新型冠状病毒肺炎治疗中应关注肝损伤及防治中(4)
我国的传统中医药在预防和治疗肝损伤方面的应用历史悠久,具有多组分、多靶点起效,不良反应较小等特点,因而备受临床青睐。近年来,大量药理研究也表明,如水飞蓟、甘草、苦参等中草药或相关复方制剂,均有不同程度的抗炎、抗纤维化、保护肝细胞等功效,临床应用可改善患者的肝脏生化指标。本文提示中药可能在COVID-19治疗过程中在肝损伤的防治方面起到积极作用,并应在治疗早期即给予保肝干预,值得临床探索。
[1]Chen N,Zhou M,Dong X,et and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan,China:a descriptive study[J].The Lancet,2020,395():391-393.
[2]国家卫生健康委员会.新型冠状病毒感染的肺炎诊疗方案(试行第五版)[EB/OL].(2020-02-05)[2020-02-04].
[3]Chan HL,Kwan AC,To KF,et significance of hepatic derangement in severe acute respiratory syndrome[J].World J Gastroenterol,2005,11(14):2148-2153.
[4]中华医学会,中华中医药学会.传染性非典型肺炎(SARS)诊疗方案(续)[J].现代实用医学,2004,16(3):172-183.
[5]郭伟锋,梁彦彦.中药治疗病毒性肝炎的疗效观察[J].中国医药指南,2011,9(31):184-185.
[6]Chai X,Hu L,Zhang Y,et ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection[J].bioRxiv,(2020-02-15)[2020-01-13].
[7]Roberts S K,Larusso of biliary epithelia[J].Biochimica Et Biophysica Acta,1994,10(5):526-533.
[8]Aizarani N,Saviano A,Mailly L,et al.A human liver cell atlas reveals heterogeneity and epithelial progenitors[J].Nature,2019,572(7768):199-204.
[9]Hao H,Cao L,Jiang C,et X Receptor Regulation of the NLRP3 Inflammasome Underlies Cholestasis-Associated Sepsis[J].Cell Metab,2017,25(4):856-867.
[10]Robertson H,Kirby JA,Yip WW,et epithelial-mesenchymal transition in posttransplantation recurrence of primary biliary cirrhosis[J].Hepatology,2007,45(4):977-981.
[11]Wallace K,Burt AD,Wright M C.Liver fibrosis[J].Biochem J,2008,411(1):1-18.
[12]王伯瑶,黄宁,吴琦.炎性反应Toll信号传导通路[J].中国病理生理杂志,2000,16(6):567-571,576.
[13]Lee LK,Bryant KJ,Bouveret R,et inhibition of human group IIA-secreted phospholipase A2 (hGIIA) signaling revealsarachidonic acidmetabolism is associated with colocalization ofhGIIA to vimentin in rheumatoid synoviocytes[J].J Biol Chem,2013,288:-.
[14]梁丽,毕倩,董金材,等.具有保肝作用的天然药物开发进展[J].生物资源,2018,40(2):148-158.
[15]Ikeda T,Abe K,Kuroda N.The inhibition of apoptosis by glycyrrhizin in hepatic injury induced by injection of lipopolysaccharide/D-galactosamine in mice[J].Arch Histol Cytol,2008,7(3):163-178.
[16]Dai JP,Wu LQ,Li R,et of23-(S)-2-Amino-3-Phenylpropanoyl-Silybin as an Antiviral Agent for Influenza A Virus Infection In Vitro and In Vivo[J].Antimicrob Agents Chemother,2013,57(9):4433-4443.
[17]Radek G,Kate P,Marhol P,et and antiviral activities of silybin fatty acid conjugates[J].Eur J Med Chem,2010,45(3):1059-1067.
[18]水飞蓟制剂肝病临床应用专家委员会.水飞蓟制剂肝病临床应用专家共识[J/CD].中华实验和临床感染病杂志(连续型电子期刊),2016,10(5):517-521.
[19]Lee CH,Park SW,Kim Mechanism of Glycyrrhizin on Acute Liver Injury Induced by Carbon Tetrachloride in Mice[J].Biol Pharm Bull,2007,30(10):1898-1904.
[20]甘草酸制剂肝病临床应用专家委员会.甘草酸制剂肝病临床应用专家共识[J].临床肝胆病杂志,2016,32(5):844-852.
[21]张明发,沈雅琴.氧化苦参碱治疗肝纤维化的临床评价研究进展[J].药物评价研究,2019,42(12):2484-2491.
[22]桑秀秀,王睿林,韩延忠,等.氧化苦参碱通过免疫调节保护刀豆蛋白A诱导的小鼠免疫性肝损伤[J].中国实验方剂学杂志,2017,23(6):125-130.
[23]陈德永,郝延如.苦参素(沃森干泰)软胶囊治疗慢性病毒性肝炎的优势[J].传染病信息,2005,18(z1):57.
[24]李剑瑜,刘鹏年,张霞,等.三七皂甙Rg1、Rb1对肝纤维化大鼠线粒体DNA三磷酸腺苷酶6、8亚基的作用机制研究[J].环球中医药,2014,7(8):591-595.
[25]黄梅,童彩玲,李本珊.三七对三苯氧胺相关肝损伤影响的临床研究[J].新中医,2011,43(3):39-41.
[26]韦维,黄永秩,梁柳丹,等.三七有效成分对免疫性肝损伤的保护作用[J].天津医药,2014,42(9):893-895.
[27]任龙海,乐瑛,陈林,等.三七皂苷促进急性肝功能衰竭大鼠肝脏修复的实验研究[J].中国药业,2007,16(15):20-21.
[28]禹白絮.三七总皂苷对肝细胞保护作用机理[J].医学信息,2014,27(2):132-133.
[29]Zhong H,Wu H,Bai H,et al.Panax notoginseng saponins promote liver regeneration through activation of the PI3K/AKT/mTOR cell proliferation pathway and upregulation of the AKT/Bad cell survival pathway in mice[J].BMC Complem Altern Medicine,2019,19(1):122-130.
[30]中国中西医结合学会肝病专业委员会.肝纤维化中西医结合诊疗指南(2018年版)[J].现代医药卫生,2019,35(15):2424.
文章来源:《中药药理与临床》 网址: http://www.zyylylc.cn/qikandaodu/2020/1023/362.html