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类风湿性关节炎治疗中雷公藤的减毒增效措施的研究现状 被引量:15

Attenuation and Synergistic Effects of Tripterygium wilfordii in Treating Rheumatoid Arthritis
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摘要 雷公藤Tripterygium wilfordii系卫矛科雷公藤属植物,其药用历史悠久,应用广泛,被用于治疗类风湿性关节炎(rheumatoid arthritis,RA)。但雷公藤毒性较大,毒副作用限制了它的临床应用,主要表现在生殖系统、免疫系统、消化系统等。因此,开展雷公藤的减毒增效研究是十分必要的。本文通过查阅近年关于雷公藤及其制剂在类风湿性关节炎治疗中的研究文献,分别针对雷公藤的炮制减毒工艺,制剂剂型改良,复方中药配伍,联合西药和针灸配合等方面展开调研工作。雷公藤的炮制之法自古有之,主要有净制,羊血炮制,加热炮制,近年又出现了微博煨制及双向固体发酵等新方法,均能起到增效减毒的作用。雷公藤制剂剂型多样,多数口服后经肠道吸收,毒性较大,外用通过皮肤黏膜吸收毒性较小。因此通过剂型改良,可以有效减少药物对胃肠道的刺激时间,增强药物的吸收利用,增加生物利用度。常见剂型包括:栓剂,缓释片,滴丸剂和贴膏等。研究表明甘草配伍雷公藤,能加速雷公藤甲素等成分的代谢转换,降低毒性;配伍白芍能够减少肝损伤。合理的复方配伍也能降低雷公藤的毒副作用。除此之外,通过联合西药或配合针灸治疗均能对雷公藤起到减毒增效的作用。本文就以上几个方面,探讨了RA治疗中雷公藤的减毒增效措施进行整理归纳,以期能促进雷公藤在临床上治疗RA的有效应用。 Tripterygium wilfordii,as a type of Tripterygium specie of Celastraceae genus,has a long history and has been widely applied in treating rheumatoid arthritis( RA). However,T. wilfordii has a high toxicity and serious side effects in humans,such as in reproductive system,immune system and digestive system,which restricts its clinical application. Therefore,it is essential to study its attenuation and synergistic effects. In this study,literatures for T. wilfordiiand its preparations in treating RA in recent years were explored to develop its attenuation process,improve formulations and define the compatibility with compound traditional Chinese medicines and the combination with western medicines and acupuncture. There had been T. wilfordii processing methods since the ancient times,mainly including cleansing,sheep blood processing and heat processing; and there are many new processing methods,such as microwave heating and bi-directional solid fermentation techniques,in recent years. All of them can achieve the attenuation and synergistic effects. There are many kinds of T. wilfordii preparations. Specifically,oral drugs have a higher toxicology through intestinal absorption,while mucosal drugs had a lower toxicology. Therefore,improved formulations can effectively reduce the irritation time in gastrointestinal tracts and increase the absorption and bioavailability. Common formulations include suppository,sustained release tablet and pill. According to the study,the combination with Glycyrrhizae can accelerate the metabolic turnover of triptolide and reduce the toxicity of T. wilfordii,the combination with Paeonia sterniana Fletcher in Journ can reduce liver injury. Besides,the combination with western medicines and acupuncture can also achieve the attenuation and synergistic effects. In this study,the T. wilfordiiprocessing methods for the attenuation and synergetic effects were summarized in the expectation of promoting the effective application of T. wilfordiiin clinical application.
出处 《中国实验方剂学杂志》 CAS CSCD 北大核心 2015年第16期208-213,共6页 Chinese Journal of Experimental Traditional Medical Formulae
基金 国家"十二五"科技支撑计划项目(2011BAI01B05)
关键词 雷公藤 类风湿性关节炎 减毒增效 Tripterygium wilfordii rheumatoid arthritis attenuation and synergy
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