七叶皂苷在急性肺损伤治疗中具有潜在应用价值

原创常规药医学组绿医天地

2024年01月12日 05:11

急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）是新型冠状病毒肺炎（COVID-19）重症患者呼吸衰竭的常见病因，临床上常表现为呼吸窘迫和进行性低氧血症^[1]。

ALI可能与炎症爆发和促炎介质的释放有关，促炎介质诱导肺泡内纤维蛋白积聚，从而减少气体交换。在对COVID-19患者进行尸检的报道中，研究者记录了肺泡渗出性炎症和间质性炎症、肺泡上皮增生和透明膜形成^[2]。另一份尸检结果显示右胸膜存在严重炎症，伴有水肿和纤维带^[3]。

在北京协和医院呼吸与危重症医学科新冠肺炎诊疗参考方案（2022年12月版）中，对于有发展为重症/危重症危险的门诊患者推荐使用Paxlovid、瑞德西韦或Molnupiravir。此外，莲花清瘟胶囊等中药被用于治疗轻中度新冠肺炎。临床上，七叶皂苷广泛应用于抗水肿、抗炎治疗，在ALI治疗及抗病毒领域，具有潜在应用价值。

七叶皂苷在急性肺损伤中的体内研究

研究显示，在脂多糖（LPS）诱导的小鼠肺炎模型中，β-七叶皂苷通过抑制脂质过氧化和促炎因子（如NO、TNF-α、IL-1β和IL-6）的表达来降低肺损伤程度并改善气体交换功能^[4]。在肺炎球菌肺炎的小鼠模型中，静脉注射七叶皂苷（1.8 mg/kg）治疗4天后，肺部炎症显著减少^[5-6]。在油酸注射液诱导的急性肺损伤实验模型中，研究人员记录了七叶皂苷钠通过调节血浆和肺组织中超氧化物歧化酶、丙二醛和基质金属肽酶9的水平来减少油酸诱导的急性肺损伤^[7]。

七叶皂苷在抗病毒领域的体外研究

在呼吸道合胞病毒（RSV）感染的上皮和巨噬细胞系中，5μg/mL七叶皂苷和25μg/mL七叶树种子提取物通过调节NF-κB、激活蛋白-1和细胞因子的活性，对RSV表现出显著的抗病毒活性^[8]。另有研究显示，七叶皂苷可能通过抑制NF-κB和激活蛋白-1信号通路，降低感染单纯疱疹病毒1型（HSV-1）或受Toll样受体配体刺激的J774A.1细胞中TNF-α和IL-6的水平^[9]。此外，对于登革热病毒、水疱性口炎病毒等，七叶皂苷同样显示出抗病毒活性^[10]。

七叶皂苷在呼吸道疾病领域的临床研究

研究显示，在SARS感染患者中注射七叶皂苷钠具有抗炎和抗吐作用，并减少了糖皮质激素给药相关的不良反应^[11]。其他作者报道了七叶皂苷对胸部创伤、放射性肺炎、开胸术和肺炎患者急性肺水肿的影响^[12-16]。研究认为，七叶皂苷通过抑制细胞因子释放，改善慢性阻塞性肺病和慢性肺源性心脏病急性加重患者的肺功能^[17-20]。

综上所述，基于基础及临床研究，七叶皂苷在急性肺损伤治疗中具有潜在应用价值。

编译：Sunny 审校：Young

参考文献：

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