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广痛消有效成分含量测定及健康人体药代动力学研究
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摘要
研究背景及目的意义
     背景:肛肠科治疗的疾病主要包括:肛瘘、痔疮、直肠脱垂、直肠肛管周围脓肿、直肠癌、肛裂等,这些疾病通常需要通过手术才能达到根治的目的,但手术后常会出现疼痛、水肿、出血、感染、创面延迟愈合等并发症,针对这些并发症除针对性治疗外,术后换药成为治疗这些术后并发症、促进创面愈合的重要手段。目前临床上常用的剂型一般为痔疮膏、痔疮栓之类,这些传统的药物剂型通过肛门给药,直接作用于手术创面或直肠黏膜发挥抗炎、镇痛、消肿等作用,但也同时存在与病变部位接触面小、分布不均匀、易融化排出、药效持续时间短、生物利用度低等缺点。正是基于目前肛肠疾病术后换药所用剂型受限的现状,赵宝明教授根据中医基础理论结合肛肠疾病自身的发病特点研制出一种中药泡沫气雾剂——广痛消泡沫气雾剂,它除具备抗炎、消肿、解痉镇痛等功效外,还具有喷出物不流动,泡沫稳定、持续时间长,药物在病灶部位作用时间长,涂布面广,均匀分散在腔道内,药物能有效地渗入黏膜皱襞等优点,其疗效优于其他剂型,是一种极具研发价值的剂型。
     “广痛消”中的”广”即广肠,包括乙状结肠和直肠,如《证治要诀》云”广肠,言其广阔于大小肠也”,表明了广痛消泡沫气雾剂可以作用的部位;”痛消”阐明该药有镇痛功效;“泡沫气雾剂”点明了该药的剂型。“广痛消泡沫气雾剂”精炼地概括了该中药复方的使用部位、疗效和剂型。
     广痛消泡沫气雾剂先后在广安门医院肛肠科及实验室、东直门医院肛肠科及中心实验室、北京中医药大学中药学院、军事科学院和北医病理系的协助下完成了该药的提取工艺、药物质量标准、药效、剂型优势和药物安全性等方面的研究。其动物实验和临床研究历时20余年,有着深厚的研究基础。
     目的:尽管目前已完成了该泡沫气雾剂部分药效的研究,但尚存在药物在体内吸收、代谢的情况不明确,其发挥作用的机理不清楚等情况,故本课题通过测定延胡索、当归、厚朴、细辛、白芍、黄柏、茜草的有效成分含量及健康人体的药代动力学研究以期对阐述其组方原理,对新药开发,质量评价及指导临床合理用药提供参考,也为今后该泡沫气雾剂的机制研究奠定基础。
     实验前期曾采用高效液相色谱法检测广痛消水提物中有效成分,但存在提取物的药效成分相互干扰严重,无法进行准确的定量分析;一些有效成分含量低,无明显的响应信号;操作繁琐、灵敏度低、分析速度慢、多成分含量同时测定色谱条件摸索困难等问题,故改用液质联用(LC-MS/MS)。液质联用技术是以液相色谱作为分离系统,质谱为监测系统,样品在质谱部分和流动相分离,被离子化后,经质谱的质量分析器将离子碎片按质量数分开,经检测器得到质谱图。液质联用体现了色谱和质谱的优势互补,将色谱对复杂样品的高分离能力,与MS具有高选择性、高灵敏度及能够提供相对分子质量与结构信息的优点结合起来,在药物分析、食品分析和环境分析等许多领域得到了广泛应用。
     研究内容及结果
     一、广痛消水提物中5种有效成分的含量的测定
     目的:建立灵敏、快速、简便的液相色谱-串联质谱法测定广痛消水提物中主要有效成分(延胡索乙素、芍药苷、盐酸小檗碱、厚朴酚、和厚朴酚)的含量。
     方法:采用色谱柱:Agilent Eclipse Plus C18柱(100mm×2.1mm,3.5μm),流动相A:0.1%甲酸水,B:乙腈,梯度洗脱,柱温30℃。质谱条件:ESI离子源,正、负离子检测方式,干燥气温度300℃,干燥气体流量10L·min-1;雾化器压力30Pa;毛细管电压正离子4000V,负离子3500V,用于定量分析的离子反应m/z分别为芍药苷(m/z479.2→m/z121)、延胡索乙素(m/z356.2→m/z192.2)、盐酸小檗碱(m/z336.1→m/z320.2)、厚朴酚(m/z265.1→m/z247.1)、和厚朴酚(m/z265.2→m/z233.1)、内标布洛芬、消旋山莨菪碱监测离子对分别为m/z205.1→m/z161.1,m/z306.1→m/z140。
     结果:芍药苷、延胡索乙素、盐酸小檗碱、厚朴酚、和厚朴酚均得到精确的分析,线性范围分别为:0.8828125-113(r=0.9998);1.54375-49.4(r=0.9995);0.9046875-115.8(r=0.9997);0.88125-112.8(r=0.9994);0.165625-21.2(r--0.9999)。加样回收率分别为1.998%,1.14%,3.117%,1.828%,1.596%。
     结论:该方法灵敏度高、分析速度快、定性能力强、定量能力好,可同时测定广痛消水提物中5种主要有效成分含量。
     二、广痛消泡沫气雾剂直肠给药的健康人体药代动力学研究
     目的:建立快速、灵敏的液相色谱-串联质谱(LC-MS/MS)法直接测定健康人体血浆中延胡索乙素、盐酸小檗碱的含量,求取药动学参数。
     方法:血浆样品以丙酮沉淀蛋白,80%乙腈萃取,对广痛消水提物中5种有效成分含量测定的色谱、质谱条件进行微调,色谱柱:Agilent Eclipse Plus C18柱(100mm×2.1mm,3.5μm),流动相A:0.1%甲酸水,B:乙腈,0~lmin(B15%、0.2mL/min);1~2min(B15%~40%,0.3mL/min);2~7min(B40%~80%,0.3mL);7~8min (B80%~15%,0.3mL/min);8~10min(B15%,0.3mL/min);10~11min(B15%,0.2mL/min);12min(B15%,0.2mL/min)质谱条件:ESI离子源,正离子检测方式,干燥气温度300℃,干燥气体流量10L·min-1;雾化器压力30Pa;毛细管电压正离子4000V,监测离子对分别为盐酸盐酸小檗碱(m/z479.2→m/z121),延胡索乙素(m/z356.2→m/z192.2),内标消旋山莨菪碱(m/z306.1→m/zl40),自动进样盘温度15℃,柱温30℃,并进行了系统的方法学评价。
     结果:延胡索乙素和盐酸小檗碱在各自的生物样品浓度范围内,均呈良好线性,r>0.99;其各成分的线性范围分为:0.000594-1.188ng/mL,0.000536-1.072ng/mL,最低定量限为:0.000536ng/ml,日内、日间精密度均小于15%,提取回收率均大于85%,8名健康志愿者肛门给广痛消泡沫气雾剂后,延胡索乙素、盐酸小檗碱的主要药代动力学参数Tmax分别为:132.5±25.4951min和132.5±30.11881min,Cmax分别为:0.550738±0.300594ng/ml和0.3108±0.324596ng/ml, T1/2分别为69.37085±72.60998min和57.06471±39.74188min, AUClast分别为46.2976±27.85874min*ng/mL和28.25056±28.34036min*ng/mL,
     结论:该方法操作简单,效率高,选择性好,灵敏度高,可成功用于广痛消泡沫气雾剂的健康人体血浆的动力学研究。
Research background and objective
     Department of anorectal surgery usually treat diseases mainly include:anal fistula, hemorrhoids, rectum prolapse, rectum and anal canal abscess, rectal cancer, anal fissure, etc. These diseases usually need surgical treatment, But the pain, edema, hemorrhage, infection, delayed wound healing complications often appear after surgical treatments. The postoperative dressing changes become an important means to treat these postoperative complications and promote wound healing in addition to symptomatic treatments.At present, hemorrhoids ointment and hemorrhoids suppository are widely used to treat anorectal diseases, These drugs are supplied through the anus,They play an anti-inflammatory, analgesic, swelling by direct role in the surgical wound or the rectum mucosa. While there are small contact surface at the lesion site, uneven distribution, easy to melt and discharge, short duration of efficacy, low bioavailability. These are based on the above situation, Professor Zhao Baoming developed Guang TongXiao foam aerosol that based on the basic theory of TCM and combined with anorectal disease clinical characteristics,the foam aerosol can not only anti-inflammatory, swelling, relieve spasm and pain but also following advantages:the ejecta no flow, foam stable, long duration in the lesion site, coated with a wide range of uniformly dispersed in the lumen, effectively penetrate the mucosal folds, etc. It's more effective than other formulations,and is a great development potential of dosage form.
     GuangTongXiao foam aerosols is a kind of traditional Chinese medicine foam aerosols. Professor Zhao Baoming developed this foam aerosols that is based on the basic theory of TCM and combined with characteristics of anorectal diseases. It is consisted of corydalis, white peony root, rubia cordifolia and othe Chinese medicines, it has spasmolysis analgesia, anti-inflammatory, hemostasis and promote wound healing. Treatment tips say"guang", means small and large intestines;"Tongxiao" means this foam aerosols have analgesia efficacy. Foam aerosol illustrate the formulations of the herbal compound."GuangTongXiao foam aerosols" summed the site of action of the herbal compound, efficacy and dosage forms.The foam aerosol has been finished these researches such as the extraction process、quality standards. efficacy, dosage form advantages and drug security researches by the department of Anorectal Surgery and laboratory of Guang An Men Hospital, the Department of Anorectal Surgery and the central laboratory of Dongzhimen Hospital、 Beijing University of Chinese Medicine the Academy of Military Sciences and Department of Pathology of Peking University Health Science. It has strong research bases because the animal experiments and clinical studies lasted more than20years, but these efficacy reasons unclear, Therefore,this subject will lay the foundation for the future study of the mechanism and guide clinical medication by determination of the active ingredient contents and pharmacokinetic study of healthy volunteers.
     Research methods and contents
     1.To determine five effective components in the water extract of GuangTongXiao.In this study, using LC-MS/MS method determine simultaneously tetrahydropalmatine, paeoniflorin, berberine, magnolol and honokiol, The results show that The method is rapid and sensitive, attribute strong, This method can determine simultaneously five kinds of effective components. LC-MS/MS method for determining contents of tetrahydropalmatine, paeoniflorin, berberine, magnolol and honokiol, the ibuprofen, raceanisodamine act internal standard. Chromatographic conditions:chromatographic column(Agilent Eclipse Plus C18,100mm×2.1mm,3.5μm), mobile phase A:0.1%of formic acid, B:acetonitrile, gradient elution, the column temperature30℃. Mass spectrometer conditions:ESI ion source, the positive ion mode drying gas temperature300℃, gas flow10L-min-1; Nebulizer pressure30Pa; the capillary voltage positive ions4000V, Paeoniflorin tetrahydropalmatine berberine, magnolol, honokiol, ibuprofen and raceanisodamine monitoring of ion-pair479.2/121,356.2/192.2,336.1/320.2,265.1/247.1,265.2/233.1,205.1/161.1,306.1/140,they are all analysised accurately.Linear ranges:0.8828125-113(r=0.9998);1.54375-49.4(r=0.9995);0.9046875-115.8(r=0.9997);0.88125-112.8(r=0.9994);0.165625-21.2(r=0.9999). spike recovery1.998%,1.14%,3.117%,1.828%and1.596%.The results show that the method high sensitivity, fast analysis,while qualitative ability and quantitative ability good, the method can determine simultaneously five main active ingredient contents in GuangTongXiao aqueous extracts.
     2. To study pharmacokinetics of Guangtongxiao foam aerosols that act on healthy human.The health human pharmacokinetics of GuangTongXiao foam aerosols that is administrated by anal.Determining the concentrations of tetrahydropalmatine and berberine in healthy male plasma by LC-MS/MS, raceanisodamine act internal mark, protein of plasma samples was precipitated by acetone,80%acetonitrile extraction, Chromatographic conditions:chromatographic column(Agilent Eclipse Plus C18,100mm×2.1mm,3.5μm), mobile phase A:0.1%of formic acid, B:acetonitrile, gradient elution0~1min(B15%、0.2mL/min);1~2min(B15%~40%,0.3mL/min);2~7min(B40%~80%,0.3mL);7~8min (B80%~15%,0.3mL/min);8~10min(B15%,0.3mL/min);10llmin(B15%,0.2mL/min);12min (B15%、0.2mL/min) Mass spectrometer conditions: ESI ion source, the positive ion mode drying gas temperature300℃, gas flow10L-min-1; Nebulizer pressure30Pa; the capillary voltage positive ions4000V, monitoring of ion-pair are479.2/121,356.2/192.2,306.1/140, the autosampler temperature15℃, the column temperature30℃. methodology evaluation show the tetrahydropalmatine and berberine hydrochloride that in biological samples show a good linear r>0.99, The linear range of the respective components are0.000594-1.188ng/mL,0.000536-1.072ng/mL, Lowest limit of quantification is0.000536ng/ml, intraday precision and day precision are both less than 15%,The extraction recovery are both more than85%. The method is simple, high efficiency, good selectivity, high sensitivity, and can be used successfully in the study of the dynamics of human plasma thay contain GuangTongXiao foam aerosols, On this basis, a high sensitivity, specificity, and accurate LC-MS/MS method has been establed, two kinds of active ingredients in the foam aerosols are determined simultaneously, and research the dynamic characteristics of foam aerosol in healthy male body,in order to provide a reference for the clinical and the late further researches.
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