淫羊藿的安全性评价与风险控制措施探讨
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摘要
淫羊藿具有补肾阳、强筋骨和祛风湿的功效,是临床常用中药。然而近年来淫羊藿及其中成药如仙灵骨葆胶囊、壮骨关节丸的不良反应报告逐渐增多,淫羊藿毒性引发越来越多的关注。该文通过全面系统的文献分析方法,对淫羊藿古今文献进行溯源考证,根据2015年版《中国药典》记载,淫羊藿为小檗科植物淫羊藿Epimedium brevicomu、箭叶淫羊藿E. sugittutum、柔毛淫羊藿E. pubescens或朝鲜淫羊藿E. koreuuum的干燥叶,《中国药典》同时收录了巫山淫羊藿E. wushanense,与淫羊藿同为小檗科植物,研究发现5种淫羊藿在地理分布、成分含量、毒性等方面均存在差异。该文同时阐述了淫羊藿毒性机制及增效减毒研究,报告其不良反应病例,并通过现代含淫羊藿中成药仙灵骨葆胶囊与壮骨关节丸的毒性回顾性对比研究,认为淫羊藿具有心血管系统、神经毒性、肝毒性、长期毒性、急性毒性、遗传毒性及特殊毒性,安全用药因素包括患者证候、医生因素、药物因素、炮制及配伍因素,并提出提高患者安全用药意识教育、规范淫羊藿品种及质量监管及深入淫羊藿毒性研究等策略,以期引起广大学者对淫羊藿安全性的重视,提高淫羊藿安全用药水平,防止不良反应事件发生。
Epimedii Folium,a commonly used traditional Chinese medicine,has the effect of tonifying kidney Yang,strengthening bones and treating rheumatism. However,in recent years,the number of reports on adverse reactions of Epimedii Folium and its Chinese patent medicines such as Xianling Gubao Capsules and Zhuanggu Guanjie Pills has been gradually increased,and the toxicity of Epimedii Folium has attracted more and more attention. In this article,the ancient and modern literature on Epimedii Folium was traced through a comprehensive and systematic literature analysis method. According to the 2015 edition of the Chinese Pharmacopoeia,Epimedii Folium refers to the dried leaves of Epimedii Folium brevicomu,E. sugittutum,E. pubescens or E. koreuuum. The Chinese Pharmacopoeia also includes E. wushanense of Wushan Epimedium,which is the same plant variety as Epimedium. The study showed that there were differences in the geographical distribution,composition and toxicity among five species of Epimedium. This paper also explained the toxicity mechanism as well as efficacy enhancing and toxicity reducing effects of Epimedii Folium,and reported its related adverse reaction cases. Through a retrospective comparative study on the toxicity of the modern Chinese patent medicines Xianling Gubao Capsules and Zhuanggu Guanjie Pills containing Epimedii Folium,it was believed that Epimedii Folium had cardiovascular system toxicity,neurotoxicity,hepatotoxicity,long-term toxicity,acute toxicity,genotoxicity and special toxicity; its safe medication factors included patient syndrome,doctor factors,drug factors,processing and compatibility factors. Meanwhile,strategies were proposed to improve patient safety medication awareness,standardize Epimedii Folium varieties and quality supervision,and the toxicity of Epimedii Folium was studied,hoping to draw attention from scholars to the safety of Epimedii Folium,improve the safe use of Epimedii Folium,and prevent adverse reactions.
Epimedii Folium,a commonly used traditional Chinese medicine,has the effect of tonifying kidney Yang,strengthening bones and treating rheumatism. However,in recent years,the number of reports on adverse reactions of Epimedii Folium and its Chinese patent medicines such as Xianling Gubao Capsules and Zhuanggu Guanjie Pills has been gradually increased,and the toxicity of Epimedii Folium has attracted more and more attention. In this article,the ancient and modern literature on Epimedii Folium was traced through a comprehensive and systematic literature analysis method. According to the 2015 edition of the Chinese Pharmacopoeia,Epimedii Folium refers to the dried leaves of Epimedii Folium brevicomu,E. sugittutum,E. pubescens or E. koreuuum. The Chinese Pharmacopoeia also includes E. wushanense of Wushan Epimedium,which is the same plant variety as Epimedium. The study showed that there were differences in the geographical distribution,composition and toxicity among five species of Epimedium. This paper also explained the toxicity mechanism as well as efficacy enhancing and toxicity reducing effects of Epimedii Folium,and reported its related adverse reaction cases. Through a retrospective comparative study on the toxicity of the modern Chinese patent medicines Xianling Gubao Capsules and Zhuanggu Guanjie Pills containing Epimedii Folium,it was believed that Epimedii Folium had cardiovascular system toxicity,neurotoxicity,hepatotoxicity,long-term toxicity,acute toxicity,genotoxicity and special toxicity; its safe medication factors included patient syndrome,doctor factors,drug factors,processing and compatibility factors. Meanwhile,strategies were proposed to improve patient safety medication awareness,standardize Epimedii Folium varieties and quality supervision,and the toxicity of Epimedii Folium was studied,hoping to draw attention from scholars to the safety of Epimedii Folium,improve the safe use of Epimedii Folium,and prevent adverse reactions.
引文
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[23]宋捷,钟荣玲,夏智,等.中药肝毒性研究方法技术的新进展及其应用[J].中国中药杂志,2017,42(1):41.
[24]王琴,张盼阳,袁晓美,等.淫羊藿不同提取物的小鼠长期毒性研究[J].中国药物警戒,2018,15(2):65.
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