辣椒素药理活性及其药物代谢动力学的研究进展CSCD

辣椒素家族是辣椒中含量很高的活性成分,具有抗氧化、抗肿瘤、抗胃肠道溃疡、减肥及镇痛等方面的药理作用。研究表明,辣椒素的药理活性取决于剂量、给药途径和不同组织中的半衰期等药代动力学性质。不同剂量的辣椒素具有抗癌(20~50 mg/kg)与促癌(≥100 mg/kg),防治胃肠道溃疡(<50 mg/kg)与引起胃肠道溃疡(>100 mg/kg)的双向作用;透皮给药的长效止痛作用;在体内肝、肾、肠、肺及血液等不同部位较短的半衰期限制其在体内的临床使用。本文综述辣椒素家族成分的结构特点和辣椒素的主要药理活性及药物代谢动力学性质方面的研究,而许多研究表明辣椒素具有较短的半衰期和低的生物利用度等代谢方面缺陷,这可能是阻碍其体内临床应用的主要原因,增强活性和克服代谢缺陷的辣椒素类似物或许是开发新一代辣椒素药物的方向。     

白芷乙醇提取物镇痛作用研究

目的:观察白芷乙醇提取物(EEAD)的镇痛作用。方法:各组小鼠连续灌胃不同剂量的白芷乙醇提取物3d,末次给药后1 h。以热板致痛法、醋酸扭体法为疼痛模型,生理盐水为阴性对照药,阿司匹林为阳性对照药,考察白芷乙醇提取物的镇痛作用。结果:白芷提取物可显著延长小鼠热板反应的潜伏期,及扭体反应出现的时间。结论:白芷乙醇提取物镇痛作用明确。     

炎性条件对于辣椒素镇痛作用的影响

目的：观察辣椒素的镇痛时间是否在炎性条件下发生改变,以及辣椒素在产生镇痛作用前的痛觉过敏时间是否受炎性条件的影响。方法：健康成年昆明雌性小鼠50只,（实验前对其测定热缩足反射潜伏期,作为基础值）,随机分为五组（n=10）,：生理盐水组,辣椒素赋形剂实验一组（吐温80：95％乙醇：生理盐水=1：1：8配置）,0．5％辣椒素实验二纽（C0．5）,剩余小鼠用完全性弗氏佐剂建立炎性模型,将建模成功的小鼠随机分为辣椒素赋形剂实验三组,0．5％辣椒素实验四组。各组小鼠均采用右后足给药,0．05ml。观察给药后1,4,7小时后小鼠的热缩足反射潜伏期时间,以及热缩足反射潜伏期恢复至正常范围所需时间。结果：1．五组小鼠的热缩足反射潜伏期的比较：五组小鼠的基础值差别无统计学意义（P〉0．05）。生理盐水组与辣椒素赋形剂实验一组相比较,差别无统计学意义（P〉0．05）。2．实验二组热缩足潜伏期时间在注药后7小时内小于生理盐水组（P〈0．05）,注药后第2-5天大于生理盐水组（P〈0．05）,第三天效果最强,作用最明显,第六天恢复至基础值。3．实验三组热缩足潜伏期时间小于生理盐水组（P〈0．05）,注药后第18．20天恢复至基础值。4．实验四组热缩足潜伏期时间在注药后4小时内小于生理盐水组（P〈0．05）,注药后4小时后大于生理盐水组（P〈0．05）,注药后第18—19天恢复至基础值,注药后第二,三天效果最强,作用最明显,以后作用逐渐减退但仍高于基础值。结论：辣椒素的镇痛时间在炎性条件下延长,而且延长的时间与炎性条件持续的时间保持一致。辣椒素在产生镇痛作用前的痛觉过敏时间在炎性条件下缩短。     

右美托咪啶在临床医学中应用的新进展

右美托咪啶为新型高选择性a2肾上腺素能受体激动剂,其激动a2与al的比例为1620:1.其分布半衰期约为6分钟,消除半衰期约为2小时,主要在肝脏进行代谢.大量的实验室实验,动物研究及健康志愿者和临床病人的临床应用表明了它的药理作用.它具有剂量依赖性的镇静催眠作用,还具有镇痛、抑制交感活性、无呼吸抑制等药理性质.其发挥镇静催眠等的作用是通过调节抑制蓝斑核和髓核的去甲肾上腺素神经元的超极化,抑制其神经元冲动的产生和减少去甲肾上腺素的释放以及激活中枢的a2ARs受体等机制而产生的.本药于1999年在美国批准用于重症监护病房(ICU)成人的镇静,镇痛.由于右美托咪啶具有上述特性,现在本药已用于术前用药,全麻辅助药,锥管内麻醉,术后镇痛等诸多临床实践中.现就其临床应用作一综述.     

吗啡受体拮抗剂翻转电针镇痛的程度决定于电针刺激的频率

电针镇痛能被吗啡受体拮抗剂所对抗,被认为是内源性吗啡样物质参与针刺镇痛的有力证据。给大鼠皮下注射吗啡受体拮抗剂纳洛酮或纳曲酮 1mg/kg, 可以对抗低频和中频(2和15Hz)电针的镇痛效应,但不能对抗高频(100Hz)电针镇痛效应。增加纳洛酮剂量至20mg/kg才能部分对抗 100Hz电针镇痛。根据不同剂量纳洛酮(0.25—20mg/kg)对抗不同频率电针镇痛的剂量效应曲线,求得对2,15和100Hz电针镇痛产生50％翻转作用的纳洛酮剂量分别为 0.53,1.02和 24mg/kg。2—15Hz变频电针的镇痛作用也需用大剂量纳洛酮(20mg/kg)才能阻断。实验表明,在三种频率下,改变电针刺激强度(1,2,3V)并不影响纳洛酮翻转电针镇痛的百分数。以上结果表明,纳洛酮翻转电针镇痛的程度决定于电针的频率,不同频率的电针刺激可能在中枢神经系统中释放出不同的内源性吗啡样物质而发挥镇痛作用。     

阿片受体的耐受机制

阿片类药物是临床疼痛治疗中重要的选择药物,限制其长期使用的主要原因在于患者生理耐受性和药物依赖性的发生。多种给药途径、不同剂量(从超低到高剂量)以及给药时间(如间歇性或持续)均可造成阿片类药物的耐受。阿片类药物的使用是一把双刃剑。它们最初被用于镇痛和抗痛觉过敏,但随后的实验研究和临床观察发现,长期使用阿片类药物会导致急性阿片类耐受(acute opioid tolerance,AOT)和阿片类诱导的痛觉过敏(opioid-induced hyperalgesia, OIH)。有研究表明,阿片类药物即使在临床接受的剂量范围内使用,也会引起剂量或时间依赖性的急性耐受性和痛觉过敏。要在实现临床疗效的情况下同时减轻或有效阻止阿片耐受的形成是一个亟待解决的问题。因此,本文主要简述了阿片受体中最重要的μ阿片受体耐受的形成机制,以期为阿片耐受的治疗提供理论依据。     

甲氨蝶吟三种方法治疗异位妊娠疗效观察

目的：探讨甲氨蝶吟治疗异位妊娠过程中不同剂量、不同给药途径所产生的疗效。方法：时2003年1月至2005年10月我院保守治疗异位妊娠的临床质料进行回顾分析。结果：小剂量分次给药治愈率81．25％,单次给药治疗好于小剂量分次给药,同等剂量,宫腔内给药明显好于肌注。     

乌金草挥发油镇痛作用的研究

采用热板法和醋酸扭体法两种经典的镇痛模型对乌金草挥发油进行了初步的镇痛作用研究。结果表明,乌金草挥发性成分具有显著的镇痛作用,能明显延长小鼠热板痛阈值,有效降低小鼠因醋酸所致扭体反应次数。在给药1mL/kg剂量和2mL/kg剂量时,该挥发油均具有明显的镇痛效果,且有一定的量效关系。     

大血藤醇提物抗炎镇痛和止血活性研究初探

为观察大血藤醇提物抗炎、镇痛、止血活性,该文采用75%乙醇提取制备大血藤醇提物(AESC),利用HPLC法测定其绿原酸含量; KM鼠(或新西兰兔)在测定抗炎、镇痛、止血活性时随机分为空白对照组、阳性对照组(云南白药酊组)、AESC组,依次测定其抑制二甲苯致小鼠耳肿胀度作用、痛阈值和兔肝脏局部创面损伤出血的记分分值,分别考察其抗炎、镇痛、止血作用。结果表明:AESC中绿原酸含量为(0.294±0.013 5)%;与空白组比较,剂量为0.700 g·kg~(-1)的AESC组能显著减轻二甲苯所致的小鼠耳肿胀度(P0.01),抑制率达26.3%;与空白组及给药前比较,剂量为1.40 g·kg~(-1)的AESC组均能显著提高小鼠痛阈值(P0.01);与空白组相比,剂量为1.40 g·kg~(-1)的AESC组能显著提高兔肝脏局部创面损伤出血的记分分值(P0.001)。大血藤醇提取物具有显著的抗炎、镇痛、止血作用,有望将其开发为抗炎、镇痛、止血制剂。该结果也为大血藤的临床应用提供理论依据。     

吗啡皮下自控镇痛泵治疗难治性癌痛的前瞻性多中心随机对照研究

摘要 目的：观察吗啡皮下自控镇痛泵治疗难治性癌痛的临床疗效。方法：采用前瞻性多中心随机对照研究,应用治疗方法分为试验组和对照组,其中试验组使用皮下自控阵痛泵给药,对照组口服吗啡片剂,5 d为一疗程,共计观察3疗程。观察两组患者治疗后疼痛积分改善情况;每疗程吗啡日均用量;疼痛起效时间、最佳缓解时间;镇痛维持时间及剂量稳定天数、爆发痛情况;生活质量改善及不良反应发生率;疗程费用情况。结果：两组患者数字疼痛评分法(numerical rating scale,NRS)评分在治疗后均较镇痛前显著降低（P＜0.05）;在吗啡用量比较方面,试验组吗啡用量显著低于对照组同期用量;试验组在疼痛缓解时间、疼痛最佳缓解时间方面均显著优于对照组;治疗期间试验组平均镇痛维持时间明显长于对照组（P＜0.05）;两组患者治疗后体力状况分析标准(performance status,PS)评分较治疗前显著改善;试验组便秘、嗜睡不良反应发生率显著低于对照组（P＜0.05）。试验组每疗程费用明显低于对照组,具有明显经济优势。结论：吗啡皮下自控镇痛泵给药方式控制难治性癌痛临床疗效确切,止痛效果明显。与对照组比较,疼痛起效时间短,疗程较吗啡用量少,不良反应发生率低,改善了患者生活质量,且减轻了患者经济压力。     

Effect of capsaicin upon afferent and efferent mechanisms of nociception and temperature regulation in birds

(1) Acute capsaicin effects on nociception in the conscious chicken were tested by close arterial injection. The threshold dose to elicit nocifensive and autonomic responses was 50 micrograms, i.e., two to three orders of magnitude higher than in mammals but four times lower than in pigeons. (2) Foot withdrawal from hot water remained unchanged after capsaicin was injected either intravenously in the chicken at a cumulative dose of 600 mg/kg or perineurally at a dose of 100 micrograms into the sciatic nerve of pigeons. (3) Temperature regulation and body temperature in the chicken were not affected by subcutaneous injection of capsaicin, but intravenous infusion at rates of 2-5 or 10-13 mg X min-1 X kg-1 transiently lowered body temperature by 1.5 degrees C and stimulated panting and sometimes vasodilatation of the comb. Repeated capsaicin infusion produced temporary tachyphylaxia but no permanent desensitization. (4) A cumulative dose of 1 g/kg body weight capsaicin reduced the relationship between breathing frequency and respiratory evaporative heat loss in the duck. This deficit was compensated by more pronounced panting and, thus, did not indicate any impairment of temperature regulation. (5) Injection of capsaicin into the sciatic nerve depleted substance P in the dorsal horn of rats. Similar treatment in pigeons caused an increase of substance P immunoreactivity in the dorsal horn. (6) The effects of high capsaicin doses in birds indicate only low susceptibility of afferent neural mechanisms. Some of the effects may be due to a capsaicin action upon efferent neural mechanisms.     

Enkephalin-like immunofluorescence in nerves of the rat iris following systemic capsaicin injection

A network of nerve fibers with an enkephalin-like immunoreactivity was demonstrated in rat iris whole mounts. Systemic administration of capsaicin in doses which caused partial (5 mg/kg) or complete (50 mg/kg) disappearance of substance P-containing fibers in the iris did not cause degeneration of enkephalin-positive nerve fibers. The enkephalin-immunoreactive network seemed intact also after a capsaicin dose of 250 mg/kg. In fact, the fluorescence intensity of the nerve fibers showing enkephalin-immunoreactivity was often increased three days after a capsaicin injection in a dose of 50 mg/kg. The mechanism behind this effect of capsaicin remains to be elucidated, but could be due either to a direct effect on the enkephalin-positive nerves or involve the disappearance of substance P nerves and/or a simultaneous inflammatory response. However, an increased fluorescence intensity of the enkephalin-immunoreactive fibers was sometimes seen also without capsaicin treatment.     

Modification of antiallodynic and antinociceptive effects of morphine by peripheral and central action of fluoxetine in a neuropathic mice model

We have previously reported that serotonin concentration was reduced in the brain of mice with neuropathic pain and that it may be related to reduction of morphine analgesic effects. To further prove this pharmacological action, we applied fluoxetine, a selective serotonin reuptake inhibitor, to determine whether it suppressed neuropathic pain and examined how its different administration routes would affect antinociceptive and antiallodynic effects of morphine in diabetic (DM) and sciatic nerve ligation (SL) mice, as models of neuropathic pain. Antiallodynia and antinociceptive effect of drugs were measured by using von Frey filament and tail pinch tests, respectively. Fluoxetine given alone, intracerebroventicularly (i.c.v., 15 microg/mouse) or intraperitoneally (i.p., 5 and 10 mg/kg) did not produce any effect in either model. However, fluoxetine given i.p. enhanced both antiallodynic and antinociceptive effects of morphine. Administration of fluoxetine i.c.v., slightly enhanced only the antiallodynic effect of morphine in SL mice. Ketanserine, a serotonin 2A receptor antagonist (i.p., 1 mg/kg) and naloxone, an opioid receptor antagonist (i.p., 3 mg/kg), blocked the combined antinociceptive effect of fluoxetine and morphine. Our data show that fluoxetine itself lacks antinociceptive properties in the two neuropathy models, but it enhances the analgesic effect of morphine in the periphery and suggests that co-administration of morphine with fluoxetine may have therapeutic potential in treatment of neuropathic pain.     

The analgesic effect induced by capsaicin is enhanced in inflammatory states

Agonists of the vanilloid receptor type 1 (VR1), such as capsaicin, induce an analgesic effect following an initial excitatory response. It has been demonstrated that the vanilloid system plays an important role in inflammatory hyperalgesia. In accordance, we show that the VR1 antagonist capsazepine (30 microg; i.pl.) prevented the thermal hyperalgesia induced by carrageenan or complete Freund's adjuvant (CFA) in mice. Furthermore, we studied whether this inflammation-induced activation of the vanilloid system could enhance the analgesic properties of capsaicin. A single administration of capsaicin (10 microg; i.pl.) induced in control mice an analgesic effect that lasted for 2 days. In contrast, in carrageenan-treated animals, the analgesic effect of this dose of capsaicin lasted for 6 days and in CFA-treated mice for 30 days. This prolongation of capsaicin-induced analgesia during inflammation was mediated through VR1 since it was completely blocked by coadministration of capsazepine (10 microg). Licking behavior induced by capsaicin in carrageenan- and CFA-treated mice was greater than in control animals. However, although capsaicin induced a more prolonged analgesia in CFA-treated mice, the licking behavior was greater in the carrageenan-treated group, suggesting that the prolongation of analgesia is independent of the initial nociceptive input. Overall, these results show that the analgesic effects of capsaicin are importantly enhanced during inflammation, supporting the fact that the stimulation of VR1 could perhaps constitute a suitable strategy to avoid inflammatory hyperalgesia.     

Spinal analgesia: Comparison of the mu agonist morphine and the kappa agonist ethylketazocine

The sites of analgesic action of the mu agonist morphine and the purported kappa agonist ethylketazocine (EKC) were compared. Using local drug injections and parenteral administration of drugs to spinalized rats, our data support a predominantly spinal site of action for EKC and a major supraspinal action for morphine in antinociceptive tests. This spinal analgesic action of EKC was dose dependent and naloxone reversible indicating opiate receptor involvement. The possibility that EKC activates a spinal kappa receptor population is under further study.     

The depolarising action of capsaicin on rat isolated sciatic nerve

The effect of capsaicin on the isolated sciatic nerve of rat was studied by extracellular recording of membrane polarisation. Capsaicin depolarised the sciatic nerve, but desensitization occurred rapidly upon repeated administration. Several other neuroactive substances, including substance P, were inactive. The depolarisation was reduced in nerves depleted of unmyelinated fibres by neonatal capsaicin treatment, suggesting that it occurs mainly in C-fibres. This depolarising action of capsaicin could explain the irritant and acute antinociceptive properties of capsaicin.     

Non-Competitive but pH-Dependent Action of SB-366791 on Proton-Induced Activation of TRPV1 Receptors

The transient receptor potential vanilloid type 1 (TRPV1) is a nonselective cation channel gated by numerous chemical and physical stimuli (protons, capsaicin, heat, etc). TRPV1 receptors are important integrators of multiple noxious and inflammatory signals in vertebrates. Modulation of TRPV1 receptors activity is considered to be a promising strategy for pain treatment. SB-366791 is a TRPV1 antagonist that demonstrates good analgesic effects in various models of pain. Molecular mechanisms of the SB-366791 action on TRPV1 are not clear. It antagonizes capsaicin activation in a competitive manner, but the data on its action in the case of activation by protons are controversial. Here we studied effects of SB-366791 when TRPV1 receptors are activated by acidification. We carried out patch-clamp experiments (voltage-clamp mode) on cultured CHO cells stably expressing rat TRPV1 receptors. The whole-cell proton-evoked currents were reduced in the presence of SB-366791. Concentration dependencies of the inhibitory effect of SB-366791 were studied at different pH values. Stronger acidification reduced the maximum effect of SB-366791, while the IC₅₀ values were virtually unaffected. Thus, SB-366791 acts in a non-competitive but pH-dependent way. Probably, there is an allosteric interplay between proton- and capsaicin-binding sites.     

Mechanisms of depletion of substance P by capsaicin

Capsaicin is a neurotoxin that can deplete sensory nerves of their content of substance P and interfere with certain sensory functions, such as responses of animals to noxious heat stimuli. In adult guinea pigs, a species that is susceptible to the effects of capsaicin on both substance P content and sensory function, capsaicin induces selective depletion of substance P from dorsal root ganglia and the dorsal spinal cord, sites of the cell bodies and central terminals of primary afferent neurons, respectively. As the onset of thermal analgesia in guinea pigs precedes depletion of substance P, direct neural actions of capsaicin probably account for its effects on sensory function. Capsaicin interferes with the retrograde transport of nerve growth factor (NGF) to the cell bodies of sensory nerves. Decreased availability of NGF at the site of neural protein synthesis leads to decreased synthesis of substance P. After failure of synthesis of substance P, the content of the peptide in sensory nerves gradually decreases until depletion occurs.     

The capsaicin VR1 receptor mediates substance P release in toxin A-induced enteritis in rats

The mechanism by which Clostridium difficile toxin A causes substance P (SP) release and subsequent inflammation in the rat ileum is unknown. Pretreatment with the vanilloid receptor subtype 1 (VR1) antagonist, capsazepine, before toxin A administration significantly inhibited toxin A-induced SP release and intestinal inflammation. Intraluminal administration of the VR1 agonist capsaicin caused intestinal inflammation similar to the effects of toxin A. Pretreatment with capsazepine before capsaicin administration also significantly inhibited capsaicin-induced intestinal inflammation. These results suggest that intraluminal toxin A causes SP release from primary sensory neurons via stimulation of VR1 receptors resulting in intestinal inflammation.     

Role of calcitonin gene-related peptide in the postischemic anti-inflammatory effects of antecedent ethanol ingestion

The aim of this study was to determine the role of calcitonin gene-related peptide (CGRP) in the postischemic anti-inflammatory effects of antecedent ethanol ingestion. Ethanol was administered to wild-type C57BL/6 mice on day 1 as a bolus by gavage at a dose that produces a peak plasma ethanol of 45 mg/dl 30 min after administration. Twenty-four hours later (day 2), the superior mesenteric artery was occluded for 45 min followed by 70 min of reperfusion (I/R). Intravital fluorescence microscopy was used to quantify the numbers of rolling (LR) and adherent (LA) leukocytes labeled with carboxyfluorescein diacetate succinimidyl ester in postcapillary venules of the small intestine. I/R increased LR and LA, effects that were prevented by antecedent ethanol. The postischemic anti-inflammatory effects of ethanol consumption were abolished by administration of a specific CGRP receptor antagonist [CGRP-(8-37)] or after sensory nerve neurotransmitter depletion using capsaicin administered 4 days before ethanol ingestion, which initially induces rapid release of CGRP from sensory nerves, thereby depleting stored neuropeptide. Administration of exogenous CGRP or induction of endogenous CGRP release by treatment with capsaicin 24 h before I/R mimicked the postischemic anti-inflammatory effects of antecedent ethanol ingestion. Preconditioning with capsaicin 24 h before I/R was prevented by coincident treatment with CGRP-(8-37), while exogenous CGRP induced an anti-inflammatory phenotype in mice depleted of CGRP by capsaicin administration 4 days earlier. Our results indicate that the effect of antecedent ethanol ingestion to prevent postischemic LR and LA is initiated by a CGRP-dependent mechanism.