大黄及其炮制品治疗慢性肾衰竭研究进展
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摘要
大黄及其炮制品治疗慢性肾衰竭(chronic renal faiure,CRF)疗效确切。本文阐述大黄及其炮制品功效,归纳其在CRF治疗中的应用及作用机制研究。从名老中医经验方面,进一步说明其延缓CRF作用,并提出大黄不良反应与剂量过大或单独使用提取物相关,为新药研发提供参考。
Rhei Radix et Rhizoma and its processed products have confirmed efficacy in the treatment of chronic renal failure(CRF). This article expounded the efficacy of Rhei Radix et Rhizoma and its processed products,concluded their application in CRF and the research on mechanism of action. From the experience of famous and senior TCM doctors, it further explained the role of Rhei Radix et Rhizoma and its processed products in delaying CRF, and proposed that adverse reactions of Rhei Radix et Rhizoma were related to overdose or extracts alone, which provided a reference for the research and development of new medicine.
Rhei Radix et Rhizoma and its processed products have confirmed efficacy in the treatment of chronic renal failure(CRF). This article expounded the efficacy of Rhei Radix et Rhizoma and its processed products,concluded their application in CRF and the research on mechanism of action. From the experience of famous and senior TCM doctors, it further explained the role of Rhei Radix et Rhizoma and its processed products in delaying CRF, and proposed that adverse reactions of Rhei Radix et Rhizoma were related to overdose or extracts alone, which provided a reference for the research and development of new medicine.
引文
[1]中华医学会.临床诊疗指南:肾脏病学分册[M].北京:人民卫生出版社,2013:218.
[2]林丰夏,雷彩云,丁陈陈,等.中医治疗慢性肾衰竭用药规律探析[J].上海中医药杂志,2015,49(5):8-11,14.
[3]国家药典委员会.中华人民共和国药典:一部[M].北京:中国医药科技出版社,2015:24.
[4]吴雪荣.大黄不同炮制品的成分研究[J].中国处方药,2017,15(11):28-29.
[5]杨敏,许伯慧,汪冬庚,等.不同炮制方法对大黄中5种蒽醌类化合物含量的影响[J].南通大学学报(医学版),2013,33(5):385-387.
[6]何爱萍,黄玉蓉,荣延娇,等.大黄泡饮辅助治疗慢性肾功能衰竭40例疗效观察[J].国际中医中药杂志,2012,34(2):162-163.
[7]商宪敏,高菁,李云谷,等.肠衣大黄片辅助治疗慢性肾功能衰竭40例[J].北京中医药大学学报,1998,21(1):57-58.
[8]王彤,程力,陈菁,等.微米大黄炭用于慢性肾衰竭的临床研究[J].中国中西医结合肾病杂志,2016,17(7):629-630.
[9]张瑞,张家凤.用“大黄附子牡蛎汤”结肠透析治疗尿毒症初探[J].饮食保健,2015,2(17):152-153.
[10]刁海洋.不同剂量大黄附子细辛汤治疗慢性肾功能衰竭的对比分析[J].医学理论与实践,2017,30(12):1780-1781.
[11]许佩兰.大黄附子汤保留灌肠治疗慢性肾功能衰竭的观察和评估[J].中国现代药物应用,2017,11(3):175-176.
[12]黄亮智.复方大黄灌肠液减少慢性肾功能衰竭维持性血液透析次数的临床研究[J].深圳中西医结合杂志,2016,26(22):62-63.
[13]张秀娟,潘健.补肾健脾活血方、金水宝胶囊、中药灌肠联合西医治疗慢性肾功能衰竭对照观察[J].实用中医内科杂志,2012,26(5):45-47.
[14]唐补生,吴传良,马志芳,等.加味温肾降浊汤配合中药灌肠治疗慢性肾功能衰竭临床研究[J].河南中医,2017,37(3):507-509.
[15]王东,王亿平,程敏,等.清肾颗粒对慢性肾功能衰竭湿热证患者NF-κB信号通路的干预作用[J].中国中西医结合杂志,2017,37(1):23-27.
[16]陈晓波,张章.尿毒清颗粒辅助治疗慢性肾功能衰竭临床观察[J].新中医,2016,48(6):73-75.
[17]贾婷,黄佑芳,谢治卿.肾康注射液治疗慢性肾功能衰竭疗效观察[J].深圳中西医结合杂志,2017,27(10):25-26.
[18]王晓靓,孙毓蔓,陈琳.肾衰宁片对CKD3~4期患者转归的影响及作用机制[J].中国实验方剂学杂志,2017,23(3):159-164.
[19]王君,王贺永.大黄蛰虫丸配合西药治疗慢性肾功能衰竭疗效观察[J].山西中医,2016,32(5):29,39.
[20]LIU Y.Cellular and molecular mechanisms of renal fibrosis[J].Nat Rev Nephrol,2011,7(12):684-696.
[21]KON R,IKARASHI N,NAGOYA C,et al.Rheinanthrone,a metabolite of sennoside A,triggers macrophage activation to decrease aquaporin-3 expression in the colon,causing the laxative effect of rhubarb extract[J].Journal of Ethnopharmacology,2014,152(1):190-200.
[22]WANG J P,HUANG H Q,LIU P Q,et al.Inhibition of phosphorylation of p38 MAPK involved in the protection of nephropathy by emodin in diabetic rats[J].Eur J Pharmacol,2006,28(553):297-303.
[23]ZHU X L,WANG Y J,YANG Y Z,et al.Suppression of lipopolysaccharide-induced upregulation of toll-like receptor 4by emodin in mouse proximal tubular epithelial cells[J].Mol Med Rep,2012,6(3):493-500.
[24]ZHU B,LIN Y,ZHU C F,et al.Emodin inhibits extracellular matrix synthesis by suppressing p38 and ERK1/2 pathways in TGF-β1-stimulated NRK-49F cells[J].Mol Med Rep,2011,4(3):505-509.
[25]YU C,QI D,SUN J F,et al.Rhein prevents endotoxin-induced acute kidney injury by inhibiting NF-κB activities[J].Scientific Reports,2015,5:11822.
[26]HE D,LEE L,YANG J,et al.Preventive effects and mechanisms of rhein on renal interstitial fibrosis in obstructive nephropathy[J].Biological and Pharmaceutical Bulletin,2011,34(8):1219-1226.
[27]GAO Q,QIN W S,JIA Z H,et al.Rhein improves renal lesion and ameliorates dyslipidemia in db/db mice with diabetic nephropathy[J].Planta Medica,2010,76(1):27-33.
[28]DUAN S,WU Y,ZHAO C,et al.The wnt/β-catenin signaling pathway participates in rhein ameliorating kidney injury in DNmice[J].Molecular and Cellular Biochemistry,2016,411(1/2):73-82.
[29]ZHENG J M,ZHU J M,LI L S,et al.Rhein reverses the diabetic phenotype of mesangial cells over-expressing the glucose transporter(GLUT1)by inhibiting the hexosamine pathway[J].British Journal of Pharmacology,2008,153(7):1456-1464.
[30]赵薇,王树,李方江.大黄酚对小鼠脑缺血/再灌注脑组织抗氧化应激和AQP4的影响[J].中国药理学通报,2015,31(10):1477-1478.
[31]ZHAO Q,WANG X,CHEN A,et al.Rhein protects against cerebral ischemic-/reperfusion-induced oxidative stress and apoptosis in rat[J].Int J Mol Med,2018,41(5):2802-2812.
[32]黄淼.大黄酸对db/db小鼠胰岛功能及炎症、氧化损伤标志物表达的影响[D].南京:南京大学,2014.
[33]梁光宇,兰智慧.张琪教授从脾肾论治慢性肾功能衰竭经验[J].中医学报,2012,27(2):164-165.
[34]余静雯,徐英.张大宁教授运用通法治疗慢性肾功能衰竭临床经验[J].新中医,2015,47(10):15-16.
[35]朱晓雷,仲昱.邹燕勤治疗慢性肾衰竭之孟河学术思想探讨[J].江苏中医药,2016,48(2):20-22.
[36]李红波.邵朝弟治疗慢性肾功能衰竭的学术思想及临床经验[J].湖北中医杂志,2004,26(6):16-17.
[37]周剑,王彤,管竞环.管竞环用大黄治疗慢性肾衰竭的临床经验[J].湖北中医杂志,2009,31(3):31-32.
[2]林丰夏,雷彩云,丁陈陈,等.中医治疗慢性肾衰竭用药规律探析[J].上海中医药杂志,2015,49(5):8-11,14.
[3]国家药典委员会.中华人民共和国药典:一部[M].北京:中国医药科技出版社,2015:24.
[4]吴雪荣.大黄不同炮制品的成分研究[J].中国处方药,2017,15(11):28-29.
[5]杨敏,许伯慧,汪冬庚,等.不同炮制方法对大黄中5种蒽醌类化合物含量的影响[J].南通大学学报(医学版),2013,33(5):385-387.
[6]何爱萍,黄玉蓉,荣延娇,等.大黄泡饮辅助治疗慢性肾功能衰竭40例疗效观察[J].国际中医中药杂志,2012,34(2):162-163.
[7]商宪敏,高菁,李云谷,等.肠衣大黄片辅助治疗慢性肾功能衰竭40例[J].北京中医药大学学报,1998,21(1):57-58.
[8]王彤,程力,陈菁,等.微米大黄炭用于慢性肾衰竭的临床研究[J].中国中西医结合肾病杂志,2016,17(7):629-630.
[9]张瑞,张家凤.用“大黄附子牡蛎汤”结肠透析治疗尿毒症初探[J].饮食保健,2015,2(17):152-153.
[10]刁海洋.不同剂量大黄附子细辛汤治疗慢性肾功能衰竭的对比分析[J].医学理论与实践,2017,30(12):1780-1781.
[11]许佩兰.大黄附子汤保留灌肠治疗慢性肾功能衰竭的观察和评估[J].中国现代药物应用,2017,11(3):175-176.
[12]黄亮智.复方大黄灌肠液减少慢性肾功能衰竭维持性血液透析次数的临床研究[J].深圳中西医结合杂志,2016,26(22):62-63.
[13]张秀娟,潘健.补肾健脾活血方、金水宝胶囊、中药灌肠联合西医治疗慢性肾功能衰竭对照观察[J].实用中医内科杂志,2012,26(5):45-47.
[14]唐补生,吴传良,马志芳,等.加味温肾降浊汤配合中药灌肠治疗慢性肾功能衰竭临床研究[J].河南中医,2017,37(3):507-509.
[15]王东,王亿平,程敏,等.清肾颗粒对慢性肾功能衰竭湿热证患者NF-κB信号通路的干预作用[J].中国中西医结合杂志,2017,37(1):23-27.
[16]陈晓波,张章.尿毒清颗粒辅助治疗慢性肾功能衰竭临床观察[J].新中医,2016,48(6):73-75.
[17]贾婷,黄佑芳,谢治卿.肾康注射液治疗慢性肾功能衰竭疗效观察[J].深圳中西医结合杂志,2017,27(10):25-26.
[18]王晓靓,孙毓蔓,陈琳.肾衰宁片对CKD3~4期患者转归的影响及作用机制[J].中国实验方剂学杂志,2017,23(3):159-164.
[19]王君,王贺永.大黄蛰虫丸配合西药治疗慢性肾功能衰竭疗效观察[J].山西中医,2016,32(5):29,39.
[20]LIU Y.Cellular and molecular mechanisms of renal fibrosis[J].Nat Rev Nephrol,2011,7(12):684-696.
[21]KON R,IKARASHI N,NAGOYA C,et al.Rheinanthrone,a metabolite of sennoside A,triggers macrophage activation to decrease aquaporin-3 expression in the colon,causing the laxative effect of rhubarb extract[J].Journal of Ethnopharmacology,2014,152(1):190-200.
[22]WANG J P,HUANG H Q,LIU P Q,et al.Inhibition of phosphorylation of p38 MAPK involved in the protection of nephropathy by emodin in diabetic rats[J].Eur J Pharmacol,2006,28(553):297-303.
[23]ZHU X L,WANG Y J,YANG Y Z,et al.Suppression of lipopolysaccharide-induced upregulation of toll-like receptor 4by emodin in mouse proximal tubular epithelial cells[J].Mol Med Rep,2012,6(3):493-500.
[24]ZHU B,LIN Y,ZHU C F,et al.Emodin inhibits extracellular matrix synthesis by suppressing p38 and ERK1/2 pathways in TGF-β1-stimulated NRK-49F cells[J].Mol Med Rep,2011,4(3):505-509.
[25]YU C,QI D,SUN J F,et al.Rhein prevents endotoxin-induced acute kidney injury by inhibiting NF-κB activities[J].Scientific Reports,2015,5:11822.
[26]HE D,LEE L,YANG J,et al.Preventive effects and mechanisms of rhein on renal interstitial fibrosis in obstructive nephropathy[J].Biological and Pharmaceutical Bulletin,2011,34(8):1219-1226.
[27]GAO Q,QIN W S,JIA Z H,et al.Rhein improves renal lesion and ameliorates dyslipidemia in db/db mice with diabetic nephropathy[J].Planta Medica,2010,76(1):27-33.
[28]DUAN S,WU Y,ZHAO C,et al.The wnt/β-catenin signaling pathway participates in rhein ameliorating kidney injury in DNmice[J].Molecular and Cellular Biochemistry,2016,411(1/2):73-82.
[29]ZHENG J M,ZHU J M,LI L S,et al.Rhein reverses the diabetic phenotype of mesangial cells over-expressing the glucose transporter(GLUT1)by inhibiting the hexosamine pathway[J].British Journal of Pharmacology,2008,153(7):1456-1464.
[30]赵薇,王树,李方江.大黄酚对小鼠脑缺血/再灌注脑组织抗氧化应激和AQP4的影响[J].中国药理学通报,2015,31(10):1477-1478.
[31]ZHAO Q,WANG X,CHEN A,et al.Rhein protects against cerebral ischemic-/reperfusion-induced oxidative stress and apoptosis in rat[J].Int J Mol Med,2018,41(5):2802-2812.
[32]黄淼.大黄酸对db/db小鼠胰岛功能及炎症、氧化损伤标志物表达的影响[D].南京:南京大学,2014.
[33]梁光宇,兰智慧.张琪教授从脾肾论治慢性肾功能衰竭经验[J].中医学报,2012,27(2):164-165.
[34]余静雯,徐英.张大宁教授运用通法治疗慢性肾功能衰竭临床经验[J].新中医,2015,47(10):15-16.
[35]朱晓雷,仲昱.邹燕勤治疗慢性肾衰竭之孟河学术思想探讨[J].江苏中医药,2016,48(2):20-22.
[36]李红波.邵朝弟治疗慢性肾功能衰竭的学术思想及临床经验[J].湖北中医杂志,2004,26(6):16-17.
[37]周剑,王彤,管竞环.管竞环用大黄治疗慢性肾衰竭的临床经验[J].湖北中医杂志,2009,31(3):31-32.