中草药相关肝损伤的表型特征及毒理机制

何婷婷; 柏兆方; 王伽伯; 肖小河

doi:10.12449/JCH240804

中草药相关肝损伤的表型特征及毒理机制

DOI: 10.12449/JCH240804

1.
解放军总医院第五医学中心肝病医学部中医肝病科，北京 100039
2.
首都医科大学中医药学院，北京 100069

基金项目:

国家自然科学基金 (82074112);

国家中医药管理局中医药创新团队及人才支持计划项目 (ZYYCXTD-C-202005);

国家自然科学基金联合基金重点项目 (U23A20519)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：何婷婷、柏兆方负责调研文献，起草论文；王伽伯、柏兆方负责修订论文，终审论文；肖小河、王伽伯负责获取研究经费，技术指导性支持。

详细信息

通信作者:
王伽伯， jiabo_wang@ccmu.edu.cn （ORCID： 0000-0002-1478-9693）

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- 被引次数: 0
出版历程
- 收稿日期: 2024-05-06
- 录用日期: 2024-07-01
- 出版日期: 2024-08-25

Phenotypic characteristics and toxicological mechanisms of herb-induced liver injury

1.
Senior Department of Hepatology，Department of Traditional Chinese Medicine，the Fifth Medical Center of PLA General Hospital，Beijing 100039，China
2.
School of Traditional Chinese Medicine，Capital Medical University，Beijing 100069，China

Research funding:

National Natural Science Foundation of China (82074112);

Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (ZYYCXTD-C-202005);

the Joint Funds of the National Natural Science Foundation of China (U23A20519)

More Information

Corresponding author: WANG Jiabo， jiabo_wang@ccmu.edu.cn （ORCID： 0000-0002-1478-9693）

摘要

摘要: 为科学看待中草药安全性问题，进一步满足人们日益增长的健康需求，与时俱进深化中草药肝损伤研究尤为必要。本文从中草药相关肝损伤的表型特征及毒理机制两方面开展论述，强调不能局限于过去传统中草药固有毒性的认知模式，还应认识到特异质毒性、间接型毒性和混合型毒性等新的类型，这些类型为认识中草药相关肝损伤毒理机制提供了全新视角，对了解中草药相关肝损伤表型和毒理机制十分重要。
- 中草药 /
- 化学性与药物性肝损伤 /
- 中药毒理学
Abstract: In order to deal with the problem of the safety of Chinese herbal medicine in a scientific way and further meet the growing health needs of people， it is particularly important to deepen the research on herb-induced liver injury. This article elaborates on the phenotypic characteristics and toxicological mechanisms of herb-induced liver injury and emphasizes that it should not only rely on the previous knowledge of the toxicity of Chinese herbal medicine， but also understand the new types of idiosyncratic toxicity， indirect toxicity， and mixed toxicity， which provide a new perspective for understanding the toxicological mechanisms of herb-induced liver injury and are of great importance to investigate the phenotype and toxicological mechanism of herb-induced liver injury.
- Drugs， Chinese Herbal /
- Chemical and Drug Induced Liver Injury /
- Toxicology of Chinese Materia Medica

HTML全文

图 1 中草药肝毒性分类、影响因素及主次关系

Figure 1. Classification， influencing factors and primary and secondary relationship of HILI

下载: 全尺寸图片幻灯片

表 1 HILI的表型特征

Table 1. The phenotypic characteristics of HILI

分型方法	代表中药或影响因素
根据受损靶细胞分型
肝细胞损伤型	黄药子、雷公藤等
胆汁淤积型	苍耳子、白鲜皮、番泻叶等
混合型	决明子、细辛等
肝血管损伤型	土三七、千里光等
根据病程分型
急性	各种肝毒性中药及产品
慢性	何首乌、雷公藤、黄药子等
根据严重程度分型
轻度	与药物的剂量大小、服用时间的长短、机体差异、联合用药间相互作用等多种因素有关
中度
重度
肝衰竭
致死
根据组织病理学分型
炎症坏死型	闹羊花、附子等
胆汁淤积型	苍耳子、雷公藤、白鲜、黄药子、番泻叶等
脂肪肝和脂肪肝炎型	大枫子
血管损伤型	土三七、千里光等

下载: 导出CSV

表 2 中草药肝毒性类型的特点及其毒理机制

Table 2. Characteristics and toxicological mechanisms of hepatotoxicity with HILI

项目	固有型毒性	特异质毒性	间接型毒性	混合型毒性
主导因素	药物	遗传、体质、病证	药理作用、药物相互作用	药物、机体及用药协同
用药疗程	相关	无关	不确定	部分相关
药物剂量	相关	无关	不确定	部分相关
可预测	可预测	不可预测	不确定	部分可预测
潜伏期	短	长短不一	短	长短不一
肝损伤类型	肝细胞损伤型为主	肝细胞损伤型、胆汁淤积型常见	肝细胞损伤型为主	肝细胞损伤型、胆汁淤积型常见
代表中药	商陆、黄药子、川楝子、雷公藤、苍耳子、土三七等	何首乌等	淫羊藿等	补骨脂联合淫羊藿等
毒理机制	细胞色素P450酶表达异常、线粒体损伤、氧化应激损伤、炎症反应等	免疫炎症反应诱发特异质肝损伤	药物代谢成分或药物间相互作用造成肝损伤	线粒体损伤、氧化应激损伤、免疫炎症损伤等

下载: 导出CSV

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