大承气汤在脑卒中治疗中的药效物质与作用机制研究进展  

Pharmacodynamic Substances and Mechanisms of Da Chengqitang in Treating Stroke:A Review

作　　者：严易之 柳心怡 段阳 龙淼青 李超亚 李强 陈怡安 杨莎莎 张月 曾鹏 YAN Yizhi;LIU Xinyi;DUAN Yang;LONG Miaoqing;LI Chaoya;LI Qiang;CHEN Yi'an;YANG Shasha;ZHANG Yue;ZENG Peng(School of Basic Medical Sciences,Hengyang Medical School,University of South China,Hengyang 421001,China;Chenzhou No.1 People's Hospital,Chenzhou 423000,China)

机构地区：[1]南华大学衡阳医学院基础医学院,湖南衡阳421001 [2]郴州市第一人民医院,湖南郴州423000

出　　处：《中国实验方剂学杂志》2025年第9期297-306,共10页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：湖南省自然科学基金青年项目(2023JJ40560);湖南省大学生创新训练计划项目(S202210555238,S202410555234,S202410555259,S202410555262);2023年度肾病发生与干预湖北省重点实验室开放基金立项项目(2023SB101)。

摘　　要：脑卒中是我国成年人死亡和残疾的主要原因,具有发病率高、致残率高、死亡率高和复发率高的特点。中西医结合治疗脑卒中及其后遗症潜力巨大,中医经典名方大承气汤治疗脑卒中历史悠久、疗效确切。临床上大承气汤常用于治疗脑卒中及其后遗症,但大承气汤治疗脑卒中的临床试验的数量与质量都有待提高,同时其基础研究薄弱,有效成分不明、多靶点作用机制不清。该课题组前期证实大承气汤能有效逆转出血性脑卒中大鼠神经功能受损、减少铁沉积、下调促炎细胞因子水平,其机制与核转录因子红系2相关因子2(Nrf2)介导的信号通路、p38丝裂原活化蛋白激酶(p38 MAPK)信号介导的小胶质细胞激活有关。为阐明大承气汤药效基础、抗脑卒中机制作用机制,该文总结了大承气汤抗脑卒中的临床研究进展、药效物质基础、安全性评价及其入血成分治疗脑卒中机制研究进展。该文汇总了大承气汤的45种主要植物化学成分,其中11个是目前确证的入血成分,其中大黄素、大黄酸、大黄酚、芦荟大黄素、辛弗林、橙皮苷、柚皮苷、厚朴酚、和厚朴酚可作为大承气汤的质量标志物(Q-Marker)。大承气汤治疗脑卒中的作用机制复杂,包括调控炎症反应、神经元损伤、氧化应激、血脑屏障、脑源性神经营养因子、抗血小板聚集等。该文有助于深入理解大承气汤治疗脑卒中的药效基础与作用机制,为大承气汤抗脑卒中的临床应用与脑卒中的药物研发提供了理论依据。Stroke is the main cause of death and disability among adults in China and is characterized by high incidence,disability,mortality,and recurrence rates.The combination of traditional Chinese and Western medicine has great potential in treating stroke and its sequelae.The classic traditional Chinese medicine prescription Da Chengqitang(DCQT)has a long history and proven efficacy in treating stroke.Clinically,DCQT is often used to treat stroke and its sequelae.However,the number and quality of clinical trials of DCQT in treating stroke need to be improved.Because of the insufficient basic research,the active ingredients and multi-target mechanism of action of DCQT remain unclear.Our research group has previously confirmed that DCQT can effectively reverse neurological damage,reduce iron deposition,and downregulate the levels of pro-inflammatory cytokines in the rat model of hemorrhagic stroke.The treatment mechanism is related to the nuclear factor erythroid 2-related factor 2(Nrf2)-mediated signaling pathway and p38 mitogen-activated protein kinase(MAPK)signaling-mediated microglia activation.To clarify the pharmacodynamic basis and anti-stroke mechanism of DCQT,this article reviews the research progress in the treatment of stroke with DCQT in terms of clinical trials,pharmacodynamic material basis,safety evaluation,and mechanisms of absorbed components.This article summarizes 45 major phytochemical components of DCQT,11 of which are currently confirmed absorbed components.Among them,emodin,rhein,chrysophanol,aloe-emodin,synephrine,hesperidin,naringin,magnolol,and honokiol can be used as quality markers(Q-markers)of DCQT.The mechanism of DCQT in treating stroke is complex,involving regulation of inflammatory responses,neuronal damage,oxidative stress,blood-brain barrier,brain-derived neurotrophic factor,and anti-platelet aggregation.This article helps to deeply understand the pharmacodynamic basis and mechanism of DCQT in treating stroke and provides a theoretical basis for the clinical application of DCQT in trea

关 键 词：大承气汤 脑卒中 药效基础 质量标志物(Q-Marker) 作用机制 

分 类 号：R287[医药卫生—中药学] R285[医药卫生—中医学] R289