减毒增效研究进展

Digestive System Injury Induced by Tripterygium wilfordii and How to Reduce Toxicity and Enhance Efficacy:A Review

雷公藤在治疗免疫性疾病方面应用广泛且疗效显著,临床最常用活性成分以雷公藤甲素、雷公藤多苷居多,但其治疗窗口狭窄,不良反应多,损伤涉及生殖系统、血液系统、心血管系统、消化系统等。临床观察结合文献总结,其不良反应症状表现在消化系统(肝、胃肠)居多。相关学者对雷公藤所致肝损伤表现及诱发肝损伤机制已有较多研究,其机制主要与肝细胞凋亡、诱导氧化应激、免疫损伤、肝细胞过度自噬、脂肪酸代谢异常、肝组织内酶代谢异常相关。该文对雷公藤致胃肠损伤也进行了相关文献查阅与总结,但不良反应表现及机制研究较少,尚待学者们进一步深入研究。另外,文章对雷公藤制剂在消化系统方面减毒增效研究也进行了相关总结,主要涉及配伍西药(甲氨蝶呤、来氟米特、艾拉莫德等)减毒、单用或配伍中药(单味药、中药单体、中药复方)减毒、针灸(电针、艾灸)减毒、剂型改良(二元醇质体凝胶、自溶性微针、固体脂质纳米粒、胃漂浮缓释胶囊等)减毒、炮制(蒸制、清炒、莱菔子炮制、金钱草炮制、甘草炮制等)减毒等方法。综上,该文通过整理相关文献,对雷公藤致肝损伤及胃肠损伤不良反应表现、机制、减毒增效方法进行分析,以期为临床雷公藤应用提供参考,并为未来雷公藤致消化系统损伤的深入研究提供部分研究思路。

Tripterygium wilfordii is widely used in the treatment of immune system disease and has a remarkable curative effect.Triptolide and Tripterygium glycosides are the most commonly used active ingredients in clinical practice,but their treatment window is narrow and there are many side effects.The damage involves the reproductive system,blood system,cardiovascular system,digestive system,etc.Based on clinical observations and literature summaries,the symptoms of adverse reactions mostly occur in the digestive system(liver and gastrointestinal tract).Relevant scholars have launched a lot of studies of the manifestations of liver injury induced by T.wilfordii and the mechanism of liver injury.The mechanism is mainly related to liver cell apoptosis,induction of oxidative stress,immune injury,excessive autophagy of liver cells,abnormal fatty acid metabolism,and abnormal enzyme metabolism in liver tissues.This article reviewed and summarized relevant literature on gastrointestinal injury caused by T.wilfordii,but there are few studies on the manifestations and mechanisms of adverse reactions,which still need further research by scholars.In addition,this article also summarized the research on how to reduce toxicity and enhance efficacy of prescriptions prepared from T.wilfordii in the digestive system,mainly involving compatibility with western medicines(Methotrexate,Leflunomide,Iguratimod,etc.),use along or combination with Chinese medicines(single Chinese medicine,Chinese medicine monomers,and Chinese medicine compounds),acupuncture and moxibustion(electroacupuncture and moxibustion),dosage form improvement(glycol plastid gel,self-dissolving microneedle,solid lipid nanoparticles,gastric floating sustained-release capsules,etc.),processing(steaming,stir-frying,radish seed processing,money grass processing,licorice processing,etc.),and other methods to reduce toxicity.To sum up,this article analyzed the manifestations,mechanisms,and methods of reducing toxicity and enhancing efficacy of T.wilfordii-induced liver injury and gastrointestinal injury by sorting out relevant literature,in order to provide a reference for the clinical application of T.wilfordii and some research ideas for the future in-depth study of T.wilfordii-induced digestive system injury.