乳香可舒筋行气,活血化瘀,是中医治疗痹症、湿阻病等多种疾病的常用药材,但乳香类药物存在诱发不良反应的风险。通过回顾性研究,将2022年1—6月于北京中医药大学附属护国寺中医医院开具含有乳香成分的中药处方作为研究对象,通过统计描述、相关性分析及多因素回归分析,旨在明确影响乳香不良反应的独立性因素。采用的指标包括处方中的乳香剂量、给药方式,患者的年龄、性别、过敏史以及记录不良反应类型等。结果共纳入108例处方,其中7例处方引发了不良反应,包括皮肤过敏6例、腹泻1例,多因素回归分析显示患者既往过敏史是影响乳香不良反应的唯一独立危险因素;说明现阶段中医临床实践使用的含有乳香的中药方剂所致的不良反应仅与既往过敏史有关,患者过敏史是合理用药、控制不良反应中需重点把握的环节。
Frankincense can relax sinew, promote flow of qi and blood circulation, and remove blood stasis. It is a commonly used medicinal material in traditional Chinese medicine for the treatment of arthralgia, dampness blocking disease and others. Frankincense drugs have the risk of inducing adverse reactions. This study used the traditional Chinese medicine prescriptions containing frankincense drugs in Huguosi traditional Chinese Medicine Hospital Affiliated to Beijing University of traditional Chinese Medicine from Jan to Mar 2022 as the research object. This retrospective study aimed to clarify the independent factors that affect the adverse reactions of frankincense through statistical description, correlation analysis and multivariate regression analysis. Indicators included dosage of frankincense in the prescription, mode of administration, as well as patient's age, gender, allergy history, adverse reactions, etc. Altogether 108 prescriptions were received, of which 7 prescriptions caused adverse reactions, including 6 skin allergies and 1 diarrhea. Multivariate regression analysis showed that the patient's allergy history was the only independent risk factor affecting the adverse reactions of frankincense drugs. It is shown that the adverse reactions of frankincense formula used in the clinical practice of traditional Chinese medicine at this stage are only related to the patient's allergy history, and which should be the focus of rational drug use and adverse reaction control.
[1] 国家药典委员会.中华人民共和国药典(一部)[M].北京:中国医药科技出版社, 2015.
[2] 宁张弛,宋志前,王淳,等.炮制温度和时间对醋乳香外观颜色及6种乳香酸含量的影响[J].世界科学技术-中医药现代化, 2017, 19(3):508-515.
[3] 朱小芳,管咏梅,刘莉,等.乳香、没药药对的研究进展[J].江西中医药, 2016, 47(12):72-75.
[4] 李晖,廖康汉,张小芹.活血化瘀类中药在心脑血管疾病治疗中的药理作用及其临床应用分析[J].北方药学, 2016, 13(9):31.
[5] 杨建土.乳香没药的临床不良反应及其毒性分析[J].中国医药指南, 2015, 13(1):49-50.
[6] 龚千锋.中药炮制学[M].北京:中国中医药出版社, 2016:218.
[7] 梁东蕊,宋志前,宁张弛,等.乳香与醋乳香对溃疡性结肠炎大鼠抗炎作用的对比研究[J].世界科学技术-中医药现代化, 2020, 22(1):101-107.
[8] 宋志前,刘振丽,彭诗涛,等.乳香与醋乳香对2型糖尿病大鼠改善作用的对比研究[J].中国中医基础医学杂志, 2022, 28(1):98-102.
[9] 孙向红.水炙乳香简介[J].河南中医, 1985(1):40.
[10] 毛世洲,黎凤珍.中医熨治法治疗腰腿疼痛(寒湿痹阻)随机平行对照研究[J].实用中医内科杂志, 2019, 33(2):13-15.
[11] 马青芳.关于乳香、没药的临床不良反应及其毒性分析[J].中西医结合心血管病电子杂志, 2018, 6(4):23.
[12] Mertens M, Buettner A, Kirchhoff E. The volatile constituents of frankincense-a review[J]. Flavour&Fragrance Journal, 2009, 24(6):279-300.
[13] Du Z, Liu Z, Ning Z, et al. Prospects of boswellic acids as potential pharmaceutics[J]. Planta Medica:Natural Products and Medicinal Plant Research, 2015, 81(4):259-271.
[14] Kokkiripati P K, Bhakshu L M, Marri S, et al. Gum resin of Boswellia serrata inhibited human monocytic (THP-1) cell activation and platelet aggregation[J]. Journal of Ethnopharmacology, 2011, 137(1):893-901.
[15] Saraswati S, Pandey M, Mathur R, et al. Boswellic acid inhibits inflammatory angiogenesis in a murine sponge model[J]. Microvascular Research, 2011, 82(3):263-268.
[16] Cao B, Wei X C, Xu X R, et al. Seeing the unseen of the combination of two natural resins, frankincense and myrrh:Changes in chemical constituents and pharmacological activities[J]. Molecules, 2019, 24(17):3076.
[17] Frank A, Unger M. Analysis of frankincense from various Boswellia species with inhibitory activity on human drug metabolising cytochrome P450 enzymes using liquid chromatography mass spectrometry after automated on-line extraction[J]. Journal of Chromatography A, 2006, 1112(1/2):255-262.
[18] Börner F, Werner M, Ertelt J, et al. Analysis of Boswellic acid contents and related pharmacological activities of frankincense-based remedies that modulate inflammation[J]. Pharmaceuticals (Basel), 2021, 14(7):660.
[19] 李卫敏,毛克臣,郑立红.乳香、没药引起过敏反应的报道[J].中药与方剂, 2012, 5(23):90-91.
[20] 王琳珊,靳会欣,董占军.系统药理学研究方法在中药不良反应研究中的应用进展[J].中国药房, 2017, 28(35):5033-5036.
[21] 侯梅荣.乳香没药致消化道不良反应2例[J].中草药, 2012, 5(2):165-167.
[22] 贾天柱.论中药炮制的"四新八化"[J].药学研究, 2019, 38(7):399-402.
[23] Morikawa T, Matsuda H, Yoshikawa M. A review of antiinflammatory terpenoids from the incense gum resins Frankincense and Myrrh[J]. Journal of Oleo Science, 2017, 66(8):805-814.
[24] 陈婷,宿树兰,段金廒,等.乳香-没药配伍前后化学成分溶出变化及其对LPS-诱导的巨噬细胞产生NO的影响[J].中国中药杂志, 2013, 38(2):179-185.