土三七导致肝窦阻塞综合征的毒性机制研究进展

Research progress on toxic mechanism of Gynura segetum induced hepatic sinusoidal obstruction syndrome

关键词:  土三七1  吡咯烷生物碱2  毒性机制3  肝窦阻塞综合征4  药物性损伤5

Key words:  gynura segetum1  pyrrolidine alkaloids2  mechanism of toxicity3  hepatic sinusoidal obstruction syndrome4  drug induced injury5

摘要:

土三七是我国常见药材之一，别名菊三七，具有止血、解毒、消肿等疗效。由于其根茎与五加科三七属植物三七极为相似，因此常被误用。国内已有多例报告表明食用土三七后诱发肝窦阻塞综合征（HSOS），但目前仍然缺乏有效的治疗策略。HSOS的特征为肝肿大、腹水和高胆红素血症等。研究表明，吡啶类生物碱是土三七中引起HSOS的主要毒性成分。随着对HSOS研究的逐渐深入，通过回顾近年来现有文献，进一步概括土三七诱导HSOS的主要原因和肝毒性机制。其中，包括氧化应激与炎症反应、内质网应激、细胞凋亡、细胞自噬、影响代谢酶、胆汁酸代谢功能障碍、TSP1-CD47通路及肠道菌群等，旨在熟悉土三七的毒性机制并提高对HSOS疾病的认识，为进一步探寻该疾病的有效治疗途径提供建议。

Abstract:

Gynura segetum is one of the familiar medicinal herbs in our country, alias Gynura japonica. It has the effects of hemostasis, detoxification and swelling. It is often misused because its rhizome is very similar to that of Panax notoginseng of the Araceae family. There have been a number of cases of Gynura segetum induced hepatic sinusoidal obstruction syndrome (HSOS) in China, but there is still a lack of effective treatment strategies. Studies have shown that pyrrolidine alkaloids are the main toxic components in Gynura segetum causing HSOS. With the deepening of the research on HSOS, the main causes and hepatotoxicity mechanisms of Gynura segetum induced HSOS were further summarized by reviewing the existing literature in recent years. Among them, including oxidative stress and inflammation, endoplasmic reticulum stress, apoptosis, autophagy, metabolic enzymes, bile acid metabolism dysfunction, TSP1-CD47 pathway, intestinal flora and so. This paper aims to understand the toxic mechanism of Gynura segetum and improve the understanding of HSOS, and provide suggestions for further exploring effective treatment of the disease.