1.河南中医药大学第一附属医院儿科医院,郑州 450099
2.河南中医药大学儿科医学院,郑州 450046
Received:25 February 2026,
Revised:2026-07-07,
Accepted:09 July 2026,
Online First:24 July 2026,
Published:30 July 2026
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赵志芬,任相阁,张佳伟,等.雷公藤及其活性成分在肾病综合征中的药理作用及减毒机制研究进展 Δ[J].中国药房,2026,37(14):1931-1936. DOI: 10.6039/j.issn.1001-0408.2026.14.22.
ZHAO Zhifen,REN Xiangge,ZHANG Jiawei,et al.Research progress on the mechanisms of pharmacological effects and detoxification of Tripterygium wilfordii and its active ingredients in nephrotic syndrome[J].ZHONGGUO YAOFANG,2026,37(14):1931-1936.
赵志芬,任相阁,张佳伟,等.雷公藤及其活性成分在肾病综合征中的药理作用及减毒机制研究进展 Δ[J].中国药房,2026,37(14):1931-1936. DOI: 10.6039/j.issn.1001-0408.2026.14.22. DOI:
ZHAO Zhifen,REN Xiangge,ZHANG Jiawei,et al.Research progress on the mechanisms of pharmacological effects and detoxification of Tripterygium wilfordii and its active ingredients in nephrotic syndrome[J].ZHONGGUO YAOFANG,2026,37(14):1931-1936. DOI: 10.6039/j.issn.1001-0408.2026.14.22.
肾病综合征(NS)是以大量蛋白尿、低蛋白血症、水肿及高脂血症为核心临床特征的肾小球疾病。雷公藤在肾脏疾病的防治中具有显著疗效,但其肝毒性、肾毒性等限制了临床应用。本文系统综述雷公藤及其活性成分在NS治疗中的药理作用及减毒机制。结果发现,雷公藤及其活性成分(包括雷公藤多苷、雷公藤甲素、雷公藤三醇等)可通过保护肾小球足细胞、修复肾小球滤过屏障、调控机体异常免疫炎症反应、抑制氧化应激损伤及阻滞肾纤维化等多种途径,有效降低机体蛋白尿水平、改善肾功能、减少病情复发,发挥显著的肾脏保护作用。依托中药配伍(如雷公藤分别与金钱草、菟丝子醇提取物、白芍配伍)调控机体抗炎抗氧化水平、优化药物代谢通路并结合现代制剂改造(如雷公藤甲素自微乳给药体系),可有效拮抗雷公藤肝毒性、肾毒性等。
Nephrotic syndrome (NS) is a glomerular disease characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia.
Tripterygium wilfordii
exhibits remarkable efficacy in the prevention and treatment of renal diseases; however, its hepatotoxicity, nephrotoxicity, and other factors limit its clinical application. This article systematically reviews the mechanisms of pharmacological effects and detoxification of
T. wilfordii
and its active ingredients in the treatment of NS. The results show that the main active components of
T. wilfordii
include tripterygium glycosides, triptolide, and triptriolide, etc.
T. wilfordii
and its active ingredients exert significant renal protective effects by protecting glomerular podocytes, repairing the glomerular filtration barrier, regulating abnormal immune and inflammatory responses, inhibiting oxidative stress injury, and blocking renal fibrosis, thereby effectively reducing proteinuria, improving renal function, and lowering the recurrence rate of NS. Traditional Chinese medicine compatibility (e.g.
T. wilfordii
combined with
Lysimachia christinae
,
Cuscuta chinensis
ethanol extract, and
Paeonia lactiflora
, respectively) can regulate anti-inflammatory and antioxidant levels and optimize drug metabolic pathways. Combined with modern preparation technologies (e.g., triptolide self-microemulsion drug delivery system), these strategies can effectively antagonize the hepatotoxicity, nephrotoxicity, and other factors of
T. wilfordii
.
Frățilă V G , Lupușoru G , Sorohan B M , et al . Nephrotic syndrome:from pathophysiology to novel therapeutic approaches [J ] . Biomedicines , 2024 , 12 ( 3 ): 569 .
Wendt R , Sobhani A , Diefenhardt P , et al . An updated comprehensive review on diseases associated with nephrotic syndromes [J ] . Biomedicines , 2024 , 12 ( 10 ): 2259 .
Trautmann A , Boyer O , Hodson E , et al . IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome [J ] . Pediatr Nephrol , 2022 , 38 ( 3 ): 877 - 919 .
Tsai Y C , Tsai C C , Lin Y H , et al . Chinese herbal medicine in the treatment of chronic kidney disease:a narrative review of mechanisms and therapeutic potential [J ] . Iran J Pharm Res , 2025 , 24 ( 1 ): e165904 .
廖春满 , 张正媚 , 王梅杰 , 等 . 2000至2023年雷公藤多苷研究热点及趋势的可视化分析 [J ] . 浙江中医药大学学报 , 2024 , 48 ( 7 ): 872 - 880 .
闫建功 , 王一竹 , 吴先富 , 等 . 雷公藤中倍半萜生物碱类化学成分的研究 [J ] . 中草药 , 2022 , 53 ( 7 ): 1933 - 1938 .
Zhang Y Q , Mao X , Li W J , et al . Tripterygium wilfordii :an inspiring resource for rheumatoid arthritis treatment [J ] . Med Res Rev , 2021 , 41 ( 3 ): 1337 - 1374 .
张明昊 , 王珍 , 高一盈 , 等 . 白芍总苷对雷公藤多苷治疗湿疹的增效减毒作用及机制 [J ] . 中国药房 , 2023 , 34 ( 4 ): 444 - 449,456 .
张国玉 , 燕树勋 . 基于网络药理学探讨雷公藤多苷治疗桥本病的潜在作用机制 [J ] . 中成药 , 2023 , 45 ( 4 ): 1358 - 1363 .
Liu Y , Lu K D . Clinical efficacy and safety of Tripte-rygium wilfordii glycosides in the treatment of idiopathic membranous nephropathy:a systematic review and meta-analysis [J ] . Front Pharmacol , 2025 , 16 : 1652789 .
Yan L , Zhang L L , Zhang X M , et al . Triptolide in renal disorders:dual roles of therapeutic potential and nephrotoxicity:a narrative review [J ] . Pharm Biol , 2026 , 64 ( 1 ): 257 - 278 .
Yang Y Q , Yan X T , Wang K , et al . Triptriolide alleviates lipopolysaccharide-induced liver injury by Nrf2 and NF-κB signaling pathways [J ] . Front Pharmacol , 2018 , 9 : 999 .
Liu W T , Peng F F , Li H Y , et al . Metadherin facilitates podocyte apoptosis in diabetic nephropathy [J ] . Cell Death Dis , 2016 , 7 ( 11 ): e2477 .
Gong J G , Jin J , Zhao L , et al . Tripterygium glycoside protects against puromycin amino nucleoside-induced podocyte injury by upregulating autophagy [J ] . Int J Mol Med , 2018 , 42 ( 1 ): 115 - 122 .
梁世凯 . Triptolide protects podocytes via autophagy in immunoglobulin A nephropathy [C ] // 中国中西医结合学会肾脏疾病专业委员会2018年学术年会 , 2018 : 1110 .
Wan Q , Liu Z Y , Yang M , et al . Triptolide ameliorates fine particulate matter-induced podocytes injury via regulating NF-κB signaling pathway [J ] . BMC Mol Cell Biol , 2020 , 21 ( 1 ): 4 .
Wang L , Zhang L W , Hou Q , et al . Triptolide attenuates proteinuria and podocyte apoptosis via inhibition of NF-κB/GADD45B [J ] . Sci Rep , 2018 , 8 ( 1 ): 10843 .
Yang Y Q , Liang J , Han X D , et al . Dual-function of triptriolide in podocytes injury:inhibiting of apoptosis and restoring of survival [J ] . Biomed Pharmacother , 2019 , 109 : 1932 - 1939 .
Wang X W , Tian R M , Yang Y Q , et al . Tripterygium glycoside fraction n2 ameliorates adriamycin-induced nephrotic syndrome in rats by suppressing apoptosis [J ] . J Ethnopharmacol , 2020 , 257 : 112789 .
Kardani A K , Fitri L E , Samsu N , et al . Forging the future:B cell activating factor’s impact on nephrotic syndrome [J ] . Malays J Med Sci , 2024 , 31 ( 6 ): 57 - 64 .
Xue C , Zhou C C , Mao Z G . Antinephrin autoantibodies:rethinking the pathogenesis of minimal change disease [J ] . Ren Fail , 2024 , 46 ( 2 ): 2434192 .
Zhang Q , Bin S , Budge K , et al . C3aR-initiated signaling is a critical mechanism of podocyte injury in membranous nephropathy [J ] . JCI Insight , 2024 , 9 ( 4 ): e172976 .
Colucci M , Oniszczuk J , Vivarelli M , et al . B-cell dysregulation in idiopathic nephrotic syndrome:what we know and what we need to discover [J ] . Front Immunol , 2022 , 13 : 823204 .
Haddad G , Lorenzen J M , Ma H , et al . Altered glycosy-lation of IgG4 promotes lectin complement pathway activation in anti-PLA2R1-associated membranous nephropathy [J ] . J Clin Investig , 2021 , 131 ( 5 ): e140453 .
Liao Y H , Hu H F , Wan Q J , et al . The role of B lymphocyte subsets in nephrotic syndrome:functions,mechanisms,clinical significance and future perspectives [J ] . Front Immunol , 2025 , 16 : 1598197 .
Kim A H , Chung J J , Akilesh S , et al . B cell-derived IL-4 acts on podocytes to induce proteinuria and foot process effacement [J ] . JCI Insight , 2017 , 2 ( 21 ): e81836 .
Chen Z H , Qin W S , Zeng C H , et al . Triptolide reduces proteinuria in experimental membranous nephropathy and protects against C5b-9-induced podocyte injury in vitro [J ] . Kidney Int , 2010 , 77 ( 11 ): 974 - 988 .
Zheng C X , Chen Z H , Zeng C H , et al . Triptolide protects podocytes from puromycin aminonucleoside induced injury in vivo and in vitro [J ] . Kidney Int , 2008 , 74 ( 5 ): 596 - 612 .
齐佳欣 . 雷公藤多苷通过抑制TLR4/MyD88信号通路改善特发性膜性肾病大鼠肾损伤 [D ] . 太原 : 山西医科大学 , 2023 : 1 .
Li Y T , Fan J J , Zhu W P , et al . Therapeutic potential targeting podocyte mitochondrial dysfunction in focal segmental glomerulosclerosis [J ] . Kidney Dis(Basel) , 2023 , 9 ( 4 ): 254 - 264 .
Li T , Bao Y , Xia Y , et al . Loss of MTX2 causes mitochondrial dysfunction,podocyte injury,nephrotic proteinuria and glomerulopathy in mice and patients [J ] . Int J Biol Sci , 2024 , 20 ( 3 ): 937 - 952 .
Osredkar J , Kopač M . Dynamic changes in oxidative stress biomarkers in a child with idiopathic nephrotic syndrome:a longitudinal case study [J ] . Int J Mol Sci , 2025 , 27 ( 1 ): 216 .
Zhu Y T , Wan C , Lin J H , et al . Mitochondrial oxidative stress and cell death in podocytopathies [J ] . Biomolecules , 2022 , 12 ( 3 ): 403 .
张进 , 范丽 . 雷公藤多苷联合免疫抑制剂治疗难治性肾病综合征的远期疗效及对氧化应激指标的影响 [J ] . 临床医学研究与实践 , 2022 , 7 ( 4 ): 49 - 52 .
樊艳敏 , 宋纯东 , 姜浩然 , 等 . 雷公藤多苷通过调控AHR信号通路缓解膜性肾病大鼠肾组织氧化应激和炎症的作用机制 [J/OL ] . 时珍国医国药 , 2026-04-21 . https://link.cnki.net/urlid/42.1436.r.20260420.2034.002 https://link.cnki.net/urlid/42.1436.r.20260420.2034.002 .
Zheng B D , Lu D F , Chen X P , et al . Tripterygium glycosides improve abnormal lipid deposition in nephrotic syndrome rat models [J ] . Ren Fail , 2023 , 45 ( 1 ): 2182617 .
Nogueira A , Pires M J , Oliveira P A . Pathophysiological mechanisms of renal fibrosis:a review of animal models and therapeutic strategies [J ] . In Vivo , 2017 , 31 ( 1 ): 1 - 22 .
Reiss A B , Jacob B , Zubair A , et al . Fibrosis in chronic kidney disease:pathophysiology and therapeutic targets [J ] . J Clin Med , 2024 , 13 ( 7 ): 1881 .
臧勇 , 田园 , 李卫东 . 雷公藤甲素通过调节TGF-β 1 信号通路和Hippo信号通路影响肾小管上皮细胞的上皮-间充质转化 [J ] . 天津医科大学学报 , 2019 , 25 ( 3 ): 205 - 209,224 .
Zhu B , Wang Y J , Zhu C F , et al . Triptolide inhibits extracellular matrix protein synthesis by suppressing the Smad2 but not the MAPK pathway in TGF-1-stimulated NRK-49F cells [J ] . Nephrol Dial Transplant , 2010 , 25 ( 10 ): 3180 - 3191 .
Cao Y J , Huang X Z , Fan Y P , et al . Protective effect of triptolide against glomerular mesangial cell proliferation and glomerular fibrosis in rats involves the TGF-β 1 /Smad signaling pathway [J ] . Evid Based Complement Alternat Med , 2015 , 2015 : 814089 .
王君明 , 李金花 , 蔡泓 , 等 . 从“化学成分谱-减毒作用谱-生物信息谱”关联分析整体评价雷公藤配伍金钱草的相杀减毒作用机制 [J ] . 中国实验方剂学杂志 , 2019 , 25 ( 3 ): 15 - 20 .
刘泽洲 . 菟丝子醇提物、雷公藤多苷配伍降低大鼠肝毒性的实验研究 [D ] . 北京 : 北京中医药大学 , 2015 : 1 .
李振彬 , 王志强 , 宫彩霞 , 等 . 白芍总苷对雷公藤多苷治疗狼疮性肾炎减毒增效作用的实验研究 [J ] . 中药新药与临床药理 , 2009 , 20 ( 6 ): 513 - 516 .
张靖 , 胡骞 , 谭亲友 , 等 . 甘草提取物对雷公藤甲素损伤后人肝L-02细胞中UGT1A、MRP2表达的影响 [J ] . 中国药房 , 2018 , 29 ( 1 ): 65 - 68 .
刘建群 , 洪沁 , 张维 , 等 . 凤尾草对雷公藤甲素的减毒作用 [J ] . 中国医院药学杂志 , 2010 , 30 ( 6 ): 443 - 446 .
章瑾 , 谢明华 , 蔡鑫君 , 等 . 自乳化给药系统对雷公藤甲素的减毒作用研究 [J ] . 中国现代应用药学 , 2019 , 36 ( 2 ): 168 - 171 .
肖芳 , 管咏梅 , 陶玲 , 等 . 雷公藤配伍白芍对雷公藤提取物透皮吸收的影响 [J ] . 中国实验方剂学杂志 , 2018 , 24 ( 22 ): 34 - 39 .
陈厚爱 , 赵诗云 , 李冶武 , 等 . 雷公藤多苷与女贞子配伍对大鼠生化指标的影响 [J ] . 四川中医 , 2010 , 28 ( 12 ): 60 - 62 .
杨瑞 , 唐思 , 董晓茜 , 等 . 基于UPLC-Q-TOF-MS分析雷公藤配伍甘草治疗肾病综合征大鼠的尿液代谢组学 [J ] . 中国实验方剂学杂志 , 2018 , 24 ( 12 ): 150 - 156 .
许海淼 . 茅苍术水提物中6种单体化合物对雷公藤内酯醇减毒增效研究 [D ] . 镇江 : 江苏大学 , 2016 : 1 .
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