Article(id=1322927257429357207, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.11.032, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340036970, onlineDateStr=2026-10-30, pubDate=1762704000000, pubDateStr=2025-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340036970, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340036970, creator=13701087609, updateTime=1793340036970, updator=13701087609, issue=Issue{id=1322926985957221241, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='11', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1762704000000', pubDateStr='2025-11-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339972247, creator='13701087609', updateTime=1793340743335, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930220201804556, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930220201804557, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=162, endPage=167, ext={EN=ArticleExt(id=1322927259325182616, articleId=1322927257429357207, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Research Progress on Xijiao Dihuang Decoction(犀角地黄汤)in Treatment of Henoch-Schonlein Purpura, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=

Henoch-Schonlein purpura is a common vascular inflammatory disease in childhood,which has the characteristics of high incidence,high recurrence rate and difficult course of disease. At present,although western medicine treatment can alleviate the disease,but long-term use has more adverse reactions. The pathogenesis is“heat,deficiency,stasis”,based on syndrome differentiation,with few adverse reactions and high patient compliance. Xijiao Dihuang Decoction(犀角地黄汤),which was first seen in Beiji Qianjin Yaofang,has the effect of clearing away heat and cooling blood,promoting blood circulation and removing blood stasis,which is suitable for this disease. By reviewing the treatment of Henoch-Schonlein purpura from the theory,the clinical application and mechanism of action,this paper aimed to provide reference for further research on the Henoch-Schonlein purpura.

, authors=Yage ZHAO1, 2, Ying DING1, 2, Shanshan XU1, 2, Long WANG1, 2, Xiaoqing ZHENG1, 2, authorsList=Yage ZHAO, Ying DING, Shanshan XU, Long WANG, Xiaoqing ZHENG, authorCompany=null, correspAuthors=Ying DING, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322927259862053529, articleId=1322927257429357207, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=犀角地黄汤治疗过敏性紫癜研究进展, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=

过敏性紫癜是儿童时期常见的一种血管炎性疾病,具有发病率高、复发率高及病程迁延难愈的特点。目前西医治疗虽可缓解病情,但长期应用不良反应较多;中医认为本病病机在于“热、虚、瘀”,辨证论治,具有不良反应少、患者依从性高等特点。始见于《备急千金要方》的犀角地黄汤,具有清热凉血、活血化瘀、宁血补虚的功效,恰合本病病机。通过从理论、临床应用和作用机制三个方面对犀角地黄汤治疗过敏性紫癜进行综述,以期为进一步深化犀角地黄汤治疗过敏性紫癜的研究提供参考。

, authors=赵亚格1, 2, 丁樱1, 2, 徐闪闪1, 2, 王龙1, 2, 郑肖庆1, 2, authorsList=赵亚格, 丁樱, 徐闪闪, 王龙, 郑肖庆, authorCompany=null, correspAuthors=丁樱, authorNote=

赵亚格(1999-),女,河南洛阳人,硕士在读,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。

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丁樱(1951-),女,江苏南京人,教授、主任医师,国医大师,博士研究生导师,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。E-mail:。
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赵亚格(1999-),女,河南洛阳人,硕士在读,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。

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赵亚格(1999-),女,河南洛阳人,硕士在读,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。

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犀角地黄汤治疗过敏性紫癜研究进展
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赵亚格 1, 2 , 丁樱 1, 2 , 徐闪闪 1, 2 , 王龙 1, 2 , 郑肖庆 1, 2
中华中医药学刊 | 国家项目点击 2025,43(11): 162-167
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中华中医药学刊 |国家项目点击 2025 , 43 (11) : 162 -167
犀角地黄汤治疗过敏性紫癜研究进展
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赵亚格(1999-),女,河南洛阳人,硕士在读,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。

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赵亚格(1999-),女,河南洛阳人,硕士在读,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。

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赵亚格1, 2, 丁樱1, 2 , 徐闪闪1, 2, 王龙1, 2, 郑肖庆1, 2
作者信息
  • 1.河南中医药大学第一附属医院儿科医院,河南 郑州 450000
  • 2.河南中医药大学儿科医学院,河南 郑州 450000
通讯作者:
丁樱(1951-),女,江苏南京人,教授、主任医师,国医大师,博士研究生导师,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。E-mail:。
作者简介:

赵亚格(1999-),女,河南洛阳人,硕士在读,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。

Research Progress on Xijiao Dihuang Decoction(犀角地黄汤)in Treatment of Henoch-Schonlein Purpura
Yage ZHAO1, 2, Ying DING1, 2 , Shanshan XU1, 2, Long WANG1, 2, Xiaoqing ZHENG1, 2
Affiliations
  • 1.Pediatric Hospital,The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China
  • 2.School of Pediatrics,Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China
出版时间: 2025-11-10 doi: 10.13193/j.issn.1673-7717.2025.11.032
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过敏性紫癜是儿童时期常见的一种血管炎性疾病,具有发病率高、复发率高及病程迁延难愈的特点。目前西医治疗虽可缓解病情,但长期应用不良反应较多;中医认为本病病机在于“热、虚、瘀”,辨证论治,具有不良反应少、患者依从性高等特点。始见于《备急千金要方》的犀角地黄汤,具有清热凉血、活血化瘀、宁血补虚的功效,恰合本病病机。通过从理论、临床应用和作用机制三个方面对犀角地黄汤治疗过敏性紫癜进行综述,以期为进一步深化犀角地黄汤治疗过敏性紫癜的研究提供参考。

犀角地黄汤  /  过敏性紫癜  /  研究进展

Henoch-Schonlein purpura is a common vascular inflammatory disease in childhood,which has the characteristics of high incidence,high recurrence rate and difficult course of disease. At present,although western medicine treatment can alleviate the disease,but long-term use has more adverse reactions. The pathogenesis is“heat,deficiency,stasis”,based on syndrome differentiation,with few adverse reactions and high patient compliance. Xijiao Dihuang Decoction(犀角地黄汤),which was first seen in Beiji Qianjin Yaofang,has the effect of clearing away heat and cooling blood,promoting blood circulation and removing blood stasis,which is suitable for this disease. By reviewing the treatment of Henoch-Schonlein purpura from the theory,the clinical application and mechanism of action,this paper aimed to provide reference for further research on the Henoch-Schonlein purpura.

Xijiao Dihuang Decoction(犀角地黄汤)  /  Henoch-Schonlein purpura  /  research progress
赵亚格, 丁樱, 徐闪闪, 王龙, 郑肖庆. 犀角地黄汤治疗过敏性紫癜研究进展. 中华中医药学刊, 2025 , 43 (11) : 162 -167 . DOI: 10.13193/j.issn.1673-7717.2025.11.032
Yage ZHAO, Ying DING, Shanshan XU, Long WANG, Xiaoqing ZHENG. Research Progress on Xijiao Dihuang Decoction(犀角地黄汤)in Treatment of Henoch-Schonlein Purpura[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (11) : 162 -167 . DOI: 10.13193/j.issn.1673-7717.2025.11.032
过敏性紫癜(Henoch-schonlein purpura,HSP)是儿童时期常见的一种全身性小血管炎症性疾病,发病率约为13~20/10万[1],复发率为2.7% ~66.2%[2],病理上表现为免疫复合物沉积于受累脏器的小血管壁从而诱发炎症反应,临床表现以皮肤紫癜、关节肿痛、腹痛等为主,约1/3患儿发展为过敏性紫癜性肾炎(Henoch-Schonlein purpura nephritis,HSPN)而见血尿、蛋白尿,严重者可进展为肾功能不全,甚至终末期肾病[3],影响患儿远期预后。目前对于本病的治疗,西医方面多将糖皮质激素和免疫抑制剂等作为首选药,虽可缓解病情,但不能控制本病的复发及预防肾损伤的发生[4]。
近年来,中医药治疗HSP的有效性和安全性得到肯定[5]。根据其临床表现,中医将其归属于古籍中的紫斑、葡萄疫、肌衄、血证等范畴[6],“热、虚、瘀”是导致HSP病情反复、迁延难愈的关键病机所在[7],在治疗上应以清热凉血、活血化瘀、宁血补虚为主要治疗原则,临床多辨证选用犀角地黄汤加减。相关临床及机制研究发现,犀角地黄汤不仅可改善HSP患儿临床症状,多靶点、多途径调节机体炎症、免疫及凝血状态,促进疾病向愈,而且不良反应少[8-9]。但目前尚缺少对相关文献的整理,故现将犀角地黄汤治疗HSP的古籍、临床及机制研究的相关文献进行综述,为犀角地黄汤治疗HSP的进一步研究和推广提供参考。
犀角地黄汤是“凉血散血法”的代表方,首见于《备急千金要方·卷十二》吐血篇:“犀角地黄汤,治伤寒及温病应发汗而不汗之内蓄血者,及鼻衄吐血不尽,内余瘀血,面黄,大便黑,消瘀血方。”其原名芍药地黄汤,出自陈延之的《小品方》,始为热毒炽盛,迫血妄行所设,后世诸多医家皆认为本方具有清热凉血、活血化瘀、宁血补虚的作用,将其作为温病血分证的代表方,如《医宗金鉴·删补名医方论》记载:“此方虽曰清火,而实滋阴;虽曰止血,而实去瘀。瘀去新生,阴滋火熄,可为探本穷源之法也。”柯韵伯在《古今名医方论》中论述:“此方虽曰清火,而实滋阴之剂。盖血失则阴虚,阴虚则无气。故阴不足者,当补之以味,勿得反伤其气也。”
原文记载:“犀角一两,生地黄八两,芍药三两,牡丹皮二两。右四味,咀,以水九升,煮取三升,分三服。”吴鞠通论其组方:“犀角味咸,入下焦血分以清热;生地去积聚而补阴,白芍祛恶血,生新血,丹皮泄血中伏火。”犀角苦、咸、寒,有凉血止血、泻火解毒之效,但因犀牛属国家珍稀动物,后多以水牛角代替,《陆川本草》谓:“辛、咸,寒。凉血解毒,止衄。治热病昏迷,麻痘斑疹,吐血,衄血,血热,溺赤”,直入血分,清热凉血,泻火解毒。生地黄性寒,味甘苦,清热生津,凉血止血,《本草求真》谓:“力专清热泻火,凉血消瘀”,既可复已失之阴血,又可助水牛角解血分之热而凉血止血。芍药,苦,微寒,有清热凉血、散瘀止痛之效,《本草经疏》谓:“赤者利小便散血;白者止痛下气。赤行血,白补血。白补而赤泻:白收而赤散。”温热病多以赤芍凉散,但若热伤阴血较甚则白芍。丹皮,辛、苦,性微寒,王孟英言:“丹皮虽凉血,而气香走泄能发汗,惟血热而瘀者宜之”,可泄血中伏热,助犀角散瘀通结。四味相合,凉血与散血并用,凉血散血又无冰伏留瘀之弊;清热中兼以养阴,热清血宁而无耗血动血之虑,共收清热凉血、活血化瘀、宁血补虚之效。正如吴谦在《医宗金鉴·删补名医方论·卷一》中评价犀角地黄汤“虽曰止血,而实去瘀。瘀去新生,阴滋火熄,可为探本求源之法也”。
中医古籍中并无HSP病名,依据其临床表现,可将其归属于“血证、葡萄疫、肌衄、紫斑”等范畴,正如《外科正宗·卷之四·杂疮毒门》所云:“葡萄疫,其患多生小儿,感受四时不正之气,郁于皮肤不散,结成大小青紫斑点,色若葡萄,发在遍体”,又如《医学入门·外集·卷四·杂病提纲·内伤》记载:“血从汗孔出者,谓之肌衄”等。
本病多因风邪兼受血热,两热相搏,迫血妄行,血溢脉外发为紫癜,热入膀胱则发尿血,正如《幼幼集成·诸血证治》曰:“外干六淫,内伤饮食,气留不行,血壅不濡,是以热极涌泄,不无妄动之患……若郁热内逼,必致荣血妄行”,又如《类证治裁·溺血》言:“故血随溺出,亦火所迫也”。《血证论》中记载:“瘀血在经络脏腑之间,则周身作痛,以其阻塞气之往来,故滞碍而痛,所谓痛则不通也”,热邪耗伤血中津液,津少血凝,涩滞成瘀,滞于关节则关节疼痛,滞于腹部经络则腹痛。李用粹在《证治汇补》中描述本病为:“热则伤血,血热不散,里实表虚,出于皮肤而为瘀,久病必及肾,本病多虚瘀相互为患……”综上,本病病机可概括为“热”“瘀”“虚”,病位在血分。
热不清则血不宁,血不散则瘀不去,不滋阴则火不熄。唐容川在《血证论》提出治血四法:“惟以止血为第一要法。血止之后,其离经而未吐出者,是为瘀血……故以消瘀为第二法;止吐消瘀之后,又恐血再潮动,则须用药安之,故以宁血为第三法……去血既多,阴无有不虚者矣……故又以补虚为收功之法,四者乃通治血证之大纲”,故清热凉血、活血化瘀、宁血补虚为本病治疗原则,而犀角地黄汤恰合本病病机。
研究发现,临床上对犀角地黄汤的临床应用十分灵活,大多对其进行加减,或与西药或与其他中医特色疗法联用,其治疗效果可得到明显提高。宋纯东等给予观察组患者犀角地黄汤加味辨证治疗,皮下瘀点、瘀斑较多者,加茜草、丹参;咽痛者,加桔梗、牛蒡子;兼有发热者,加金银花、连翘;腹痛者,加延胡索、广木香、白芍;关节肿痛者,加忍冬藤、海风藤、怀牛膝。治疗后结果显示,治疗组总有效率为93.33%,明显高于对照组的73.33%[10]。宋珂等[5]给予治疗组患者犀角地黄汤联合西医常规治疗,结果显示,治疗组临床疗效总有效率96.66%,明显高于西医常规治疗组的80.00%,且能够更有效地预防肾脏损伤,降低HSPN的发生率。黄育志等[11]给予对照组患者采用犀角地黄汤口服或者耳穴埋籽法治疗,实验组患者采用耳穴埋籽法联合犀角地黄汤口服进行治疗,结果显示,实验组中患者恢复情况优于对照组。景文芳等[12]给予治疗组犀角地黄汤口服配合中药熏洗治疗,结果表明,治疗组治愈率95%高于单纯西医治疗组的93%,复发率低于对照组,安全性指标亦未见异常。以上研究均证实,犀角地黄汤治疗HSP,具有临床推广应用价值。
目前HSP的病因及发病机制尚未十分清晰,主流认识为“四重打击学说”,即在遗传易感的个体中,过敏和感染等环境因素触发机体异常免疫反应,循环中半乳糖缺乏的免疫球蛋白水平升高导致自身抗体的产生,免疫复合物沉积,形成免疫球蛋白A(Immunoglobulin A,IgA)介导的系统性血管炎[13-14]。IgA为主的免疫复合物沉积在肾脏系膜区及内皮下,能激活补体系统,导致炎症因子分泌,从而引起肾脏损伤[15]。故HSP发病机制多与炎症反应、氧化应激反应、免疫失衡、凝血系统紊乱及血管损伤等有关。以下相关研究发现,犀角地黄汤及其组分或组分的主要成分多具有调节炎症反应、抗氧化应激、调节免疫、抗凝、抗血栓及保护血管内皮细胞等药理作用,为犀角地黄汤治疗HSP的多中心、多靶点、多途径的特点提供了依据。
HSP是全身系统性小血管炎,发病机制复杂,目前大部分研究认为其发病与细胞炎性反应密切相关[16],多表现为肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)、白细胞介素-6(Interleukin,IL-6)及白细胞介素-8(Interleukin,IL-8)等表达升高[17]。临床研究发现,犀角地黄汤能够降低HSP患儿体内TNF-α、IL-6及IL-8等炎症因子的水平[18]。动物实验及细胞实验证实,犀角地黄汤能降低大鼠TNF-α、IL-6等表达[19-20]。另外,药理研究表明,犀角地黄汤的组方或组方主要成分如生地、丹皮酚、芍药苷及水牛角提取液均可显著抑制TNF-α和IL-6的释放[20-23],有效缓解炎症反应。
HSP发病与氧化应激反应有关[24],其中中性粒细胞内髓过氧化物酶(Myeloperoxidase,MPO)可诱发调节炎性反应[25]、丙二醛(Malondialdehyde,MDA)具有细胞毒性,而超氧化物歧化酶(Superoxide dismutase,SOD)具有抗氧化作用,可减轻HSP患儿氧化应激损伤[24]。关键靶点PPI网络推测犀角地黄汤可能通过MPO等靶点发挥作用[26],实验研究证实这一观点,发现犀角地黄汤能够发挥抑制小鼠氧自由基以及脂质过氧化作用,降低MDA水平,升高SOD水平[19]。药理研究表明,水牛角、芍药苷、丹皮酚能有效减少小鼠MPO的表达[22,27-28],生地可降低MDA含量,提高SOD活力[29],进而清除氧自由基,发挥抗氧化作用。
辅助性T淋巴细胞17/调节性T淋巴细胞(T helper lymphocytel 17/T regulatory lymphocyte,Th17/Treg)细胞平衡失调在HSP患儿的免疫微环境中发挥重要作用,表现为血清中转化生长因子-β(Transforming growth factor-β,TGF-β)、IL-6及白细胞介素-17(Interleukin,IL-17)表达水平升高,叉头翼状螺旋转录因子3(Forkhead Box P3,FoxP3)、干扰素-γ(Interferonγ,IFN-γ)等表达水平下降等[30-31]。犀角地黄汤作用于大鼠后,可见外周血淋巴细胞中Treg细胞所占比例、FoxP3 mRNA相对表达量均明显上升,而Th17细胞所占比例及IL-17水平均明显下降[32]。药理研究发现,白芍总苷及丹皮提取物可上调外周Treg细胞和Treg细胞中的转录因子FoxP3,同时通过抑制Th17、IFN-γ等相关细胞因子表达,进而抑制IL-6和IL-17分泌[33-34],从而维持Th17/Treg平衡,进而调节相关细胞因子表达。
多数研究发现HSP患儿血浆D-D、FIB、FDP水平升高,血小板功能增强,血小板聚集及血栓形成,其凝血功能的变化与肾损害有显著的相关性[35-36]。临床研究发现,犀角地黄汤能够升高APTT、PT、TT值,降低FIB含量,从而改善HSP患者凝血功能[37]。药理研究进一步证实,水牛角、生地、赤芍、白芍及牡丹皮等,可通过内、外源凝血途径共同调节凝血系统[38-40],降低FIB、AT、FDP,延长PT、APTT,缩短TT,降低全血及血浆黏度,增加血液流动性,从而改善凝血系统。
血管内皮细胞的损伤是HSP发生的病理基础[41]。HSP患者炎症反应激活及血管内皮细胞损伤后,可引起相关凋亡蛋白表达异常[42],可见Bax升高,Bcl-2表达降低,且Fas与其配体FasL相互作用激活后其下游的天冬氨酸特异性蛋白酶系列(Caspase系列)将引起DAN片段化,最终导致细胞凋亡[43]。犀角地黄汤可以上调大鼠Bcl-2的表达,下调Caspase-3的表达[44-45]。药理研究证实,芍药苷干预后能通过介导Fas/FasL信号转导通路,下调Fas mRNA、Caspase-3 mRNA、Caspase-8 mRNA的表达水平[46-47],而地黄苷、芍药苷及丹皮酚给药可抑制细胞Bax/Bcl-2的升高[48-50],同时在一定程度上能降低Caspase水平[51-52],有效抑制细胞凋亡率,从而起到保护内皮细胞作用。内皮细胞损伤可出现血管细胞黏附分子-1(Vascular cell adhesion molecule-1,VCAM-1)、细胞间黏附分子-1(Intercellular adhesion molecule-1,ICAM-1)及血管内皮生长因子(Vascular endothelial growth facto,VEGF)的表达,加重血管内皮损伤,破坏血管内皮完整性,增加通透性,参与HSP的发生发展[53-54]。犀角地黄汤能够抑制小鼠皮损组织中ICAM-1、VCAM-1表达的增高,从而抑制炎症反应[55]。药理研究证实,地黄梓醇及丹皮酚可抑制下调VEGF过度表达[56],从而减少VCAM-1、ICAM-1的释放,改善内皮细胞功能障碍。
NF-κB通路在炎症反应过程中发挥了重要作用[57-58],可导致多种促炎细胞因子分泌增加[59],促进异常IgA1介导的系统性血管炎,参与HSP的血管炎性损伤[60]。犀角地黄汤加味能够对NF-κB的活化发挥抑制作用,从而进一步调节各种细胞因子的表达,缓解小鼠机体炎症反应[61]。丁樱教授团队以犀角地黄汤为基础进行加减,创制清热止血方,联合雷公藤多苷共同应用于人脐静脉内皮细胞建立的HSPN的细胞模型,结果发现其可明显抑制HSPN患者血清源性多聚IgA诱导的NF-κB通路激活,调节通路相关蛋白表达量,从而抑制炎症反应,减少肾脏损害,发挥细胞保护作用[62],动物研究进一步证实,两药联合可通过抑制NF-κB信号通路的激活,从而减少炎症反应,进而降低HSPN大鼠的血尿及蛋白尿水平[63]。药理研究发现,丹皮酚、白芍总苷以及赤芍总苷可以显著降低大鼠体内NF-κB表达,降低TNF-α、TGF-β及IL-1β等水平,减轻损伤[64-67]。
炎症因子在HSP的病程中发挥着重要作用,尤其是IL-6,可导致JAK的激活,而后介导信号转导和STAT的磷酸化,使得IgA1糖基化过程中酶活性异常,从而导致Gd-IgA1产生增多[68],进而促进促炎因子合成与释放[69],加重炎症反应。研究发现,犀角地黄汤加减可能通过JAK/STAT信号通路,调节STAT蛋白表达水平,减少血清促炎因子分泌,增加抑炎因子分泌[70],控制炎症反应。药理研究发现,生地黄提取物、丹皮酚及白芍总苷可通过抑制JAK/STAT途径的激活,从而发挥抗氧化活性和抗炎作用,最终达到减轻小鼠HSP症状的目的[71-74]。
PI3K/AKT通路和炎症、氧化应激关系密切,该通路的激活参与IgA1诱导人肾小球系膜细胞增殖,导致肾损伤、肾小球肥大[75-76],参与HSP的发生。而抑制PI3K和Akt蛋白的表达,可明显降低细胞膜的通透性[77],减轻内皮细胞损伤,从而减少HSPN大鼠蛋白尿及肾组织损伤,改善肾脏功能[78]。犀角地黄汤加减干预后能够下调模型小鼠PI3K、Akt、mTOR的表达[79],从而达到调节免疫、抑制炎症的作用[80]。药理研究表明,芍药苷及白芍苷等可调控PI3K/Akt信号通路,显著降低PI3K、Akt及下游促炎细胞因子水平[81-82],减少促炎细胞因子分泌,增加抗炎细胞因子释放,调节促炎-抗炎细胞因子的平衡。赤芍及丹皮酚等可以通过促PI3K/Akt通路的磷酸化激活,从而抑制细胞的氧化应激和炎症反应[83-84]。
研究发现,TLR4活化后将激活MyD88依赖途径,进而导致NF-κB活化,丝裂原活化蛋白激酶(Mitogen-activated protein kinase,MAPK)途径激活,诱导免疫细胞表达,刺激IL-6、TNF-1、ICAM-1等炎症细胞因子的释放[85-86],进而引起血管内炎症反应,导致HSP的病理生理改变[87-88],抑制TLRMyD88-NF-κB通路,则免疫反应的发生发展将减轻,下游的炎症因子和自身抗体随之减少,从而保护脏器组织[89]。研究发现,犀角地黄汤可通过抑制TLR4/MyD88/NF-κB信号通路[90],调节免疫细胞分化,从而改善Th17/Treg细胞失衡,降低小鼠体内TNF-α、IL-6等炎症因子的表达,从而控制炎症反应[91-92]。而单味药如地黄主要成分梓醇、白芍总苷及丹皮酚等亦可通过阻断TLR4/My D88/NF-κB信号通路传导,抑制TLR9、My D88和NF-κB p65等分子蛋白表达,降低血清TNF-α和IL-6含量[93-96],进而抑制其下游相关炎症因子表达,抗炎、调节免疫并减轻小鼠肾损伤。
温病学派创始人叶天士强调:“入血就恐耗血动血,直须凉血散血。”HSP病位深在营血,基本治法是凉血、散瘀、养阴。而犀角地黄汤具有止妄行之血,清血分之热,散血分之瘀,解血分之毒,滋血分之阴等多方面的疗效,恰合本病病机。对目前的基础实验研究进行综合分析,发现犀角地黄汤治疗HSP的作用机制主要与其通过调节NF-κB信号通路、JAK/STAT通路、PI3K/Akt通路及TLR4/My D88/NF-κB信号通路等发挥调节炎症反应、下调抗氧化应激反应、调节免疫、抗凝抗血栓及保护血管等药理作用有关。临床研究方面,多项研究表明,犀角地黄汤加减或联合西医常规治疗或中医特色治疗对于减少紫癜复发,缩短疗程,缓解临床症状等方面均具有显著疗效,充分发挥了中西医结合在临床HSP治疗中的优势。但是目前仍存在部分问题,首先是部分作用机制并非是犀角地黄汤组方干预的结果,而是其中某味药,或某味药的主要成分所发挥的作用,不能笼统地概括为犀角地黄汤整体的药理作用。此外,当前单中心随机对照试验少且样本量小,同时缺乏多中心随机对照的临床试验,且文献质量不太令人满意,其结果可能存在发表偏倚的风险,未来需要进一步扩充样本量,以便证实犀角地黄汤在HSP治疗中的优势所在,更好地服务于临床。
  • 国家自然科学基金青年科学基金项目(82305311; 82305310)
  • 河南省“双一流”创建学科中医学科科学研究专项(HSRP-DFCTCM-2023-7-12)
  • 河南中医药大学第一附属医院博士启动基金项目(2022BSJJ2005)
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2025年第43卷第11期
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doi: 10.13193/j.issn.1673-7717.2025.11.032
  • 首发时间:2026-10-30
  • 出版时间:2025-11-10
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国家自然科学基金青年科学基金项目(82305311; 82305310)
河南省“双一流”创建学科中医学科科学研究专项(HSRP-DFCTCM-2023-7-12)
河南中医药大学第一附属医院博士启动基金项目(2022BSJJ2005)
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    1.河南中医药大学第一附属医院儿科医院,河南 郑州 450000
    2.河南中医药大学儿科医学院,河南 郑州 450000

通讯作者:

丁樱(1951-),女,江苏南京人,教授、主任医师,国医大师,博士研究生导师,研究方向:中医药防治小儿肾脏及风湿免疫性疾病。E-mail:。
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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