中药对阿霉素肾毒性的作用  

Research Progress of Chinese Medicinals on Adriamycin-Induced Nephrotoxicity

作　　者：余寒祎 周恩超[1] YU Hanyi;ZHOU Enchao(Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,Jiangsu,China,210000)

机构地区：[1]南京中医药大学附属医院,江苏南京210000

出　　处：《河南中医》2024年第10期1611-1620,共10页Henan Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81873270)。

摘　　要：阿霉素是常用的抗肿瘤药物,但临床使用阿霉素会对机体产生多种毒性损伤。改善阿霉素肾毒性的中药提取物有黄芪水提物、茵陈水提物、虎杖提取物、黄蜀葵花水乙醇提取物、白茅根乙酸乙酯提取物等;改善阿霉素肾毒性的中药复方有:真武汤、越婢汤、肾炎消白颗粒、健脾清化方、温阳化浊方、右归丸等;改善阿霉素肾毒性的中药活性成分如黄酮类、多糖类、多酚类、皂苷类、生物碱类和萜类等。经过汇总分析发现,目前中药防治阿霉素肾毒性的研究还存在着一些不足之处如:(1)用阿霉素造模时,大鼠的品系、性别、年龄、来源、给药方式、次数及剂量,都会直接影响该模型的成模率和稳定性,从而影响阿霉素对肾组织的损伤程度,进而影响后期对所研究中药的药效评价。(2)有些研究仅仅局限于阿霉素肾病大鼠模型,观察指标限于临床生化指标及肾脏组织病理学表现,对于小管细胞、足细胞等肾脏固有细胞没有过多的研究,因此无法判断中药对于足细胞病变乃至对各种蛋白介导的分子机制的影响,从而影响后续深入研究的开展。(3)目前中药防治阿霉素毒性的研究仍停留在动物及细胞实验阶段,而临床研究较为匮乏,临床实践性尚不明确。(4)现有的实验研究缺乏大量高质量的多维度作用机制研究,如蛋白组、基因组以及肠道菌群等和分子生物学等多维度多层次研究,许多研究还停留在表浅的阶段。(5)大部分研究关注的焦点是中药对阿霉素肾毒性的治疗作用,很少关注其对肿瘤细胞的影响,及其协同作用。后续的研究可针对以下方面进行:第一,应加强对阿霉素肾病大鼠模型的研究,运用现代药理学等手段进行多方向、对比性的实验,建立完整的实验操作流程,并进一步明确模型的评价标准,针对不同的中药提取物、中药复方、中药活性成分进行多项对照试验,�Adriamycin(ADR)is a commonly used antitumor drug,but its clinical use can lead to various toxic injuries in the body.Chinese medicinal extracts that have shown potential in alleviating ADR-induced nephrotoxicity include aqueous extracts of Huangqi(Radix Scutellariae),Yinchen(Herba Artemisiae Scopariae),Huzhang(Rhizoma Polygoni Cuspidati),water-ethanol extracts of Huangshukuihua(Abelmoschus Moschatus),and ethyl acetate extracts of Baimaogen(Rhizoma Imperatae).Compound formulas of Chinese medicinals such as True Warrior Decoction,Maidservant from Yue Decoction,Shenyan Xiaobai Granules,Spleen-Invigorating and Clearing and Resolving Formula,Yang-Warming and Turbidity-Resolving Formula,Right-Restoring Pill,etc.have also been noted for improving ADR nephrotoxicity.Active components from these,such as flavonoids,polysaccharides,polyphenols,saponins,alkaloids,and terpenes,etc.play a crucial role as well.However,after summarizing and analyzing the current research on the prevention and treatment of ADR nephrotoxicity with Chinese medicinals,several shortcomings have been identified as follows:(1)When modeling with ADR,factors such as strain,gender,age,source,administration route,frequency,and dosage in rats directly impact the modeling success rate and stability,which in turn affects the degree of kidney damage caused by ADR and subsequently the efficacy evaluation of the studied Chinese medicinals.(2)Some studies are limited to rat models with ADR nephropathy,focusing only on clinical biochemical indicators and pathological changes in kidney tissues.There is insufficient research on intrinsic renal cells like tubular cells and podocytes,making it difficult to assess the impact of Chinese medicinals on podocyte lesions and various protein-mediated molecular mechanisms,thus hindering further in-depth research.(3)Current studies on Chinese medicinal prevention and treatment of ADR toxicity remain at the animal and cell experimental stages,with clinical research being relatively scarce and practical application still unclear

关 键 词：阿霉素 肾毒性 中药提取物 中药复方 中药活性成分 

分 类 号：R284.2[医药卫生—中药学]