新冠肺炎炎症风暴的机制探讨及中医药的干预作用

Mechanism of Inflammatory Storm Induced by Novel Coronavirus Pneumonia and Intervention Measures of Traditional Chinese Medicine

摘要:

新型冠状病毒肺炎（新冠肺炎，COVID-19）部分患者在疾病发展过程中因炎症风暴的发生而出现病情的急剧加重，并发急性呼吸窘迫、多器官功能衰竭等严重并发症，预后不良，死亡率较高。对于炎症风暴，目前西医多采取糖皮质激素、营养支持、人工通气辅助等措施。人工肝、血液净化疗法、体外膜肺氧合等技术的日益成熟，也在一定程度上降低了患者死亡率，但因设备要求较高等诸多条件限制，尚未得到广泛开展。从中医角度看，COVID-19基本病机为疫毒外侵，肺脾受邪，损伤正气，病理性质涉及湿、热、毒、瘀、虚。病情发展至炎症风暴阶段，邪盛正虚，出现邪毒闭肺、毒扰心神、瘀毒互结与气阴亏虚并见，严重者甚至出现阴竭阳亡的危候。目前已有多项研究显示，多种中草药对病毒性肺炎和细胞因子风暴具有多靶点的免疫调节作用。中医药在炎症风暴发生发展的全过程中均有参与，早期祛邪为主，控制炎症、阻断炎症风暴的发生，降低重症发生率；中期祛邪扶正并进以祛除炎症风暴的病理产物，促进炎症的消散和吸收；后期则以益气固脱、回阳救逆等法挽救生命。该文结合COVID-19炎症风暴的病理生理机制与中医辨证施治理论，总结相关中草药、中药方剂、中药制剂对炎症风暴干预的药理研究，并探讨中医药在炎症风暴不同发展时期的干预措施，以期为临床治疗提供指导。

Abstract:

Some patients with corona virus disease-2019 (COVID-19) experienced a severe exacerbation of the disease due to the occurrence of inflammatory storm during the development of the disease. They are complicated with acute respiratory distress, multiple organ dysfunction syndrome and other serious complications, with a poor prognosis and a high mortality. For the inflammation storm, western medicine mostly adopts glucocorticoids, nutritional support, artificial ventilation assistance and other measures at present. The development of artificial liver, blood purification therapy, extracorporeal membrane oxygenation and other technologies have also reduced the mortality of patients to some extent. However, due to the high requirements for equipment, the measures have not yet been widely carried out. From the perspective of traditional Chinese medicine(TCM), the basic pathogenesis of COVID-19 is epidemic toxin invasion, lung and spleen being affected by pathogens, damaging vital Qi, and pathological properties involving dampness, heat, poison, stasis and deficiency. At the stage of inflammation storm, the pathogens are abundant, while the vital Qi is deficient， and the pathogens occlude lung, and disturb the heart and mind, and blood stasis and toxicity are combined with Qi-Yin deficiency. In severe cases, even both Yin and Yang exhaustion occurs. At present, a number of studies have shown that a variety of Chinese herbal medicines have multi-target immunomodulatory effect on viral pneumonia and cytokine storm. TCM participates in whole process of the occurrence and development of inflammation storm, mainly eliminating pathogens in early stage, controlling inflammation and blocking occurrence of inflammation storm， eliminating pathogens and strengthening the body resistance to eliminate the pathological products of the inflammation storm, and promoting the dissipation and absorption of inflammation in the middle stage， and saving lives in late stage by benefiting Qi and relieving depletion, and restoring Yang and rescuing from collapse. On the basis of pathophysiological mechanism of COVID-19 inflammation storm and the theory of TCM syndrome differentiation and treatment, this paper summarized the pharmacological studies on intervention on inflammatory storm with relevant Chinese herbal medicine, Chinese medicine prescriptions and Chinese medicine preparations, and discussed the intervention measures of TCM in different development stages of inflammatory storm, in expectation of providing the guidance for clinical treatment.