CN108514627A - 一种治疗慢性荨麻疹的中药组合物 - Google Patents
一种治疗慢性荨麻疹的中药组合物 Download PDFInfo
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- CN108514627A CN108514627A CN201810416948.3A CN201810416948A CN108514627A CN 108514627 A CN108514627 A CN 108514627A CN 201810416948 A CN201810416948 A CN 201810416948A CN 108514627 A CN108514627 A CN 108514627A
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- chronic urticaria
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Abstract
本发明涉及一种治疗慢性荨麻疹的中药组合物,该中药组合物由有效成份和医学上可接受的辅料组成,其中所述的有效成份由以下重量百分比的原料药制成:干姜10~12%,淫羊藿10~12%,黄芪15~18%,白鲜皮10~12%,煅牡蛎30~36%,五味子6~7%,防风10~12%。本发明所述的中药组合物的药味少,具有药简力专的优点。
Description
技术领域
本发明涉及医用配置品,具体涉及含有来自姜科植物的未确定结构的药物制剂,该药物适用于治疗慢性荨麻疹。
背景技术
荨麻疹是皮肤科极为常见的一类疾病,据流行病学调查数据,20%的人一生中至少会经历一次荨麻疹的发作,故荨麻疹患者人群庞大。荨麻疹一旦反复迁延达6周以上,即成为慢性荨麻疹,其反复发作将严重影响患者的生活质量。由于病因不明确,西医的抗感染、脱敏、抗胆碱能等手段未必能发挥确切的效果,且并非所有患者都对常规抗过敏治疗敏感。目前西医治疗将H1组胺受体拮抗剂作为指南推荐的一线用药,但国外已有研究显示接近一半的慢性自发性荨麻疹病人对该类药物反应不佳,即使将药物用量升级为常规剂量的四倍以上,仍有许多病人收效甚微。也就是说,如果经典的西药方案对于病人的疗效不理想,西医便难有其他更奏效的治疗手段。
目前治疗慢性荨麻疹的常用中药成药为紫鑫荨麻疹丸(国药准字Z22020198),该丸剂由威灵仙、黄芩、亚麻子、红花、白藓皮、土茯苓、荆芥、升麻、三棵针、蒺藜、川芎、防风、当归、何首乌、苦参、白芷、薄荷、赤勺和菊花制成,它能够清热祛风,除湿止痒,对慢性荨麻疹的瘙痒症状有一定治疗作用,但是其治疗慢性荨麻疹的效果不理想。
关于治疗慢性荨麻疹的验方也有学者撰文报导,作者钟达源公开了卢传坚教授选用玉屏风散加减方的经验,玉屏风散加减方为:牡蛎30g,黄芪、白鲜皮、熟地黄、酸枣仁、益智仁、淫羊藿、首乌藤各15g,白术、防风、五味子、乌梢蛇、干姜各10g,炙甘草5g(钟达源.卢传坚治疗慢性荨麻疹经验[J].中国民间疗法,2017,25(02):6-7.)。上述验方虽具有较好的疗效,但处方量大,患者的肠胃负担重,药味偏多,制成中成药的质量控制相对困难。
发明内容:
本发明所要解决的技术问题是提供一种治疗慢性荨麻疹的中药组合物,该中药组合物的药味少,具有药简力专的优点。
本发明解决上述问题的技术方案如下:
一种治疗慢性荨麻疹的中药组合物,该中药组合物由有效成份和医学上可接受的辅料组成,其中所述的有效成份由以下重量百分比的原料药制成:
干姜10~12%,淫羊藿10~12%,黄芪15~18%,白鲜皮10~12%,煅牡蛎30~36%,五味子6~7%,防风10~12%。
本发明所述的中药组合物,其中所述的原料药的最佳配比为:
干姜11%,淫羊藿11%,黄芪16.5%,白鲜皮11%,煅牡蛎33%,五味子6.5%,防风11%。
本发明所述的中药组合物,其中所述的有效成份由以下方法制得:
(1)取干姜加12倍量水,蒸馏5小时,收集挥发油,β-环糊精包合后备用;蒸馏后药液过滤,药渣加入8倍量水,煎煮2小时,滤过,合并煎液,减压浓缩至25℃下相对密度为1.30的稠膏;
(2)取淫羊藿和黄芪加入10倍量体积浓度为75%的乙醇回流提取2次,每次2小时,滤过,合并滤液,回收乙醇,减压浓缩至25℃下相对密度为1.30的稠膏;
(3)白鲜皮、煅牡蛎、五味子和防风加入10倍量水煎煮2次,每次2小时,合并水煎液,滤过,滤液减压浓缩至25℃下相对密度为1.30的稠膏;
(4)合并步骤(1)~(3)所得到的稠膏,真空干燥,得干膏粉,制粒后与步骤(1)β-环糊精包合物混合,即得所述的有效成份。
本发明所述的中药组合物为常规的颗粒剂、片剂、丸剂或胶囊剂。
本发明所述的中药组合物中,干姜和淫羊藿共为君药,黄芪和白鲜皮共为臣药,五味子和煅牡蛎共为佐药,防风为使药。本方中,干姜温阳力强,然性燥烈,故用温而不燥的淫羊藿与之相配,干姜得淫羊藿之助力,则可使肌表之阳气充盛而连绵不绝,解决卫表不固之根本;黄芪益气升阳,疏通三焦而导营卫之气上行,白鲜皮燥湿祛风止痒,能解决慢性荨麻疹瘙痒明显之次症,其性寒又可治疗风团发作时郁而不散所生之标热,二者一助里阳出表以充实表气,一助表湿外散以清解标热,两者合用以助君药升阳祛风、化湿止痒;五味子能滋肾敛肺止汗,用其制约君药发散太过,以恢复肌表阴阳的平衡,煅牡蛎入肾而使阳气安潜,与五味子配合使用,有助缓解慢性荨麻疹患者因长期瘙痒而造成的烦躁失眠问题,同时能使阳入于阴以助君臣药发挥更好的补益作用;防风善于走表,能引诸药之力行于肌表,使全方温阳托里固表。全方共奏健脾补肾固表,祛风化湿止痒之效。
本发明所述的中药组合物的组方是由现有玉屏风散加减方优化而成,药味减少了一半,但药简力专,既减轻了患者的肠胃负担,又便于控制产品的质量。
本发明药物能有效地治疗慢性荨麻疹,减轻风团的发作及瘙痒程度,且无明显的毒副作用。本发明药物对慢性荨麻疹的治疗效果,可通过下述研究得到进一步证实。
一、临床研究
1、病人来源:全部病例均来自广东省中医院的门诊病人。
2、病例选择标准:
西医诊断标准:西医诊断标准参照由EAACI/GA(2)LEN/EDF/WAO联合发布的荨麻疹诊疗指南2013版;中国荨麻疹诊疗指南(2014版)。
荨麻疹是指突然出现的风团和(或)血管性水肿,风团表现为大小不等的红斑、肿胀伴有瘙痒,常可在24小时内消退,不留有色素沉着;风团反复发作,每周至少两次,持续达6周及以上的为慢性荨麻疹。
中医诊断标准:参照最新版中华中医药学会2012年发布的《中医皮肤科常见病诊疗指南》关于瘾疹的诊断标准。
①突然发作,皮损为大小不等,形状不一的水肿性斑块,境界清楚;
②皮疹时起时落,剧烈瘙痒,发无定处,持续时间≦24h,退后不留痕迹;
③部分病例可有腹痛腹泻,或发热、关节痛等症,严重者可有呼吸困难,甚至引起窒息;
④皮疹经过6周以上不愈或反复间断发作者为慢性者。
3、纳入标准
①年龄在18-65周岁;
②临床上符合荨麻疹西医诊断标准或中医诊断标准;
③本人同意并接受治疗
4、排除标准
①不符合慢性荨麻疹诊断标准者;
②合并有心血管、脑血管、肝、肾和造血系统等严重原发性疾病,或精神病患者;
③伴有严重呼吸困难、腹泻等并发症,需要使用系统治疗药物如口服糖皮质激素等;
④年龄在18周岁以下或者65周岁以上;
⑤1周内曾服用治疗本病的任何其他药物者。
5、研究内容:基本情况包括姓名、性别、年龄、就诊时间等;病史特征(病程、过敏史、药物史、既住病史等);中医临床特征(主症、兼症、舌象、脉象、女性还包含月经情况等);荨麻疹发作情况(风团数目及发作时间,瘙痒程度)。
6、治疗方法:
(1)分组资料:选择根据纳入标准和排除标准预筛选出符合要求的病例204例,随机分为下述两组:
治疗组:105人,男47人,女58人,平均年龄为34.47±13.60岁;
对照组:99人,男40人,女59人,平均年龄为33.14±16.04岁。
(2)治疗方案:
治疗组口服下述实施例1的颗粒剂,每次1包(10g/包),每天2次,疗程为8周;对照组口服按现有玉屏风散加减方配比制备的颗粒剂,每次1包(10g/包),每天2次,疗程为8周。
上述对照组服用的玉屏风散加减方颗粒剂的制备方法如下所述:
处方:牡蛎300g,黄芪150g,白鲜皮150g,熟地黄150g,酸枣仁150g,益智仁150g,淫羊藿150g,首乌藤150g,白术100g,防风100g,五味子100g,乌梢蛇100g,干姜100g,炙甘草50g。
制备方法:
(1)取干姜、益智仁和白术加12倍量水,蒸馏5小时,收集挥发油,β-环糊精包合后备用;蒸馏后药液过滤,药渣加入8倍量水,煎煮2小时,滤过,合并煎液,减压浓缩成稠膏(25℃密度为1.30);
(2)淫羊藿和黄芪加入10倍量75%乙醇回流提取2次,每次2小时,滤过,合并滤液,回收乙醇,减压浓缩至稠膏(25℃密度为1.30);
(3)其余药味加入10倍量水煎煮2次,每次2小时,合并水煎液,滤过,滤液减压浓缩成稠膏(25℃密度为1.30);
(4)合并步骤(1)~(3)所得到的稠膏,真空干燥,得干膏粉,制粒后与步骤(1)β-环糊精包合物混合,加入糊精和淀粉至1000g,制成颗粒剂。
7、疗效评定标准:
参考《中药新药临床指导原则》中对于“瘾疹”的临床疗效评价标准判定,以风团发作减少及瘙痒程度减轻为主要指标。
临床痊愈:无风团、红斑发生,完全不痒,随访3个月无复发。
显效:发作时风团减少70%以上,或风团消退后复发间隔时间明显延长,瘙痒等症状明显减轻。
有效:发作时风团减少30%以上,或风团消退后复发间隔时间延长,瘙痒等症状减轻。
无效:症状及体征未达有效标准。
8、观察指标:就诊时和治疗后第8周随访,记录患者瘙痒、风团的数量和大小,按以下4级评分法记分。瘙痒:无瘙痒感为0,轻度瘙痒但不烦躁为1,中度尚能忍受为2,严重不能忍受为3;风团大小(最大直径):无风团为0,直径<0.5cm为l,直径0.5~2.0cm为2,直径>2.0cm为3;风团数量:无风团为0,1~6个为1,7~12个为2,12个为3。各项指标相加为总分,依据其变化判断病人疗效。
9、统计方法:主要采用的统计方法有卡方检验和秩和检验等,检验水准取α=0.05,P<0.05表示差异具有统计学意义。
10、结果:
从门诊就诊病人中筛选符合条件的慢性荨麻疹患者,共纳入204例患者,随机分为两组,其中治疗组105例,对照组99例。以风团发作减少及瘙痒程度减轻为主要指标,204例患者总体治疗有效率为81.4%(166例),其中治疗组患者治疗有效率(84.8%)高于对照组患者治疗有效率(77.8%),且差异有统计学意义(P=0.200)。
(1)人口学特征统计分析:两组患者性别、年龄差异无统计学意义(P>0.05),具体结果见表1。
表1.两组患者人口学特征
(2)病程统计分析:两组患者病程差异无统计学意义(P>0.05),具体结果见表2。
表2.两组患者病程
(3)疗效统计分析:204例患者中,总体治疗有效率为81.4%(166例)。其中治疗组痊愈6例、显效12例、有效71例、无效16例,总有效率84.8%(89例);对照组痊愈5例、显效10例、有效62例、无效22例,总有效率77.8%(77例),经检验两组疗效及有效率差异无统计学意义,具体结果见表3。
表3.不同组别疗效比较
11、复发率考察:在治疗结束后,随访1年,在8周治疗后有效的166例患者中,统计复发病例并计算复发率。判断是否复发的指标与观察指标相同,指标相加总分与治疗前的总分比较,达到治疗前的90%以上者判断为复发,两组复发率比较结果如下表4,经检验两组复发率差异无统计学意义(P=0.241):
表4.不同组别复发率比较
小结:整体疗效和复发率指标显示治疗组与对照组相比无统计学差异。
在本研究纳入的病例中,两组未发现病人有任何不良反应报告,表明药物安全性较高。
二、动物实验
1药物与试剂:
专利方:取下述实施例1的颗粒剂加入纯水溶解,配制成相当每毫升含原料药0.75克的溶液;
玉屏风散加减方玉屏风散加减方:取上述临床研究中对照组所使用的颗粒剂加入纯水溶解,配制成相当每毫升含原料药2克的溶液;
玉屏风颗粒,购于国药集团广东环球制药有限公司;
扑尔敏,购于浙江瑞新药业股份有限公司;
右旋糖酐,购于国药集团化学试剂有限公司;
卵白蛋白,购于国药集团化学试剂有限公司;
Al(OH)3,购于国药集团化学试剂有限公司;
INF-γ、IL-4和IgG酶联免疫(Elisa)试剂盒:购于广州瑞博奥生物科技有限公司。
实验动物:Wistar大鼠50只,体重200-220g,雌雄各半;KM小鼠50只,体重18-22g,雌雄各半,购于广东省医学动物实验中心;
实验仪器:AUY120 SHIMADZU分析天平,广州湘仪机电设备有限公司;MEGAFUGE2.0R低温高速离心机,德国HERMLE公司;漩涡混合器,上海青浦沪西仪器厂;
2实验方法
2.1专利方和玉屏风散加减方对大鼠腹腔肥大细胞脱颗粒及血清中INF-γ、IL-4和IgG含量的影响比较:
取wistar大鼠50只,雌雄各半,体重200-220g,随机分成5组,每组10只,即模型对照组、专利方组、玉屏风散加减方、扑尔敏阳性对照组以及玉屏风对照组。以生理盐水配制Al(OH)3混悬液(10g/L),除正常组外,其余各组大鼠均腹腔注射卵白蛋白(OVA 1mg)与Al(OH)3混悬液(1mL)的混合液进行初次免疫,第1天重复一次。
从初次免疫第6天开始给药,共14天。其中正常对照组和模型对照组每天灌胃生理盐水4mL/只,专利方剂量为7.5g/kg(生药量),玉屏风散加减方剂量为20g/kg(生药量),玉屏风组剂量为6g/kg(生药量),扑尔敏阳性对照组剂量为4mg/kg。
I型超敏反应动物模型成功后给药14天,大鼠麻醉后,眼眶静脉丛取血,2000r/min离心15min,取血清,采用酶联免疫试剂盒测定INF-γ、IL-4和IgG含量。处死大鼠后,立即腹腔内注射肥大细胞冲洗液(15%枸橼酸钠和0.9%生理盐水等量混合),轻揉腹部3min,剖开腹腔,用吸管吸出全部液体,2000r/min离心15min,弃上清,沉淀物加肥大细胞混悬保存液0.2mL。细胞涂片中性红染色立即镜检。随机计算100个细胞,计数脱颗粒细胞数,计算脱颗粒百分数和抑制率。肥大细胞脱落颗粒率(%)=脱颗粒细胞数/肥大细胞总数×100%,肥大细胞脱颗粒抑制率(%)=(1-用药脱颗粒率/模型脱颗粒率)×100%。
2.2专利方和玉屏风散加减方对右旋糖酐所致小鼠全身性皮肤瘙痒的疗效比较:
取KM小鼠60只,雌雄各半,体重18-22g,随机分成5组,每组10只,即模型对照组、专利方组、玉屏风散加减方、扑尔敏阳性对照组以及玉屏风对照组。其中正常对照组和模型对照组每天灌胃生理盐水4mL/只,专利方剂量为15g/kg(生药量),玉屏风散加减方剂量为40g/kg(生药量),玉屏风组剂量为12g/kg(生药量),扑尔敏阳性对照组剂量为8mg/kg,连续给药14天,与末次给药30min后,尾静脉注射右旋糖酐1.25mg/kg,以小鼠前爪搔抓头部,后爪搔抓躯干,嘴咬全身各部位作用瘙痒特征,记录30min内瘙痒发作的总次数和持续总时间
2.3统计方法:
结果以均数±标准误(Mean±S.E.M.)表示,并采用SPSS 17.0统计软件进行分析,各组间差异比较用单因素方差分析(One-way ANOVA)(不假定方差齐性Dunnett's T3)。P<0.05表示差异具统计学意义。
3结果:
3.1专利方和玉屏风散加减方对卵蛋白诱导大鼠腹腔肥大细胞脱颗粒的影响
实验结果如图1所示,与模型组相比,专利方和玉屏风散加减方能够明显降低大鼠腹腔肥大细胞脱落颗粒率,呈显著差异(均P<0.01),但是两组相比并没有显著性差异。
3.2专利方和玉屏风散加减方对卵蛋白诱导大鼠血清中细胞因子INF-γ、IL-4和IgG含量的影响
实验结果如图2所示,专利方和玉屏风散加减方干预后,与模型组相比,INF-γ有明显的上调(P<0.05),而IL-4和IgE显著下降(均P<0.01),但两组相比,并没有显著性差异。
3.3专利方和玉屏风散加减方对右旋糖酐诱导小鼠全身性皮肤瘙痒的影响
实验结果如图3所示,专利方和玉屏风散加减方干预后,与模型组相比,能够明显减少右旋糖酐诱导小鼠瘙痒次数和瘙痒持续时间(均P<0.01),但两组相比,并没有显著性差异。
4结论
本研究采用I型超敏反应大鼠和右旋糖酐诱导瘙痒模型评价专利方和玉屏风散加减方的保护作用,结果显示,专利方和玉屏风散加减方均能够显著性降低大鼠腹腔肥大细胞脱落颗粒率,提高Th1细胞分泌INF-γ,抑制Th2细胞分泌IL-4,使大鼠血清中IgE的合成减少,但是专利方与玉屏风散加减方相比,并没有明显差异;在右旋糖酐诱导小鼠瘙痒模型中,专利方和玉屏风散加减方均能够降低瘙痒次数和瘙痒持续时间,但是两者相比,并没有显著性差异。
附图说明
图1为不同药物对卵蛋白诱导大鼠腹腔肥大细胞脱落颗粒率影响的条形图。
图2为不同药物对卵蛋白诱导大鼠血清中三种细胞因子含量影响的条形图,其中,A图为INF-γ细胞因子,B图为IL-4细胞因子,C图为IgE细胞因子。
图3为不同药物对右旋糖酐诱导小鼠瘙痒次数和瘙痒持续时间影响的条形图,其中,A图为瘙痒次数,B图为瘙痒持续时间。
具体实施方式
实施例1(颗粒剂)
1、处方:
干姜100g,淫羊藿100g,黄芪150g,白鲜皮100g,煅牡蛎300g,五味子60g,防风100g。
2、制备方法:
(1)取干姜加12倍量水,蒸馏5小时,收集挥发油,β-环糊精包合后备用;蒸馏后药液过滤,药渣加入8倍量水,煎煮2小时,滤过,合并煎液,减压浓缩至25℃下相对密度为1.30的稠膏;
(2)取淫羊藿和黄芪加入10倍量体积浓度为75%的乙醇回流提取2次,每次2小时,滤过,合并滤液,回收乙醇,减压浓缩至25℃下相对密度为1.30的稠膏;
(3)白鲜皮、煅牡蛎、五味子和防风加入10倍量水煎煮2次,每次2小时,合并水煎液,滤过,滤液减压浓缩至25℃下相对密度为1.30的稠膏;
(4)合并步骤(1)~(3)所得到的稠膏,真空干燥,得干膏粉,制粒后与步骤(1)β-环糊精包合物混合,加入适量糊精和淀粉至1000g,再加水制成颗粒,然后干燥、整粒,分装成10g/包。
实施例2(颗粒剂)
1、处方:
干姜90g,淫羊藿90g,黄芪143g,白鲜皮107g,煅牡蛎319g,五味子63g,防风98g。
2、制备方法:
与实施例1相同。
实施例3(颗粒剂)
1、处方:
干姜99g,淫羊藿90g,黄芪135g,白鲜皮99g,煅牡蛎316g,五味子63g,防风108。
2、制备方法:
与实施例1相同。
实施例4(颗粒剂)
1、处方:
干姜109g,淫羊藿100g,黄芪137g,白鲜皮91g,煅牡蛎300g,五味子64g,防风109g。
2、制备方法:
与实施例1相同。
实施例5(颗粒剂)
1、处方:
干姜110g,淫羊藿110g,黄芪147g,白鲜皮92g,煅牡蛎277g,五味子64g,防风110g。
2、制备方法:
与实施例1相同。
实施例6(胶囊剂)
将按照实施例1的方法制备成的药物颗粒,装入明胶胶囊,制成胶囊剂。
实施例7(片剂)
取按照实施例1的方法制备成的药物颗粒,加入糖粉,用95%乙醇作润湿剂制软材,过16目筛制粒,干燥,常规方法压片,制成片剂。
Claims (4)
1.一种治疗慢性荨麻疹的中药组合物,该中药组合物由有效成份和医学上可接受的辅料组成,其中所述的有效成份由以下重量百分比的原料药制成:
干姜10~12%,淫羊藿10~12%,黄芪15~18%,白鲜皮10~12%,煅牡蛎30~36%,五味子6~7%,防风10~12%。
2.根据权利要求1所述的一种治疗慢性荨麻疹的中药组合物,其特征在于,所述的有效成份由以下重量百分比的原料药制成:
干姜11%,淫羊藿11%,黄芪16.5%,白鲜皮11%,煅牡蛎33%,五味子6.5%,防风11%。
3.根据权利要求1或2所述的一种治疗慢性荨麻疹的中药组合物,其特征在于,所述的有效成份由以下方法制得:
(1)取干姜加12倍量水,蒸馏5小时,收集挥发油,β-环糊精包合后备用;蒸馏后药液过滤,药渣加入8倍量水,煎煮2小时,滤过,合并煎液,减压浓缩至25℃下相对密度为1.30的稠膏;
(2)取淫羊藿和黄芪加入10倍量体积浓度为75%的乙醇回流提取2次,每次2小时,滤过,合并滤液,回收乙醇,减压浓缩至25℃下相对密度为1.30的稠膏;
(3)白鲜皮、煅牡蛎、五味子和防风加入10倍量水煎煮2次,每次2小时,合并水煎液,滤过,滤液减压浓缩至25℃下相对密度为1.30的稠膏;
(4)合并步骤(1)~(3)所得到的稠膏,真空干燥,得干膏粉,制粒后与步骤(1)β-环糊精包合物混合,即得所述的有效成份。
4.根据权利要求3所述的一种治疗慢性荨麻疹的中药组合物,其特征在于,所述的中药组合物为常规的颗粒剂、片剂、丸剂或胶囊剂。
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