壮骨关节丸致肝损伤的研究进展  

Research progress in liver injury induced by Zhuanggu Guanjie pills

作　　者：熊殷 吴嘉瑞[2] 张程亮 XIONG Yin;WU Jia-rui;ZHANG Cheng-liang(School of Pharmacy,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030;School of Chinese Materia Medica,Beijing University of Chinese Medicine,Beijing 100102;Department of Pharmacy,Tongji Hospital Affiliated with Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030)

机构地区：[1]华中科技大学同济医学院药学院,武汉430030 [2]北京中医药大学中药学院,北京100102 [3]华中科技大学同济医学院附属同济医院药学部,武汉430030

出　　处：《中南药学》2019年第12期2084-2087,共4页Central South Pharmacy

基　　金：国家自然科学基金资助项目（No.81670521）

摘　　要：壮骨关节丸是临床应用广泛的中成药,较多应用于骨外科各种疾病。近年来有关其致肝损伤的病例报道逐渐增加,并被国家药品不良反应监测中心两次通报。有研究发现壮骨关节丸致肝损伤为免疫应激介导的特异质肝损伤,且肝损伤类型多为胆汁淤积型,其机制与免疫炎症反应和影响肝脏代谢有关。壮骨关节丸为复方制剂,经毒性药味筛选发现补骨脂、淫羊藿、乳香没药和木香等单味药材具有一定肝毒性。临床工作者应在合理的炮制、特殊人群用药、用药疗程、辨证论治等方面对壮骨关节丸给予重视,以提高其用药安全性。本文综述壮骨关节丸致肝损伤的临床特征、毒性筛选和机制的研究进展,并对炮制减毒与临床合理用药提出建议。Zhuanggu Guanjie pill(ZGP)is a widely used Chinese patent medicine for various orthopedic diseases.In recent years,reports of liver damage induced by ZGP have increased.The National Center for Adverse Drug Reaction Monitoring has also alerted its liver toxicity twice.The liver injury induced by ZGP was found to be immune stress-mediated idiosyncratic liver injury,and mostly cholestasis.The mechanism was related to the immune inflammatory reaction and effects on the activity of CYP450.As a compound preparation,Psoralea corylifolia,Epimedii Herba,Frankincense,Myrrh and Radix Aucklandiae in the pills may possess certain hepatotoxicity according to toxic herbal medicine screening.Clinicians should focus on reasonable processing of ZGP,medication and course for special population,syndrome differentiation,etc.,to improve the safety of medication use.This article reviewed the clinical features,toxicity screening and mechanism research of liver injury induced by ZGP,and proposed suggestions for toxicity attenuation in processing and rational drug use.

关 键 词：壮骨关节丸 特异质肝损伤 胆汁淤积型肝炎 

分 类 号：R285.1[医药卫生—中药学]