Xu Ying, Fan Yuan-Fang, Zhao Yuan, Lin Na
Institute of Chinese Materia Medica,China Academy of Chinese Medical Sciences Beijing 100700,China.
Zhongguo Zhong Yao Za Zhi. 2019 Aug;44(16):3406-3414. doi: 10.19540/j.cnki.cjcmm.20190524.401.
This paper summarizes the research progress of reproductive toxicity of Tripterygium wilfordii from 1979,and the toxicity characterization,damage mechanism,and attenuated measures are summarized. It was found that,the reproductive toxicity caused by T. wilfordii is mainly distributed on components of Tripterygium glycosides,triptolide,tripchlorolide,and clinically preparations,such as Leigongteng Tablets and Tripterygium Glycosides Tablets. Adverse reactions to male reproductive system caused by Tripterygium preparations mainly include decreased sperm motility,oligospermia or spermatozoa,decreased fertility or infertility,etc. Long-term drug use may also lead to testicular atrophy and decreased sexual desire. Adverse reactions to women are mainly manifested as menstrual disorders,decreased menstrual volume or even amenorrhea,decreased sexual desire,infertility,etc. The reproductive toxicity of T. wilfordii is related to apoptosis of reproductive cells,disturbance of spermatogenesis or oogenesis,damage of testis and ovary in reproductive target tissues,and changes of internal environment in gonad tissues( hormones,hormone synthesis rate-limiting enzymes and energy metabolism). Drug compatibility,hormone replacement,medication duration and dosage form changes can help reduce the damage of T. wilfordii to the reproductive system. In addition,in view of the existing problems in the current study,the author proposes new directions in clinical studies,pharmacological metabolism mechanism,preparation quality standards and new therapeutic effects,etc.,to provide a basis for the safe and reasonable clinical application of T. wilfordii.
本文总结了1979年以来雷公藤生殖毒性的研究进展,概述了其毒性特征、损伤机制及减毒措施。研究发现,雷公藤所致生殖毒性主要分布于雷公藤总苷、雷公藤甲素、雷公藤氯内酯醇等成分及临床制剂,如雷公藤片、雷公藤多苷片等。雷公藤制剂对男性生殖系统的不良反应主要包括精子活力下降、少精或无精、生育力降低或不育等。长期用药还可能导致睾丸萎缩、性欲减退。对女性的不良反应主要表现为月经紊乱、月经量减少甚至闭经、性欲减退、不孕等。雷公藤的生殖毒性与生殖细胞凋亡、生精或卵子发生紊乱、生殖靶组织睾丸和卵巢损伤以及性腺组织内环境(激素、激素合成限速酶和能量代谢)改变有关。药物配伍、激素替代、用药疗程及剂型改变有助于减轻雷公藤对生殖系统的损害。此外,针对当前研究中存在的问题,作者提出了临床研究、药理代谢机制、制剂质量标准及新治疗效果等方面的新方向,为雷公藤临床安全合理应用提供依据。