顺铂毒性损伤机制及中药防治机制的研究进展

顺铂作为临床常用的广谱抗肿瘤药物之一,用于治疗睾丸癌、卵巢癌、头颈癌、膀胱癌、肺癌、宫颈癌等多种实体癌,疗效显著但毒副作用较强,易对机体产生极大的损害,毒性反应可涉及不同脏器造成严重的损伤,诱导机体出现肾损伤、肝损伤、耳损伤、心脏损伤、神经损伤及其他损伤等。动物实验研究发现,顺铂诱导的损伤是由多种因素共同参与的结果,呈时间、剂量依赖性。而在临床使用过程中,顺铂的治疗剂量也因损伤作用受到极大限制,严重影响患者的生存质量。因此,寻找合适的治疗方案或药物与顺铂联合用药实现减毒增效成为目前研究的主要方向。随着中医药在临床参与度的逐渐增加,中医药在治疗疾病方面显示出其特有的优势,可通过改善机体氧化应激状态、抑制正常细胞凋亡及炎症损伤、激活细胞自噬、调节药物转运蛋白的异常表达等途径有效降低顺铂化疗引起的毒性反应,协同顺铂提高化疗疗效。该文通过对顺铂引起机体各脏器的损伤机制及中药防治顺铂损伤的机制2个方面进行详细的概述,其中包括顺铂诱导不同脏器的损伤剂量与机制,中药与顺铂联合应用降低损伤的有效治疗剂量、联合用药方式、防治机制等,以期为中药联合顺铂等化疗药物增效减毒的合理应用及临床用药提供依据。

Research Advance in Mechanism of Cisplatin Toxic Injury and Its Prevention and Treatment by Traditional Chinese Medicine

Cisplatin,as one of the commonly used broad-spectrum anti-tumor drugs in clinical practice,is used to treat testicular cancer,ovarian cancer,head and neck cancer,bladder cancer,lung cancer,cervical cancer and other solid cancers. It has obvious curative effect but strong toxic and side effect,and is easy to cause great damage to the body. The toxic reaction may involve serious toxic damages to different organs,and induce nephrotoxicity,hepatotoxicity,ototoxicity,cardiotoxicity,neurotoxicity and other toxicity. Animal experiments have shown that the toxic damage induced by cisplatin is the result of many factors in a time-and dose-dependent manner. In the course of clinical use,the therapeutic dose of cisplatin is also greatly limited due to toxic damage,which seriously affects the quality of life in patients. Therefore,it is the main research direction to find a suitable treatment plan or to use drugs in combination with cisplatin to reduce toxicity and increase efficiency. With the increasing clinical participation of traditional Chinese medicine(TCM),TCM has shown its unique advantages in treating diseases,and can effectively reduce the cisplatin chemotherapy-induced toxic reaction by improving the oxidative stress state of the body, inhibiting normal apoptosis and inflammatory injury, activating autophagy,regulating the abnormal expression of drug transporters,etc. In this paper,the mechanism of cisplatin-induced toxic damage to various organs and the mechanism of TCM in prevention and treatment of cisplatin-induced toxic damage were summarized in detail,including the dose and mechanism of cisplatininduced toxic damage to different organs, the effective treatment dose, combined medication mode and prevention and treatment mechanism of combined application of TCM and cisplatin,in order to provide a basis for rational application and clinical medication of TCM combined with chemotherapy drugs such as cisplatin.