【相关性分析何首乌肝毒性成分】

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何首乌的肝毒性分析及炮制减毒

何首乌的肝毒性分析及炮制减毒

何首乌的药理作用
何首乌具有滋补肝肾、益精血、乌须发等作用,常用于治疗肝肾两虚、精血不足 等症状。
何首乌还具有降血脂、抗衰老、抗氧化等多种药理作用,被广泛用于心脑血管疾 病的预防和治疗。
何首乌的毒性作用
何首乌在临床上使用过量或长期使用可导致肝毒性,表现 为肝功能异常、黄疸、肝区疼痛等症状。
此外,何首乌的炮制方法不当也可能增加其肝毒性,因此 需要采取合理的炮制方法以降低其毒性。
何首乌的肝毒性分析及炮制 减毒
2023-11-08
目录
• 何首乌概述 • 何首乌肝毒性分析 • 何首乌炮制减毒研究 • 何首乌安全性评价与展望 • 结论
01
何首乌概述
何首乌简介
何首乌是一种多年生的缠绕藤本植物,其块根可入药,被广 泛应用于中医临床。
何首乌的产地主要分布于中国的华东、中南和西南等地,具 有较高的药用价值。
方法和药物减毒技术,为临床安全使用何首乌提供更加可靠的依据。
05
结论
主要观点与结论
何首乌具有肝毒性,但经过炮制后可降低毒性。 何首乌的肝毒性主要与其所含的蒽醌类化合物有关。
炮制过程中可以改变何首乌中蒽醌类化合物的含量和组成,从而降低其肝毒性。
研究不足与展望
目前对何首乌肝毒性的研究还 不够深入,需要进一步探讨其 作用机制和影响因素。
用药剂量
长期或过量使用何首乌可能导致肝毒性加重 。
联合用药
与其他药物或食物联合使用,可能产生相互 作用,增加肝毒性。
肝毒性预防措施
严格控制用药剂量和用药时间,遵循 医嘱使用。
定期检查肝功能,及时发现并处理肝 脏异常情况。
避免与其他药物或食物联合使用,特 别是可能对肝脏有损害的药物和食物 。

何首乌相关肝毒性的机制研究进展

何首乌相关肝毒性的机制研究进展

何首乌相关肝毒性的机制研究进展
李妍怡;张玉杰;汪祺;马双成
【期刊名称】《中国药物警戒》
【年(卷),期】2022(19)6
【摘要】目的分析探讨何首乌肝毒性作用机制及肝毒性物质基础。

方法通过查阅何首乌文献对肝毒性机制和争议成分相关报道进行整理、分析、归纳。

结果何首乌的肝毒性具体表现在影响肝脏代谢酶的功能与表达、使胆汁代谢循环及转运蛋白的功能受阻、以及免疫应激与线粒体功能紊乱等,文献报道其可能的毒性成分为脂溶性蒽醌类、特征性二苯乙烯苷类、鞣质类和二蒽酮类化合物,推测上述物质对机体的单独或协同作用可能与肝毒性发生有关。

结论何首乌肝毒性机制可能众多,相关研究可为何首乌现代研发和安全运用奠定理论基础。

【总页数】5页(P605-609)
【作者】李妍怡;张玉杰;汪祺;马双成
【作者单位】北京中医药大学中药学院;中国食品药品检定研究院
【正文语种】中文
【中图分类】R961;R969.3
【相关文献】
1.中药何首乌肝毒性物质基础及其毒性机制研究
2.何首乌毒性物质基础及肝毒性机制研究进展
3.何首乌肝毒性的物质基础、毒性机制与防控策略
4.基于二相代谢酶
探讨何首乌肝毒性风险及其发生机制5.何首乌对于肾虚模型大鼠肝毒性机制的实验研究
因版权原因,仅展示原文概要,查看原文内容请购买。

何首乌致重度肝功能损伤1例

何首乌致重度肝功能损伤1例

何首乌致重度肝功能损伤1例摘要本文报道1例何首乌致重度药物性肝炎,患者,男,34岁,以“尿黄、纳差2月”为主诉入院,肝功能示:总胆红素(TBil)368.96 μmol/L,直接胆红素(DBil )290.84 μmol/L,谷丙转氨酶(ALT)1621 U/L,谷草转氨酶(AST)1234 U/L,经保肝、降酶、退黄治疗,患者肝功能检测接近正常水平、肝脏功能基本恢复。

关键词何首乌;中毒;肝功能损伤何首乌是蓼科植物何首乌的干燥块根,根据炮制方法不同,何首乌分为生何首乌和制何首乌。

生首乌具有解毒、消痈、截疟、润肠通便的功效;制首乌主要用于补肝肾、益精血、乌须发、强筋骨、化浊降脂[1]。

随着何首乌及其制剂在临床上的广泛应用,其潜在的不良反应逐渐引起人们的关注,本文报告1例何首乌致严重肝功能损害的典型病例。

1 病例资料1. 1 主诉患者,男,34岁,因“尿黄、纳差2月”于2014年2月11日收入院。

1. 2 现病史患者于2个月前无明显诱因出现上腹部不适,进食后加重,伴食欲下降及进食减少,进食量约为平素一半左右,厌油,角膜黄染,小便赤黄,进行性加重,患者未加以重视。

患者发现全身黄染,遂来本院就诊。

门诊检查结果示TBil 368.96 μmol/L,DBil 290.84 μmol/L,ALT 1621 U/L,AST 1234 U/L,遂以“肝功能损害待查”收入本院消化内科。

患者发病以来,精神、睡眠可,纳差,小便赤黄,体重无明显变化。

1. 3 既往史否认病毒性肝炎及结核等传染病史,否认外伤及重大手术史,无输血及血液制品史,预防接种随当地进行。

否认药物过敏史。

为治疗斑秃,患者于入院前2个月开始应用何首乌(制首乌、生首乌不详),何首乌粉2勺加水冲服,1~2次/d。

1. 4 体格检查神志清,精神可。

查体体温(T)37.6℃,脉搏(P)97次/min,呼吸(R)21次/min,血压(BP)127/76 mm Hg(1 mm Hg=0.133 kPa),全身皮肤黏膜重度黄染,未见蜘蛛痣及肝掌,浅表淋巴结未触及。

中药何首乌肝毒性物质基础及其毒性机制研究

中药何首乌肝毒性物质基础及其毒性机制研究

中药何首乌肝毒性物质基础及其毒性机制研究
方文君;谭兴起;胡永胜;施雯宇
【期刊名称】《海峡药学》
【年(卷),期】2015(27)6
【摘要】何首乌是蓼科蓼族何首乌属多年生缠绕藤本植物,有多种药理作用,是临床上应用广泛的一味传统中药.但近年其引起的肝毒性报道不断增多,引发临床的广泛关注.本文从何首乌引起肝毒性的物质基础、临床特点、病理学基础和肝毒性发生机制几个方面进行综述,以便为何首乌临床安全用药和科学研究提供更多方法和依据.
【总页数】3页(P41-43)
【作者】方文君;谭兴起;胡永胜;施雯宇
【作者单位】中国人民解放军第118医院温州325000;中国人民解放军第118医院温州325000;中国人民解放军第118医院温州325000;中国人民解放军第118医院温州325000
【正文语种】中文
【中图分类】R282.71
【相关文献】
1.肝毒性中药及其与药性和有效成分的关系--对55种中药肝毒性文献资料的分析报告 [J], 宋秉智;施怀生
2.何首乌毒性物质基础及肝毒性机制研究进展 [J], 于瑞丽; 门伟婕; 周昆; 于英莉
3.HPLC指纹图谱评价何首乌和制何首乌不同提取部位肝毒性 [J], 许晓丽; 任晶; 翟文泽; 罗兰; 王淑美; 梁生旺; 陈超
4.何首乌肝毒性的物质基础、毒性机制与防控策略 [J], 林艳;李亚梅;吴萍;夏伯候;林丽美;廖端芳
5.抑制CYP2E1增强何首乌水提物肝毒性作用及其毒性成分筛选研究 [J], 胡英还;王子建;李登科;全正扬;王呈谕;孙震晓
因版权原因,仅展示原文概要,查看原文内容请购买。

何首乌致肝损害13例临床分析

何首乌致肝损害13例临床分析

论著何首乌致肝损害13例临床分析Ξ杨兴祥,江 南,林建梅△(四川省人民医院感染科,四川成都610072) 【摘要】 目的 回顾性分析何首乌所致肝损害13例临床特征。

方法 收集2005年4月~2007年7月收治的何首乌所致的肝损害13例,详细记录每例患者服药史、临床表现、肝功能、凝血酶原时间、肝炎标志物检查、自身免疫相关检查、影像学检查、治疗经过及预后。

结果 何首乌所致的药物性肝损害潜伏期为7~30d,主要临床表现为乏力、纳差、皮肤巩膜黄染,2例伴有皮肤瘙痒,肝大5例,脾大3例,腹水1例;肝功能酶学明显升高,以A LT升高为主,9213%(12/13)伴有黄疸,以直接胆红素升高为主,重症药物性肝损害2例。

结论 何首乌所致药物性肝损害服药史较隐蔽,多数伴有黄疸,临床分型为混合型,本病预后较好。

【关键词】 何首乌;药物性肝损害;临床分析 【中图分类号】 R57511 【文献标识码】 A 【文章编号】 100420501(2008)1221619202 Clinical analysis of13p atients with liver disease induced polygonum multiflorum thumb.Y ANG Xing2xiang,JIANG Nan,LINJian2mei.Department o f Infectious Disease,Sichuan Provincial People’s Hospital,Chengdu,Sichuan610072,China 【Abstract】 Objective T o investigate clinical character of13patients with liver disease induced polyg onum multiflorum thumb retrospectively.Methods The every patient’s data,including administration history,clinical manifestations,liver function,prothrombin time,hepatitis virus markers,examination of autoimmunity disease,imaging outcome,treatment and prognosis,were recorded in detail from May2005to July2007.R esults The incubation was7~30days.The m ost patients showed hypodynamia,decreased food appetite,skinand icteric sclera.2patients of them accom panied itch of skin.hepatauxe and splenomegaly were5patients and3patients respectively.1 patiet showed ascites.The aminotrans ferase of all patients raised up obviously.A LT was higher than AST.Jaundice was observed by92.3%(12/13)and direct bilirubin raised m ore than indirect bilirubin.severe liver disease induced drug occurred in2patients.Conclusion I t is difficult to discover oral administration history of liver disease induced polyg onum multiflorum thumb.Clinical classification of the disease is mixed type.In spite of occurring m ostly jaundice,its prognosis was g ood.【K ey w ords】 polyg onum multiflorum thunb;liver disease induced drug;clinical analysis 何首乌(polyg onum multiflorum thunb)是一味传统中药,具有广泛的药理作用和临床用途,主要用于滋补肝肾、益精血、乌须发、强筋骨等功效[1]。

对何首乌伤肝的看法

对何首乌伤肝的看法

如对您有帮助,可购买打赏,谢谢
对何首乌伤肝的看法
导语:前些时候在门诊给一位女患者开了治疗白发的处方,这位细心患者将处方中所有药在网上查有什么副作用,其中方中有制何首乌15克,二次回来便大
前些时候在门诊给一位女患者开了治疗白发的处方,这位细心患者将处方中所有药在网上查有什么副作用,其中方中有制何首乌15克,二次回来便大叫起来,你给我开的何首乌会引起人体肝脏损害的,如果我服你的药后化验有肝脏损害,你要负完全责任。

我就耐心的做了如下解释:
一、何首乌的副作用
何首乌具有一定的毒副作用,其毒副作用主要是因为何首乌含有毒性成分蒽醌类,如大黄酚,大黄素,甲醚等,如服用量过大对胃肠产生刺激作用,出现肠鸣,恶心,腹痛,腹泻,呕吐等症。

重者可出现阵发性强直性痉挛,躁动不安,抽搐,甚至发生呼吸麻痹。

生首乌是不能长期大剂量使用的,长期大剂量使用容易引起了人体的肝脏损害,出现了转氨酶或胆红素增高,临床出现腹胀、腹泻、恶心、厌食等症状,如果发现有这种情况就需尽早停药了。

二、何首乌的用药禁忌有哪些?
何首乌的在临床使用有生用和制用之分。

生用是指使用未经炮制的何首乌,制用则是指将何首乌按照一定的炮制方法加工后再使用。

未经炮制的何首乌即生首乌,生首乌有解毒、润肠通便的效果;经过炮制的何首乌即制首乌,制首乌具有补肝肾、益精血、乌须发、强筋骨、化浊降脂的功效,主要用于血虚萎黄、眩晕耳鸣、须发早白、腰膝酸软、肢体麻木、崩漏带下、高脂血症等。

究竟应该用生首乌还是制首乌,要根据不同症候和症状特点辨证使用。

常识分享,对您有帮助可购买打赏。

何首乌中二蒽酮类成分肝毒性研究

何首乌中二蒽酮类成分肝毒性研究

活性分析·代谢分析何首乌中二蒽酮类成分肝毒性研究*汪祺1,戴忠1,张玉杰2**,马双成1**(1.中国食品药品检定研究院,北京100050;2.北京中医药大学,北京100102)摘要 目的:以胆红素代谢过程中UDP-葡萄糖醛酸转移酶1A1(UGT1A1酶)介导的胆红素葡萄糖醛酸结合环节为切入点,考察何首乌中二蒽酮及蒽酮糖苷成分的肝毒性。

方法:以胆红素为UGT1A1酶底物,以表观抑制常数Ki为评价指标,采用体外大鼠肝微粒体孵育法测定待测单体成分肝毒性有无及大小,并寻找构效关系。

结果:待测单体成分在大鼠肝微粒体(RLM)体系中对UGT1A1酶的抑制由强至弱的顺序为:顺式- 大黄素-大黄素二蒽酮(强抑制),反式-大黄素-大黄素二蒽酮(强抑制),polygonumnolide C2(强抑制),polygonumnolide C3(中等强度抑制),polygonumnolide C4(弱抑制),且存在构效关系,推测6(6′)- 羟基为活性必需基团,其空间暴露程度可影响其与UGT1A1酶的结合,导致不同程度的抑制作用。

结论:本实验初步探讨了何首乌中二蒽酮类成分潜在肝毒性的作用机理,为研究毒性中药提供了新的思路。

关键词:何首乌;二蒽酮;肝毒性;UDP-葡萄糖醛酸转移酶1A1;代谢酶;大鼠肝微粒体;表观抑制常数;中药安全性中图分类号:R 917 文献标识码:A 文章编号:0254-1793(2018)02-0268-07doi:10.16155/j.0254-1793.2018.02.11Study on the hepatotoxicity of dianthrones inPolygoni Multiflori Radix*WANG Qi1,DAI Zhong1,ZHANG Yu-jie2**,MA Shuang-cheng1**(1. National Institutes for Food and Drug Control,Beijing 100050,China;2. Beijing University of Chinese Medicine,Beijing 100102,China)Abstract Objective:To study the hepatotoxicity of dianthrones in Polygoni Multiflori Radix on the basis of the bilirubin metabolism mediated by glucuronidation of UDP-glucuronosyltransferases 1A1 (UGT1A1 enzyme).Methods:Using bilirubin as the UGT1A1 enzyme substrate and the apparent inhibition constant Ki as the evaluation index,the hepatotoxicity was tested by adding the monomers into the rat liver microsomes.And the structure-activity relationship (SAR) was investigated.Results:The order of the inhibition of UGT1A1 enzyme in the system of rat liver microsomes(RLM)was as follows:cis-emodin dianthrones(strong inhibition),trans-emodin dianthrones (strong * 国家自然科学基金(81503347) ** 通信作者 张玉杰 Tel:(010)84738618;E-mail:zhyj226@ 马双成 Tel:(010)67395272;E-maiL:msc@ 第一作者 Tel:(010)67395282;E-maiL:sansan8251@inhibition),polygonumnolide C2(strong inhibition),polygonumnolide C3(moderate inhibition),polygonumnolide C4(weak inhibition).And structure-activity relationship was found.It was presumed that the 6 (6′)-position hydroxyl group was an active and necessary group,whose spatial exposure directly affected the combination with UGT1A1 enzyme to induce different inhibition.Conclusion:The mechanism of potential hepatotoxicity of dianthrones in Polygoni Multiflori Radix was discussed in this study,thus providing a new idea for the study of toxic traditional Chinese medicine.Keywords:Polygoni Multiflori Radix;dianthrones;hepatotoxicity;UDP-glucuronosyltransferases 1A1;metabolic enzymes;rat liver microsome;apparent inhibition constant;safety of traditional Chinese medicine何首乌为蓼科植物何首乌的块根;其味苦,甘,涩,性微温,归肝、肾经,是临床常用的补益药,临床应用有生何首乌与制何首乌之分。

何首乌2(25-49)1982-2012年肝毒性病例分析

何首乌2(25-49)1982-2012年肝毒性病例分析

赖性和时间依赖性,低剂量的何首
乌提取物并没有肝脏损伤的作用,
甚至还有一定的肝脏保护作用,然
而随着剂量的升,何首乌的肝脏保
NA
首次发生
。无“肝炎”患者密 首次发生 切接触史。病前半年 内无输血及血制品应 用史。有在外就餐, 近期有进食海鲜史。 无伤寒、猩红热等传 染病史,无“心、脑 、肺、肾”等脏器慢 性病史,无外伤史, 无药物及食物过敏史
1
、49
(女)
35
2008
13 男5女 32-68 乌发及治疗脱发6 例, 治
8
疗失眠2 例, 用于耳鸣、
降血压、腿膝无力、性功
能减退及皮肤病各1 例
36
2000-2008 9 男6女 34-68 8例为治白发、脱发,1例
年收治
3
为治偏瘫
37
2009
1 女 31
产后大便不畅
38
2009
1 女 54
首乌片(炮制品) 单味
18片/d
30-40d
54岁者因巩膜及全身皮 肤粘膜黄染十余日入 院.26岁者因食欲不振、 恶心、尿黄9 d入院.
饮片(炮制品),水 复方(组方 NA
18d
体检时肝功能异

不明)
首乌丸
复方
12g/d
45d
乏力、纳差、食欲不振
、厌油、尿黄、皮肤、
巩膜黄染
饮片(生品),水煎 38岁者单 38岁者30g/d; 味;51岁者 51岁者15g/d 复方
除1例HBS一Ab阳性 2例2次发生;3例3次 浙江余姚
(有明确乙肝疫苗接 发生;4例3例发生
种史)外,均为阴性;
血清各种自身抗体检
测均为阴性。
无肝病史

何首乌致肝损害相关文献回顾性分析及其预防措施初探

何首乌致肝损害相关文献回顾性分析及其预防措施初探

何首乌致肝损害相关文献回顾性分析及其预防措施初探王晓仙;鄢友娥【摘要】Objective To understand medications for hepatic lesion caused by polygonum multiflorum and its preparations along with their influencing factors in order to provide the basis for improvement of rational clinical drug use as well as risk control.Methods Retrieve the 32 articles by means of literature retrieval,and analysis causes of polygonum on liver by classification statistics and cases. Results The injury effect of Polygonum Multiflorum on liver is possibly related with the hepatotoxicity,processing of the medicine or the patient who is deficient in liver enzymes or genes.Moreover,the side effects of Polygonum Multiflorum as well as the difference between crude and processed Polygonum Multiflorum in curative effects are not well -known to the public,which is also a leading fac-tor to the liver damage.Conclusion The clinical safety propaganda of Polygonum Multiflorum should be strengthened,and monitoring on liver function before and after administration of Polygonum Multiflorum must be done.%目的:整理、分析何首乌及其制剂发生肝损害不良事件的相关用药情况和影响因素,为提高临床合理用药水平及控制风险提供依据。

何首乌化学成分、药理作用及肝毒性的研究进展

何首乌化学成分、药理作用及肝毒性的研究进展

何首乌化学成分、药理作用及肝毒性的研究进展
汪明金;陈雯清;袁伟博;杜婧璇;左文明;李锦萍;刘力宽
【期刊名称】《上海中医药杂志》
【年(卷),期】2024(58)3
【摘要】从化学成分、药理作用及肝毒性3个方面综述何首乌的研究进展。

何首乌含有二苯乙烯苷类、蒽醌类、磷脂类、黄酮类等多种化学成分,具有延缓衰老、抗癌、抗疲劳、抗炎镇痛、保护心血管等药理作用。

目前,何首乌引起肝毒性的化学成分探讨主要集中于3类,即蒽醌类、二苯乙烯苷类及鞣质类。

加大何首乌肝毒性成分、肝毒性机制研究的力度,加强中药安全用药知识宣教,规范其炮制及使用,可以在一定程度上降低何首乌肝毒性。

【总页数】6页(P86-91)
【作者】汪明金;陈雯清;袁伟博;杜婧璇;左文明;李锦萍;刘力宽
【作者单位】青海师范大学生命科学学院;青海师范大学高原科学与可持续发展研究院
【正文语种】中文
【中图分类】R28
【相关文献】
1.何首乌的化学成分与药理作用研究进展
2.何首乌及夜交藤化学成分及药理作用的研究进展
3.何首乌的化学成分和药理作用研究进展
4.何首乌毒性物质基础及肝毒性机制研究进展
5.何首乌的化学成分和药理作用研究进展
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警惕何首乌的肝毒性

警惕何首乌的肝毒性

警惕何首乌的肝毒性何首乌是临床常用的一味中药,因具有诸多传奇功效的中药,被民间传为具有“返老还童”、“延年益寿” 功效而被广泛应用。

何首乌性微温、味甘,归心、肝、肾经,具补肝益肾、养血养精的功效,用于治疗血虚头晕、肝肾阴虚、须发早白、腰膝酸软、筋骨酸痛、梦遗滑精、肢体麻木、失眠、崩漏带下、久痢等症。

未经加工炮制的首乌为生首乌,性寒、味苦,归肝、肾、大肠经,有润肠通便、解毒、截疟的功效,多用于大便秘结、痔疮、痈肿等症状,但毒性大。

现代药理研究表明,首乌对实验性家兔血清胆固醇的增高有抑制作用,能减少肠道对胆固醇的吸收;首乌对人型结核杆菌、福氏痢疾杆菌有抑制作用;对离体蛙心有强心作用,尤其对疲劳的心脏,其强心作用更为显着;首乌煎剂对血糖有先升后降的作用;首乌还有纤维蛋白溶解活性,可使动脉粥样硬化患者减少血栓或微血栓的形成。

首乌含卵磷脂相当高,而卵磷脂是脑髓的主要成分,也是血细胞的原料之一,可促进血细胞的生成,还有抗氧化作用,增加机体免疫功能等。

由于何首乌具有以上功能,深受人们的推崇,到过山区景点的人都会见过在景区买“何首乌”摊位。

年轻人用来治疗脱发,白发;中老年人用于治疗腰膝酸软,失眠、便秘,降血脂、治疗脂肪肝等。

俗话说,是药三分毒,我们既要了解何首乌的药效功能,也要警惕其副作用。

近年来,我们不断收到因为急性肝功能损害而住院的患者,在排除了常见的肝炎病因后,仔细询问近期有无吃过什么药物时,有的用过首乌染发剂、有治疗脱发的中成药(含何首乌)、有喝含何首乌降脂茶的等等,均是在用药2周左右出现乏力、恶心、食欲不振或伴有尿黄、眼睛巩膜黄染,到医院一查,转氨酶升高到1000U/L。

有一位患者因为胆红素升高到400以上,且有重症肝炎的倾向而采取血浆置换治疗。

近年来,常见的服用何首乌引起肝损伤的报道。

这种由药物引起的急性药物肝损伤,如不及时治疗,有的发展为重症肝炎,甚至危及生命。

何首乌有毒成分主要为大黄酸、大黄素等葱酿类衍生物。

何首乌制剂肝毒性

何首乌制剂肝毒性

1.《家族性何首乌过敏》1993年发表李某,女,62岁,干部。

1988年因失眠多梦伴头昏、诊断“神经衰弱”来门诊求医、处以酸枣仁汤加味。

枣仁、知母、茯苓各12g、川芎、五味子各10g、甘草6g、何首乌15g。

服药后2h,患者出现憋气、心慌,上腹部隐痛,烦燥不安、呼吸急促,身有发痒红疹,经急诊静滴地塞米松,口服朴尔敏、维生素C,含糖钙片2h后症状消失,次日试服上剂中药少许,30min后又出现上述症状。

但较轻微、未服西药、自行缓解。

患者自述以前也服过这些药,效果很好,就是没服过何首乌,家属将第二剂未熬的生药弃去何首乌、再服、果然不出现上述过敏现象,确诊为何首乌过敏。

张某,女,40岁。

是李患的女儿,1990年5月因贫血病,其爱人购得制首乌60g,回家煮荷包蛋吃,以求补血。

2.。

何首乌与药物性肝损伤

何首乌与药物性肝损伤

何首乌与药物性肝损伤作者:孟捷来源:《养生大世界》2021年第02期药物造成的肝损伤可分为药物的直接肝毒性和特异质性肝毒性作用两种。

药物本身或代谢产物的直接肝细胞损伤属于固有型药物性肝损伤。

固有型药物性肝损伤具有可预测性,与药物剂量密切相关,潜伏期短,个体差异不显著;特异质型药物性肝损伤具有不可预测性,个体差异显著,与药物剂量常无相关性,动物实验难以复制,临床表现多样化。

以往认为何首乌的肝毒性可能和其所含的蒽醌类物质相关,蒽醌类物质具有通便作用。

在大黄、芦荟等具有通便作用的中药中都含有蒽醌类物质,但并未发生类似何首乌的严重肝损伤。

何首乌导致的肝损伤属于特异质肝损伤,其发生和遗传相关。

2019年我国科学家首次发现HLA-B*35:01等位基因是何首乌肝损伤发生的特异性生物标志物,揭示了何首乌肝损伤发生与机体遗传背景之间的关系。

中药的临床应用需要辨证论治。

中医典籍有“病之当服,附子、大黄、砒霜皆是至宝;病之不当服,参茸、枸杞子皆是砒霜”1的记载,不按照中医辨证使用中药,就很容易出现不良反应。

中医认为“发为血之余”“肾之华在發”,大凡头发变白与血虚肾亏有关。

老年白发是生理虚衰的表现,《黄帝内经·素问·上古天真论》中说:“男子六八阳气衰竭于上,面焦,发鬓颁白。

”何首乌治疗的须发早白应当属于肝肾亏虚,通常伴有腰膝酸软、头眩耳鸣、阳萎遗精、口干等症状,但部分青年少白头则属于“血热”,常有鼻衄、牙龈出血、心烦、容易急躁等表现,血热型的少白头不宜使用何首乌。

肝肾亏虚型的少白头可以选用桑葚、黑芝麻、枸杞子、黑豆等药食同源的中药。

中药的炮制也能起到减毒作用。

何首乌有毒,古人早就发觉并记载:“制非九次,勿寝其毒”,2强调九蒸九晒,才能减轻毒性。

现行《中国药典》3中记载黑豆汁拌炖或拌蒸将生首乌炮制为制首乌,也能降低可能发生的毒性作用。

何首乌导致肝损伤毕竟是不常见的,服用的药物中如果含有何首乌成分,出现全身乏力、食欲不振、厌油、恶心、尿黄、目黄、皮肤黄染等可能与肝损伤有关的临床表现时,应立即停药并就医。

38例何首乌致肝损害的原因分析

38例何首乌致肝损害的原因分析
2 . 3 肝 损 害情 况
1 9 9 6 -2 0 1 3年间发表 的与何首乌及 其相关 制剂 导
致肝 损 害 的相关 文 献 。
1 . 2 病 例入 选 标 准
筛选出何首 乌单 味药或含何 首乌 的相关制 剂 导致 肝 损 害 的 个 例 报 道 ,去 除 综 述 性 文 献 、 回顾 性分 析 报告 、重复 病例 以及记 述不 完 整 的病 例等 。
2 . 2 用 药情 况
疗后均治愈 ,无死 亡病 例 ,可 见何首 乌导致 的肝 损 害预 后 良好 ,肝 功异 常具 有 可逆 性 。
3 讨 论 3 . 1 不 同炮 制规 格 对何 首 乌致肝 损 害的影 响
从 2 . 2 . 2中可 以看 出 ,肝 损 害与 首 乌炮制 规 格

3 8例 何 首 乌 致 肝 损 害 的原 因分 析
王晓萌 林 晓兰 张 鹏
( 首都医科大 学宣武医院药剂科 。 北京 1 0 0 0 5 3 )
通信作 者 :林晓兰 ,T e l :( 0 1 0 )8 3 1 9 8 6 8 4 ;E - ma i l :x l l i n 8 3 @1 6 3 . t o m
3 8 例病例 中 ,男性 2 0例 ( 5 3 %) ,女性 1 7例
( 4 5 %) ,性别不详 1 例 。年龄在 1 5~ 7 2岁 ,其 中 1 5— 2 O岁 6例 ( 1 6 %) ,2 1—3 0岁 6例 ( 1 6 %) , 3 l~ 4 0岁 1 0例 ( 2 6 %) ,4 l~5 0 岁 8例 ( 2 1 %) , 5 1 ~ 6 0岁 6例 ( 1 6 %) ,6 0岁 以上 2例 ( 5 %) 。其 中有肝损害家族史者 4例 ,有再激发现象者 5例。

何首乌肝毒性物质基础探索研究

何首乌肝毒性物质基础探索研究

何首乌肝毒性物质基础探索研究通过观察何首乌中蒽醌类成分对HepG2细胞的细胞毒作用,并通过精密肝切片技术对细胞毒成分进行验证,探讨何首乌致肝毒性的物质基础。

运用MTT 法检测何首乌中游离蒽醌、结合蒽醌及柰类共11个单体成分对HepG2细胞的毒性。

将有明确细胞毒的成分与大鼠肝切片共同培养6 h后制备肝组织匀浆,通过BCA 法测定匀浆液中蛋白含量,连续监测法测定并计算每1 μg蛋白中丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ谷氨酰氨基转肽酶(GGT)和乳酸脱氢酶(LDH)的漏出率,以考察这些成分对肝组织的毒性作用。

细胞试验结果显示,只有大黄酸、大黄素、大黄素甲醚8OβD葡萄糖苷和大黄素甲醚8O(6′O乙酰基)βD葡萄糖苷显示一定的细胞毒作用,其IC50分别为7107,12562,24227,40232 μmol·L-1,而其他7个化合物的毒性很小。

肝切片试验结果显示,大黄酸400 μmol·L-1组能引起肝切片ALT,AST,LDH漏出率的显著升高(P<001),100 μmol·L-1组能引起肝切片LDH漏出率的显著升高(P<005);随药物浓度增大,肝切片中蛋白含量显著下降(P<005),显示有一定的量毒关系。

大黄素400 μmol·L-1组可引起肝切片ALT,GGT,LDH漏出率的显著升高(P<001)。

大黄素甲醚8OβD葡萄糖苷800 μmol·L-1组能引起肝切片ALT,AST,LDH漏出率的显著升高(P<001或P<005),200 μmol·L-1组能引起肝切片LDH 漏出率的显著升高(P<005);且随药物浓度的增大肝切片中ALT,AST,LDH 漏出率呈升高趋势,蛋白含量呈下降趋势。

此外,浓度为800 μmol·L-1的大黄素甲醚8OβD葡萄糖苷还可使肝切片MTT还原能力显著下降(P<001)。

何首乌的副作用范文

何首乌的副作用范文

何首乌的副作用范文
何首乌是一种常见的中草药,具有滋补肝肾、黑发乌顺、抗衰老等功效,多用于治疗肝肾不足、脱发白发等问题。

尽管何首乌有很多好处,但过量服用或长期使用可能会导致一些副作用和不适症状。

下面是关于何首乌的一些可能的副作用:
1.胃肠道问题:长期或过量使用何首乌可能会导致胃肠道不适症状,如恶心、呕吐、腹胀、腹泻等。

这是因为何首乌含有一些刺激性成分,对胃肠道有一定的刺激作用。

2.肝毒性:据有关研究表明,长期使用何首乌可能会对肝脏产生一定的毒性作用。

这是因为何首乌中的一些成分在体内代谢过程中会产生有害物质,对肝脏造成一定的伤害。

因此,存在肝病或肝功能不良的人应慎重使用何首乌。

4.与其他药物相互作用:何首乌中的一些成分可能会与其他药物相互作用,影响其疗效或产生不良反应。

例如,与抗凝药物(如华法林)一起使用可能会增加出血风险;与降压药一起使用可能会导致血压过低等。

因此,在使用何首乌之前,应先告知医生或药师正在服用的其他药物,以避免不必要的风险。

5.过敏反应:个别人群可能对何首乌中的一些成分具有过敏反应,表现为皮肤瘙痒、红肿、水疱、呼吸困难等症状。

如果出现过敏反应,应立即停止使用何首乌并寻求医生的建议。

何首乌致严重肝损伤1例

何首乌致严重肝损伤1例

何首乌致严重肝损伤1例患者女,47岁,因腹泻5天,稀水样便,伴皮肤黄染,于2010年9月3日来我科就诊,以“肝损害”收住入院,既往体健,无烟酒等不良嗜好,1980年曾患“黄疸型肝炎”,患者20余天前为治脱发应用“益肾乌发口服液”,其主成分为何首乌(即黑豆酒炙),每次10ml,每日2次,于8月29日始突发上症,其间末服用过其他药物。

诊时查体:T 36.5,P 78次/min,率齐,R 19次/min,血压130/80mmHg,皮肤巩膜深度黄染,未见肝掌及蜘蛛疮,各瓣膜听诊区未闻及杂音,肝肋下2.0cm,剑下2.5cm,质中偏软,叩压痛(—),脾未触及,双下肢无水肿。

彩超示:肝、胆未见明显异常,化验胆炎分型(—),肝功能示: ALT:1468umol/L;TBIL:198umol/L;DBIL:111.6umol/L;IBIL:86.4umol/L;GGT:78U/L;ALP:164;U/L;TBA:269.1umol/L;据其临床特征与发病前服用何首乌,诊断为药物中毒性肝炎(重度黄疽型)。

嘱其停服何首乌,并即日住院治疗。

除应用复方益肝灵片,叶酸片、维生素B1片、金双歧、易善弗等药物外,同时静脉滴注复方甘草酸苷注射液80m1/d,苦参碱150mg/d,还原型谷胱甘肽1.2g/d,脂溶性维生素1支/d。

经上述措施治疗13d后,肝功能逐渐恢复接近正常,ALT:85umol/L;TBA:19.3umol/L,于9月16日出院,叮嘱患者继续服用上述口服保肝药物,1个月后复查肝功能。

讨论何首乌主要化学成分有羟基蒽醌类化合物、二苯乙烯苷类化合物、磷脂成分等。

何首乌对肝脏的毒性成分主要可能为蒽醌类[1]。

但对于何首乌导致肝功能损害的机制目前不明确[2],既往报道何首乌致家族性急性肝损伤,认为与遗传性肝脏代谢酶缺陷有关[3],目前尚无直接肝脏毒性的报道,是否存在何首乌口服后经肝脏处理产生肝毒性物质,值得进一步研究。

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Journal of Hazardous Materials 299(2015)249–259Contents lists available at ScienceDirectJournal of HazardousMaterialsj o u r n a l h o m e p a g e :w w w.e l s e v i e r.c o m /l o c a t e /j h a z m atA novel method to analyze hepatotoxic components in Polygonum multiflorum using ultra-performance liquidchromatography-quadrupole time-of-flight mass spectrometryLongfei Lin a ,Hongmei Lin a ,Miao Zhang a ,Boran Ni b ,Xingbin Yin a ,Changhai Qu c ,Jian Ni a ,∗aSchool of Chinese Materia Medica,Beijing University of Chinese Medicine,Beijing,China bSchool of Basic Medical Science,Beijing University of Chinese Medicine,Beijing,China cModern Research Center for TCM,Beijing University of Chinese Medicine,Beijing,Chinah i g h l i g h t s•Investigated the hepatotoxicity ofPolygonum multiflorum and its con-stituents.•The run time of each sample was 25min by UPLC-Q-TOF/MS.•Used an analytical method based on Progenesis QI and Makerlynx XS soft-ware.•Identified 9potential hepatotoxic components in P.multiflorum.g r a p h i c a la b s t r a cta r t i c l ei n f oArticle history:Received 17March 2015Received in revised form 21May 2015Accepted 6June 2015Available online 9June 2015Keywords:Polygonum multiflorumPolygonum multiflorum Praeparata Hepatotoxicity ToxicityUPLC-Q-TOF/MSa b s t r a c tPolygonum multiflorum ,called Heshouwu in China,is a traditional Chinese medicine used to treat var-ious diseases .However,the administration of P.multiflorum (PM)and P.multiflorum Praeparata (PMP)causes numerous adverse effects.This study sought to analyze the toxic components of PM using ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS),and their hepatotoxicity in L02human liver cells.Toxicity was evaluated by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT),lactate dehydrogenase (LDH)leakage,and liver enzyme secretion (aspartate aminotransferase [AST]and alanine aminotransferase [ALT])assays.Furthermore,UPLC-Q-TOF/MS,Progenesis QI,and Makerlynx XS software analyses were used to differentiate extracts and analyze the toxic components.The order of toxicity was P.multiflorum ethanol extract (PME)>P.multiflorum water extract (PMW)>P.multiflorum Praeparata ethanol extract (PMPE)>P.multiflorum Praeparata water extract (PMPW),which was determined by MTT assay,LDH leakage,and liver enzyme secretion levels.The analysis methods suggest that PM toxicity may be associated with anthraquinone,emodin-O -(malonyl)-hex,emodin-O -glc,emodin,emodin-8-O -glc,emodin-O -(acetyl)-hex,and emodin-O -hex-sulphate.The toxic mechanisms of these components require further study.©2015Elsevier B.V.All rights reserved.∗Corresponding author.Fax:+861084738607.E-mail address:njtcm@ (J.Ni).1.IntroductionPolygonum multiflorum is a popular traditional Chinese medicine used in many patent medicines and prescriptions.Recent stud-ies showed that PM has antioxidant activity,due to its flavonoid/10.1016/j.jhazmat.2015.06.0140304-3894/©2015Elsevier B.V.All rights reserved.250L.Lin et al./Journal of Hazardous Materials299(2015)249–259Table.1The dried extract rate and diluted concentrations of different extracts.Name Dried extract rate(%)Concentrations for cell tests(␮g/mL)PME29.201000.00704.00352.00176.0088.0044.0022.0011.00 PMW35.601000.00859.00429.5214.75107.3853.6926.8413.42 PMPE20.681000.00500.00250.00125.0062.5031.2515.637.81 PMPW41.441000.00500.00250.00125.0062.5031.2515.637.81and phenolic acid compounds[1].Additionally,stilbene from PM has anti-tumor,anti-aging,and liver-protective effects[2,3]. Furthermore,anthraquinones have many biological effects,includ-ing antimicrobial,antioxidant,and antihuman cytomegalovirus activity[4].However,researches have reported PM-induced hepa-totoxicity,nephrotoxicity,and embryonic toxicity.Hepatic adverse events,including acute toxic hepatitis,have been reported in many countries[5–9].PM also induces nephrotoxicity[10,11].Emodin, rhein,and physcion,the major components of PM,significantly inhibit the proliferation of a human proximal tubular epithelial cell line(HK-2)[12].Moreover,PM can also induce lung toxicity[13].Although PM toxicity is of great concern,the hepatotoxic com-ponents remain unknown.In this study,the toxicity of water and ethanol extracts from PM and PMP wasfirstly compared.Secondly, the components in these four extracts were comprehensively ana-lyzed by UPLC-Q-TOF/MS,tofind out the variation tendency of the components in these four extracts based on Progenesis QI and Makerlynx XS software.Thirdly,the toxic components in PM were speculated through the combination of the toxicity results and data analysis.The well-designed experiments in vitro to predict the toxi-city induced by risky material and medicine foe humans.MTT assay is the most common method for detecting cell growth and survival, and it is also widely used to evaluate the cytotoxicity.So,the toxi-city induced by PM and PMP was investigated on human liver cells (L-02)in vitro in this study,and used a novel analytical method to analyze the toxic components.2.Materials and methods2.1.ChemicalsMethanol(HPLC-grade)was purchased from Fisher Scientific (Waltham,MA,USA).HPLC-quality water was obtained from a Cascada TM IX-water Purification System(Pall Co.,Port Washing-ton,NY,USA).Ammonia was purchased from Guangdong Xilong Chemical Co.,Ltd.(Shenzhen,China).PM and PMP were provided by Beijing Tongrentang Co.,Ltd.(Beijing,China).Standard samples of emodin and2,3,5,4 -tetrahydroxystilbene-2-O-␤-glucoside were purchased from Shanghai Standard Biotech Co.,Ltd.(Shanghai,China).Emodin-8-O-␤-d-glucopyranoside,cat-echin,l-epicatechin,P-hydroxybenzaldehyde,rhaponiticin,and gallic acid were purchased from Shanghai Yuanye Bio-Technology Co.,Ltd.(Shanghai,China).2.2.Preparation of P.multiflorum extractsPM and PMP were decocted three times with10-fold water or 70%ethanol for1.5h.The resultingfiltrates were mix together and concentrated to dryness under reduced pressure.The dried extract rate of each extraction was shown in Table1.The concentrations of the major components were displayed in Supplementary data 1.The stock solutions for the cellular evaluations were made by dissolving the extracts in50%dimethylsulfoxide(DMSO).Extracts were further diluted with0.2%fetal bovine serum(FBS,Hyclone, Logan,UT,USA)in Dulbecco’s modified Eagle’s medium(DMEM, Gibco Invitrogen Corp.,Grand Island,NY,USA)to the concentra-tions shown in Table1.The diluted concentrations of the different extracts were not same with each other,because the purpose is to ensure the quantity of the crude herbs was equivalent,allowing for the comparison of extract toxicity.For example,704␮g/mL of PME,859␮g/mL of PMW,500␮g/mL of PMPE,and1000␮g/mL of PMPW contained the same quantity of crude herbs.In this section, the diluted manner was different from previous studies,because we are not only to obtain the IC50of each extracts,but also to make a parallel-group study to compare the hepatotoxicity(ALT,AST and LDH)about these four extracts at the same amount of crude herbs.2.3.Culture conditionsL02cells,a human-derived fetal hepatocyte cell line,were pur-chased from China Infrastructure of Cell Line Resources.Cells were cultured in DMEM supplemented with10%FBS.Cultures were maintained in a humidified incubator with5%CO2and95%air at 37◦C.Trypsin(0.5%,Sigma,St.Louis,MO,USA)was used to passage cells at80–90%confluence.2.4.MTT cell viability assayThe MTT reduction assay was used to determine cell viability. The L02cells were seeded into96-well plates(1×104cells/well, Corning Incorporated,Corning,NY,USA)and incubated for24h. And then,cells were exposed to fresh medium with various extract concentrations for36h.Following incubation,5mg/mL of MTT (10␮L,BioTOP,Suzhou,China)dissolved in PBS(pH7.4)was added and incubated for4h.The medium was then removed,and100␮L of DMSO was added to dissolve the formazan product.Crystals were dissolved in DMSO after gently swirling the96-well plates for 5min at room temperature.The absorbance change of specimen was measured under570nm using a Multiskan GO spectrometer (Molecular Devices,Thermo,Waltham,MA,USA).2.5.Enzyme leakage from L02cell after extract treatmentThe activity of the AST,ALT,and LDH releasing,were regarded as the index of hepatotoxicity.L02cells were seeded in24-well plates(2×104cells/well,Corning Incorporated).After24h,cells were exposed to fresh medium with the test compounds or extrac-tions for36h.The Culture medium was then analyzed for AST,ALT and LDH using a kit(Beijing Leadman Biochemistry Co.,Ltd.,Bei-jing,China)on the Glamour4000biochemical analyzer(Glamour Co.,Ltd.,USA).Six plates were read in parallel,with4wells per condition.2.6.UPLC-Q-TOF/MS analysis of PME,PMW,PMPE and PMPW2.6.1.Sample preparationThe PME,PMW,PMPE and PMPW samples(365.1,445.0,258.3, and518.1mg,respectively)were accurately weighed respectively for6times.The PMW and PMPW were dissolved in50mL of water, and the PME and PMPE were dissolved in50mL of70%ethanol. Varying concentrations were diluted to1mL.Then,they were cen-trifuged at14,000rpm for10min to separate the supernatant for UPLC-Q-TOF/MS analysis.L.Lin et al./Journal of Hazardous Materials299(2015)249–259251 Table.2MTT assay results for PME,PMW,PMPE and PMPW.PME PMW PMPE PMPW␮g/mL Cell proliferation(%)␮g/mL Cell proliferation(%)␮g/mL Cell proliferation(%)␮g/mL Cell proliferation(%)11.0095.16±11.1313.42100.93±5.137.8198.58±3.707.81100.85±2.4522.0097.58±8.4926.8496.87±4.4715.6397.65±13.2615.63101.21±0.9444.00101.00±9.8053.6997.08±5.9331.2594.16±2.7031.2599.86±10.8488.0087.04±25.54107.3895.09±4.9162.5088.46±2.3462.5099.00±8.41176.0082.26±4.64214.7594.37±5.52125.0089.46±0.89125.0097.86±12.70 352.0042.31±3.39429.5068.95±6.72250.0078.42±3.67250.00103.77±6.33 704.0011.47±0.63859.0020.58±1.85500.0073.22±5.28500.00101.42±5.671000.008.62±1.281000.0020.16±0.631000.0056.20±6.621000.0086.89±4.50Table.3Enzyme secretion of AST,ALT and LDH from L02cell after exposure of PME,PMW,PMPE and PMPW.Group AssayPME Concentration(␮g/mL)1000.00703.00351.50175.7587.8843.9421.9710.98Control AST(U/L)23.08±9.27***21.10±4.85**15.85±0.8313.98±2.8113.38±2.6414.03±1.1512.00±2.3314.60±0.4514.11±2.84 ALT(U/L)10.65±3.25*** 6.85±1.14*** 4.43±0.41** 3.03±0.83 2.65±0.88 2.10±0.55 2.30±0.92 2.20±2.03 2.01±0.54 LDH(U/L)62.73±8.37***60.75±11.48***46.45±4.80***39.68±8.02***29.13±1.5923.55±1.5222.98±3.4421.85±6.4022.16±5.52PMW Concentration(␮g/mL)1000.00916.00458.00229.00114.5057.2528.6214.31 AST(U/L)21.50±2.40***17.93±1.70*15.13±1.8014.15±2.0711.70±2.1912.50±1.2713.08±3.8611.48±3.0714.11±2.84 ALT(U/L)7.23±2.99*** 5.25±0.99*** 3.90±0.57** 2.30±0.48 2.20±0.59 2.00±0.41 1.90±0.42 2.20±0.43 2.01±0.54 LDH(U/L)55.05±4.78***56.73±0.57***40.63±7.04***30.13±3.13*23.23±4.5521.85±2.2420.58±2.9315.93±5.7422.16±5.52 PMPE Concentration(␮g/mL)1000.00500.00250.00125.0062.5031.2515.637.81 AST(U/L)15.48±3.5715.08±3.6614.18±0.7712.50±1.6812.03±2.4812.98±0.9312.40±3.0612.33±1.9714.11±2.84 ALT(U/L) 4.05±1.75*** 2.85±1.18 2.78±0.71 2.10±0.32 2.10±1.31 2.05±0.66 1.75±0.71 2.05±0.52 2.01±0.54 LDH(U/L)44.25±2.30***37.38±2.40***31.25±2.22**23.90±4.8419.58±4.4322.13±7.8621.48±2.5722.40±3.2422.16±5.52PMPW Concentration(␮g/mL)1000.00500.00250.00125.0062.5031.2515.637.81 AST(U/L)15.90±2.5114.63±2.9915.90±2.0913.50±1.5113.53±1.4414.63±1.0114.13±2.6614.10±1.1614.11±2.84 ALT(U/L) 3.30±1.21* 2.08±0.40 2.13±0.54 2.15±0.90 2.13±0.28 2.00±0.98 1.85±n0.72 2.15±0.96 2.01±0.54 LDH(U/L)31.78±4.21**24.33±5.7824.93±3.9521.28±3.0021.83±1.5722.93±6.9322.85±3.9319.45±2.6622.16±5.52*,**,***Significant difference compared with control cells,p<0.05,p<0.01,p<0.001.2.6.2.Chromatographic and mass spectrometric conditionsAnalysis was performed on a Waters Acquity Ultra Performance LC system coupled with a Xevo G2Q-TOF mass spectrometry equipped with an electrospray ionization(ESI)source(Waters Corp.,Milford,MA,USA).The separation of all samples was per-formed on an ACQUITY UPLC HSS T3(100×2.1mm,1.8␮m).The gradient elution employed0.1%of formic acid-acetonitrile solu-tion as solvent A and0.1%of formic acid aqueous solution as solvent B.The gradient program was as follows:0–3min,0–10%A; 3–10min,10–20%A;10–20min,20–70%A;20–21min,70–100% A;21–21.1min100–0%A;21.1–25min0%A.Theflow rate was set at0.3mL/min,the injection volume was5␮L.Negative ion ionization was used for the detection of more com-pounds and it had higher sensitivity than the positive mode[14]. The cone gas and the source temperature were set to50L/h and 120◦C.The capillary was2.5kV.High-purity nitrogen served as both the nebulizing and dry gas.The desolvation temperature was held at350◦C,and the gasflow was600L/h.The full-scan range was from50to1200m/z.The validation of the UPLC-Q-TOF/MS method was displayed in Supplementary data2.2.7.Statistics and DATA analysisAll cytotoxicity data were expressed as the mean±SD.The data were subjected to one-way analysis of variance(ANOVA)fol-lowed by multiple group comparisons test,and were calculated by using the Probit function in SPSS17.0.The half-maximal inhibitory concentration(IC50)of each tested compound or extraction was cal-culated with GraphPad prism5.Results were classified into three significance levels using the p-values0.05,0.01,and0.001.The LC–MS runs were loaded on Progenesis QI software,which can visualize the raw data at each step in the analysis without missing values.Ion intensity maps shows a2D representation of retention time,m/z,and feature intensity,as well as mass spectra and chromatogram views,provided quality assurance of the auto-matic alignment,peak picking,and compound deconvolution on every run.Wefiltered the data as necessary,and then imported into Makerlynx XS software to analyze.3.Results and discussion3.1.Extract toxicityIn order to evaluate the hepatotoxicity of PM and PMP,more than one assay should be used to determine cell viability in vitro, in order to increase the reliability of the results.The MTT and LDH assays reflect the proliferation and the function of cell membranes. In contrast,the ALT and AST activity levels are the important indi-cator of hepatotoxicity.The ALT level is3times greater than normal indicate liver injury[15,16].Changes in cell proliferation after PME,PMW,PMPE and PMPW exposure are listed in Table2.The AST,ALT and LDH levels are shown in Table3.PME showed significant cytotoxicity and hepatotoxicity,inhibit-ing cell growth57.69%at352␮g/mL and88.53%at704␮g/mL,as determined by MTT assay.LDH leakage was elevated significantly following the176␮g/mL treatment.ALT leakage was significantly increased in the352and704␮g/mL groups.Furthermore,the ALT and LDH levels were3times higher than those in the control group after the704␮g/mL treatment.PMW cytotoxicity was weaker than PME.Cell survival rates after PMW treatment were higher than the rates in MTT assay,with 31.05%and79.42%inhibition at429.5and859␮g/mL,respectively.252L.Lin et al./Journal of Hazardous Materials299(2015)249–259Table.4The constituents detected in PME by UPLC-Q-TOF/MS.No.t R[M-H]−or[M+FA-H]−Error(ppm)Formula Identification10.889227.03214C8H9N2O9Unknown20.941195.0508 1.5C6H11O7Gulonic acid3 1.0311025.3427 1.9C36H65O33Trehalulose4 1.065341.1082/683.2263−0.6C12H21O11Glucosyl-glucose5 1.065404.1038−0.7C12H22NO14Unknown6 1.116439.0771−1.6C14H19N2O14Unknown7 1.416387.1136−0.8C13H23O13Unknown8 1.433133.0135−1.5C4H5O5Malic acid9 1.454475.12990C16H27O16Unknown10 2.524503.1588−4.8C18H31O16Glucopyranosyl–glucopyranosyl-glucose11 2.579128.03490.8C5H6NO3N-Acryloyl glycine12 2.648191.0187−2.6C6H7O7Citric acid13 3.529169.0132−3C7H5O5Gallic acid14 4.021331.0654−3.3C13H15O10Glucosyl gallate15 4.162419.1667−3.3C22H27O8cis-rhaponitin16 4.179419.1666−4.5C22H27O8Rhaponitin17 6.164531.1502−0.2C26H27O12Unknown18 6.202142.0654−2.1C10H8N Unknown19 6.322531.1499−0.8C26H27O12Unknown20 6.763289.0718 2.1C15H13O6Catechin217.289549.1605−0.5C26H29O13Unknown227.73567.173 2.8C26H31O14Tetrahydroxystilbene-O-di-hex238.312289.0704−2.8C15H13O6l-Epicatechin248.556729.145−0.8C37H29O16Mono-o-galloylprocyanidin258.979405.1184−0.5C20H21O9Tetrahydroxystilbene-O-hex269.172729.1453−0.4C37H29O16Mono-o-galloylprocyanidin279.33729.1454−0.3C37H29O16Mono-o-galloylprocyanidin289.419405.1185−0.2C20H21O9cis-2,3,5,4 -Tetrahydroxystilbene-2-O-glc 299.595729.1446−1.4C37H29O16Mono-o-galloylprocyanidin3010.07421.1145 2.4C20H21O10Catechin-O-furanoside3110.263567.1722 1.4C26H31O14Tetrahydroxystilbene-O-di-hex3210.755567.17140C26H31O14Tetrahydroxystilbene-O-di-hex3311.477405.1197 2.7C20H21O92,3,5,4 -Tetrahydroxystilbene-2-O-glc 3411.863557.12960.2C27H25O13Tetrahydroxystilbene-O-(galloyl)-hex 3512.513557.12960.2C27H25O13Tetrahydroxystilbene-O-(galloyl)-hex 3612.551447.12920.2C22H23O10Tetrahydroxystilbene-O-(acetyl)-hex 3712.727555.11390C27H23O13Unknown3812.988431.0984 1.4C21H19O10Emodin-O-glc3913.129447.1284−1.6C22H23O10Tetrahydroxystilbene-O-(acetyl)-hex 4013.219557.1302 1.3C27H25O13Tetrahydroxystilbene-O-(galloyl)-hex 4113.779312.1245 2.9C18H18NO4N-trans-feruloyl tyramine4213.819551.1559 1.1C36H23O6Tetrahydroxystilbene-2-O-(coumaroyl)-hex 4313.821581.16610.3C30H29O12Tetrahydroxystilbene-2-O-(feruloyl)-hex 4413.869511.05460C21H19O13S Emodin-O-hex-sulphate4513.886431.09810.7C21H19O10Emodin-O-glc4614.078407.1339−0.7C20H23O9Torachrysone-8-O-glc4714.185431.0980.5C21H19O10Emodin-8-O-glc4814.536559.1458 1.1C27H27O13Torachrysone-O-glucogallin4914.75517.0979−0.6C24H21O13Emodin-O-(malonyl)-hex5014.767473.1083−0.2C23H21O11Emodin-O-(acetyl)-hex5115.045283.0604−0.7C16H11O5Anthraquinone5215.383473.10840C23H21O11Emodin-O-(acetyl)-hex5315.486329.2327−0.3C18H33O5Trihydroxy-octadecenoic acid5416.786283.0609 1.1C16H11O5Anthraquinone5517.492283.06−2.1C16H11O5Anthraquinone5618.39269.0445−1.9C15H9O5Emodin5719.515269.0445−1.9C15H9O5Anthraquinone5819.952277.1809 1.8C17H25O3Heptadecanoic acid-ester5920.093329.2326−0.6C18H33O5Trihydroxy-octadecenoic acidThe ALT and LDH leakage also significantly increased at these two concentrations,although to a smaller extent than PME.The toxicity of PMPE was obviously weaker than that of PME and PMW,as the growth inhibition rates were markedly lower. Although the LDH leakage significantly increased with250␮g/mL treatment,ALT levels were not significantly altered.PMPW did not inhibit cell proliferation in the MTT assay,except where they were at the condition of highest concentration(1000␮g/mL).The cyto-toxicity and hepatotoxicity of this extract was the lowest in four extracts.In summary,the PME(IC50=345␮g/mL in the MTT assay), PMWE(IC50=555␮g/mL),PMPE(IC50=1536␮g/mL),and PMPW (IC50>10,000␮g/mL)showed severe,moderate,less and no cyto-toxicity,respectively.The cytotoxicity of PM was stronger than that of PMP,and the ethanol extract exerted greater cytotoxicity than the water extract.Considering that the elevated enzyme secre-tion affects liver function,patients should be monitored during the long-term use of PM.3.2.UPLC-Q-TOF/MS analysis of PMW,PME,PMPW and PMPEIn this study,59major ingredients in PMW,PME,PMPW and PMPE were separated and detected by using a UPLC-Q-TOF/MS system(Table4).49of the59compounds were identified byL.Lin et al./Journal of Hazardous Materials299(2015)249–259253 Table5The difference between every two groups using OPLS-DA.Group1vs Group2m/z Retention time(min)Group1Group2PME vs PMW341.1081 1.36640545738565475.1298 1.435054104482133.0135 1.4290354181835557.129411.86316547201540231.065412.816478812085431.097213.0122276674154245.08114.0872097188886230.05714.0812824717141407.133714.0811********.19431.097714.2223004701118380863.202614.2213853617641.3473.108414.73129229079405.8517.098414.73142514526.5861035.20514.73909360.0015245.081214.81487792117.35283.060415.01665031131789919.229915.05584530.001283.059915.682296227751.92269.044519.5232710051968.1 PMW vs PMPE341.1082 1.03666478161144683.2248 1.0342942932758341.1081 1.3673856561138.8683.2244 1.36213840159531.1497 6.1537316285792531.1499 6.2936169212242243.065711.4439327001883750405.118611.4447948601470430811.245411.44101500099166431.097913.853*********511.054813.852*********.55431.097714.221118380376589269.044519.5251968225075PMW vs PMPW341.1082 1.03666478138351683.2248 1.0342942928648341.1081 1.3673856575162683.2244 1.36213840113133.0135 1.4218183588001503.0854 2.980.0004131238289.0707 6.76154848805405.118611.4447948602098970811.245411.441015*********557.129411.8620154061124.8431.097913.853*********511.054813.852********431.097714.221118380177239269.044818.35223263820PME vs PMPE341.1082 1.03712067161144683.2248 1.0345459832758341.1081 1.3664054561138683.2244 1.36227135159531.1497 6.157806285792531.1499 6.297936212242549.16057.297580170192405.118611.4443458801470430811.245411.4494793899166557.129411.8631654762642431.097913.855261368941511.054813.852*********245.08114.0872097159594431.097714.222300470376589473.108414.7312922901283.88283.060415.01665031104527283.059915.6822962211130293.178118.18150920352149269.044818.3526474112517PME vs PMPW277.03210.897464.06243919341.1082 1.03712067138351683.2248 1.0345459828648341.1081 1.3664054575162503.0854 2.980.0004131238405.118611.4443458802098970811.245411.44947938226532431.097913.855261362604511.054813.852********245.08114.0872097124817254L.Lin et al./Journal of Hazardous Materials 299(2015)249–259Table 5(Continued )Group1vs Group2m /zRetention time (min)Group1Group2431.097714.222300470177239473.108414.731292290182283.060415.0166503135021293.178118.18150920322613269.044818.35264741820269.044519.5232710028539PMPE vs PMPW531.1497 6.1528579293664531.1499 6.2921224273385549.16057.2917019283491531.158.158949542089811.245411.4499166226532431.097714.22376589177239283.060415.0110452735021269.044519.5222507528539595.287620.78132010666712.536321.41756430.003Fig.1.The translation process by Progenesis QI software.the comparison with standards or investigating -pounds 8,15,16,20,25,35,and 47were attributed to gallic acid,rhaponitin,catechin,l -epicatechin,2,3,5,4 -tetrahydroxystilbene-2-O -glc,emodin-8-O -glc,and emodin,respectively,by comparing the retention times and mass spectral data with reference pounds 2and 4were attributed to gulonic acid and glucosyl-glucose,whereas compound 12was identified as citric acid by using references [17].Compound 11was characterized as N -acryloyl glycine [18].Compound 24,26,27,and 29showed the same [M–H]−ions at m /z 729.145,so they may be isomers of mono-o -galloylprocyanidin [14].Compounds 22,25,28,31,32,34,35,36,39,40,42,and 43gave diagnostic ions at m /z 405and 243,suggesting that they are tetrahydroxystilbene-O -hex derivatives.There are four groups of compounds (compounds 22,31,32;com-pounds 25,28;compounds 34,35,40and compounds 36,39)that produced the same [M–H]−ions at m /z 567.17,557.13,and 447.13,indicating they may be isomers of tetrahydroxystilbene-O -di-hex,2,3,5,4 -tetrahydroxystilbene-2-O -glc,tetrahydroxystilbene-O -(galloyl)-hex,and tetrahydroxystilbene-O -(acetyl)-pounds 42and 43were identified as tetrahydroxystilbene-2-O -(coumaroyl)-hex and tetrahydroxystilbene-2-O -(feruloyl)-hex [19–21],pounds 46and 48gave [M–H]−ions at m /z 407.1339(C 20H 23O 9)and m /z 559.1458(C 27H 27O 13),which were torachrysone-8-O -glc and torachrysone-O -glucogallin,respectively.[20]Compounds 44,45,49,50and 52showed [M–H]−ions at m /z 511.0546,431.0981,517.0979,473.1083,and 473.1084,which further yielded the same ions at m /z 431and 269.By investigating the reference data,the compounds were ten-tatively characterized as emodin-O -hex-sulphate,emodin-O -glc,emodin-O -(malonyl)-hex,emodin-O -(acetyl)-hex,and emodin-O -(acetyl)-hex [14,17,22,23].Compounds 51,54,55,and 56showed [M–H]−ions at m /z 283.0604,283.0609,283.06,and 269.0445.These four compounds were anthraquinone constituents;how-ever,they did not match the standards for physcion,rhein,and emodin.Thus,compounds 35,37,and 38may be isomers of physcion,rhein,or pounds 58and 59were lipids in PM,which were identified as heptadecanoic acid–ester and trihydroxy-octadecenoic acid [24].Some components were diffi-cult to identify,because the levels were low in PM.L.Lin et al./Journal of Hazardous Materials299(2015)249–259255Fig.2.The peak picking-ion map.Fig.3.The normalization graphs of the PME,PMW,PMPE and PMPW.256L.Lin et al./Journal of Hazardous Materials 299(2015)249–259Fig.4.OPLS-DA scatter plots of the difference between two groups.A =PME vs PMW;B =PMW vs PMPE;C =PMW vs PMPW;D =PME vs PMPE;E =PME vs PMPW;F =PMPE vsPMPW.Fig.5.The dendrogram of the correlation analysis.3.3.DATA analysis of PMW,PME,PMPW and PMPEIn order to observed all differences among the four extracts,fur-ther sample profiling of the gelatins required the use of multivariate statistical tools.In this study,the first step of the multivariate sta-tistical analysis was to convert the 3D LC/MS data into a 2D matrix,expressed as an Exact Mass Retention Time (EMRT)pair by using Progenesis QI3.3.1.Step 1:DATA analysis by Progenesis QIFirstly,the TIC spectrum (Fig.1A)created by UPLC-Q-TOF/MS for all samples were imported into the Progenesis QI software andL.Lin et al./Journal of Hazardous Materials 299(2015)249–259257Fig.6.The results of presumed toxic components.(Note:m /z at 517and 1035were one compound.407,m /z at 230and 245also were one compound in A.m /z at 863and 431,t R at 14.2,m /z at 473and 245also were one compound in B,respectively).translated into a 2D ion intensity map,as shown in Fig.1B.The ordinate represented the retention time,and the abscissa was m /z .Secondly,six QC samples were evaluated to determine whether all four group samples were aligned.The alignment vector is shown in Fig.1C.The results of the alignment quality evaluation revealed thatthe scores of all samples had scores greater than 90%,as shown in Fig.1D.Not all peaks in the total ion chromatogram (TIC)spectrum represent a single compound,due to high background,chromatog-raphy condition,or sample handling methods.Thus,we set the sensitivity value to three,and the minimum peak width to 0.15min,Fig.7.Suggested method of presumed the toxic ingredients in TCM.258L.Lin et al./Journal of Hazardous Materials299(2015)249–259Table6The constituents selected by correlation analysis.Name No.t R[M-H]−Identification6-A115.68283.0599Anthraquinone215.01283.0604Anthraquinone314.08407.1337Torachrysone-8-O-glc414.73517.0984Emodin-O-(malonyl)-hex6-B513.01431.0972Emodin-O-glc618.35269.0448Emodin713.85431.0979Emodin-O-glc811.86557.1294Tetrahydroxystilbene-O-(galloyl)-hex914.22431.0977Emodin-8-O-glc1014.73473.1084Emodin-O-(acetyl)-hex1113.85511.0548Emodin-O-hex-sulphatethis setting which has been found to give the best balance of detect-ing as many real feature ion signals as possible while detecting as little random noise as possible.Under these conditions,1403 peaks were observed in the2D ion intensity map,as shown in Fig.2.The normalization graphs for the four groups are shown in Fig.3.Although we identified1403compounds in the extracts, not all compounds are targets for our analysis.To identify the rea-sons for the differences in toxicity,we must identify difference in the composition between the four extracts.In order to obtain more accurate results,we included two restriction conditions to choose analytes:an ANOVA p-value≤0.05and a maximum fold change≥2fold change,these two parameter using for selecting significantly changing compounds,setting like these will reduce the“false discovery rate(FDR)”.Under these conditions,1103of the1403compounds satisfy the requirements.Finally,the selected compounds were exported into EZinfo for analysis.3.3.2.Step2:DATA analysis by Makerlynx XSThe data set was visualized by using unsupervised PCA to check for outliers and classification trends among the extracts.In the score plot obtained by PCA,the four extracts were located farther from each other,indicating a clear differentiation between the extracts. The difference between two groups was evaluated by using OPLS-DA.The obtained scatter plots are shown in Fig.4.In the scatter plot, each point represents accurate mass-retention time data.The X-axis represents the variable,and the distance of the data point from the origin indicates the relative contribution.The data at both ends of the S-curve represent the highest credibility characteristic ions of the groups.So,it is suggested tofilter out the significantly dif-ferent variables(Markers)between two groups.These plots clearly display the observations with a high absolute value of p(corr)[1] and a high absolute value of the coefficients.The observations dif-ferentiating between every two groups are listed in Table5.3.3.3.Step3:Correlation analysis the DATAThe differentiated compounds which found in step2were re-imported into Progenesis QI software for correlation analysis,as shown in Fig.5.This analysis correlates with the content of these differentiated compounds in the four extracts.bined results of the toxicity and data analysis to identify toxic componentsAs shown in Fig.6A,upon combining the results of the correla-tion analysis,the compound content inside the box was abundant in PME,but low in the other three extracts.The description of these ingredients is shown in Table6A(Combined the different ions produced by the same compound).This may be the rea-son why the toxicity of PME was stronger than other extracts. Based on the cytotoxicity analysis,the order of extract toxicity was PME>PMW>PMPE>PMPW.The AST,ALT,and LDH leakage also reflected this trend.Furthermore,the results of the correlation anal-ysis(Fig.6B)showed that the levels of the compounds inside the box were consistent with this trend.Characterization of these com-pounds is shown in Table6B(Combined the different ions produced by the same compound).The toxicity of PMPE was stronger than PMPW.The results of the OPLS-DA may explain why PMPE toxic-ity was stronger than PMPW.The analysis revealed11compounds that may be associated with PM hepatotoxicity(Table6).In the investigation of the reference samples,emodin showed severe cytotoxicity in L-02cells,is an important chemical con-stituent that induces liver cell damage[25–28].Our results coincided with these conclusions,as9of the11compounds were anthraquinone or its’derivatives,and7of the9compounds were emodin and its’derivatives,suggesting that PM toxicity may be caused by emodin and its derivatives.The results of the toxic-ity test of emodin showed that emodin has strong cytotoxicity indeed(Supplementary data3).Emodin derivatives are inher-ently toxic,or they produce toxicity by their metabolites,such as emodin,which requires further research.The other two compounds were torachrysone-8-O-glc and tetrahydroxystilbene-O-(galloyl)-hex.However,research regarding these compounds is limited and they require further study.4.ConclusionsPM hepatotoxicity is of great concern;however,the com-ponents that induce hepatotoxicity are unknown.Besides,the present studies also have many contradictions,such as some stud-ies demonstrated that PMW has greater toxicity than other extracts [29,30],but another study considered as PME[31].In this assays,it is proved that the water extractions were less toxic than the70% ethanol extractions which indicated that water decoction was a more rational extractive agent for PM and PMP.Judging from the results,the processing produce could reduce the cytotoxicity of PM to a certain extend.The difference in the toxicity above-mentioned was related to the ingredients differences(both in species and con-tents)in the four extracts.The omics research method,which was based on PCA and OPLS-DA,was introduced into the study.The purpose is tofind out the toxic ingredients instead of biomarkers. Because traditional Chinese medicine(TCM)is complex compo-nents,it is hardly to obtain and research each ingredient in TCM. But,we provide an idea can greatly narrow the scope of the tar-get compounds and also greatly reduce the effort and cost in the research,just shown as Fig.7.Under this method,the results of our data analysis and toxicity study suggest that PMP toxi-city may be related to anthraquinone,emodin-O-(malonyl)-hex, emodin-O-glc,emodin,emodin-O-glc,emodin-8-O-glc,emodin-O-(acetyl)-hex,and emodin-O-hex-sulphate.The toxic of these components require further study.Appendix A.Supplementary dataSupplementary data associated with this article can be found,in the online version,at /10.1016/j.jhazmat.2015.06. 014References[1]S.J.Song,F.F.Li,H.Yue,Z.W.Yin,Study on the anti-aging effects of radixpolygnum multiflorum,J.Hebei Med.Univ.24(2003)90–91.[2]G.Y.Lv,Z.H.Lou,S.H.Chen,H.Gu,L.T.Shan,Pharmacokinetics and tissuedistribution of2,3,5,4-tetrahydroxystilbene-2-O-␤-glucoside from traditional Chinese medicine Polygonum multiflorum following oral administration to rats,J.Ethnopharm.137(2011)449–456.[3]L.Zhang,Y.C.Rui,Y.Qiu,T.J.Li,H.J.Liu,W.S.Chen,Expression of VEGF inendothelial cells and the effects of2,3,5,4 -tetrahydroxystilbene-2-O-␤-d-glucoside,Acta Pharm.Sin.39(2004) 406–409.。

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