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קדד קרומי, אסטרגלוס - Astragalus membranaceus

עודכן בתאריך 27/08/2020

Astragalus - Huang Qi


משפחה בוטנית: פרפרניים – (Fabaceae (Leguminosae

 

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אסטרגלוס או קדד קרומי הוא צמח מרפא נפוץ ברחבי העולם בעל היסטוריה של אלפיים שנות שימוש ברפואה הסינית המסורתית.

שמו הסיני (Huang Qi) מרמז על עליונותו ברפואה הסינית כצמח מחזק וכאדפטוגן (Qi tonic).

ברפואה הסינית נודע הצמח כמחזק טחול, דם וצ'י ושימש לחיזוק כללי ולהגברת העמידות של הגוף במצבי פציעה ומחלות שונות, לרבות מחלות נשימתיות, חולשת מערכת העיכול, מחלות לב ומחלות כליה.
אסטרגלוס הינו צמח רב שנתי הגדל בבר בסין, במונגוליה ובקוריאה לגובה של 50-150 סנטימטרים, במורד גבעות או על גדות נחלים.

שני זנים עיקריים הדומים בשימושם הרפואי הם A. membranaceus ו-A. membranaceus var. mongholicus (הידוע גם כ-A. mongholicus) – שניהם מוגדרים ברפואה הסינית כשורש אסטרגלוס. עקב הידלדלות המשאבים הטבעיים של הצמח ולאור התצרוכת העולמית הגבוהה, הצמח מגודל כיום בסין בגידול חקלאי מסחרי. השורשים נקצרים באביב או בסתיו.
אסטרגלוס נחשב לצמח עדין ובטוח לשימוש לתקופות ארוכות.
אסטרגלוס מותר לשיווק בישראל.

 

חלק הצמח בשימוש

שורש

 

איכויות

טמפרטורה: חמים

לחות: יבש

טעם: מתקתק

 

רכיבים פעילים עיקריים

סאפונינים טריטרפנואידים (Astragalosides I-VII, Astragalus saponins I-III), פוליסכרידים, פלבונואידים, חומצות אמינו (arginine, aspartic acid, asparagine, proline, alanine), חומצות אורגניות (ferulic acid, vanillic acid, isoferulic acid, hydroxy phenyl acrylic acid, caffeic acid), חומצות שומן (linoleic acid, linolenic acid, palmitic acid, daucosterol, lupeol, 13-sitosterol), ויטמינים: חומצה פולית, כולין, בטאין, יסודות קורט: נחושת, כרום, ברזל, אבץ, סלניום, מוליבדנום, קובלט ועוד.

 

פעילות רפואית

להלן פעילויות רפואיות שהצמח ורכיביו הדגימו בשלל מחקרים (קליניים, בע״ח או מעבדה)*:

אדפטוגן, נוֹגד סַרטן, מווסת חיסון, נוֹגד אַלרגיה, נוֹגד דַלקת, נוֹגד חִמצון, נוֹגד אַנמיה, מעלה ספירות לבנות, מוריד רמות סוכר בדם (היפוגליקמי), מגן/מחזק לב, נוגד טרשת עורקים, מפחית לחץ דם, מגן כבד, מגן כליות, נוֹגד וִירוסים.

*העדויות לגבי הפעילויות הרפואיות מוצגות בסעיפי מנגנוני פעולה בהמשך.

 

התוויות

התוויות המגובות במחקרים קליניים*:
חולשה חיסונית, נויטרופניה, אנמיה, סרטן, מחלות אוטואימוניות, אלרגיות, תסמונת התשישות הכרונית, דלקת כבד, הפטיטיס, אי ספיקת לב, דלקת זיהומית של הלב, שבץ, תעוקת חזה, אסתמה, אי ספיקת כליות, סוכרת, נפרופתיה סוכּרתית, הרפס, איידס.

 

התוויות המגובות במחקרים פרה-קליניים (בעלי חיים ומעבדה)*:

טרשת עורקים, לחץ דם גבוה, חרדה, סטרס, הפרעות זיכרון, אלצהיימר, פרקינסון, אפילפסיה, אי פריון בקרב גברים.

 

התוויות נוספות אשר עדיין לא קיימות להן ראיות מחקריות:
שלשול.

 

*סיכום המחקרים נמצא כאן.

 

מינונים

תמצית נוזלית בריכוז 1:3, 45% אלכוהול – 6-24 מ"ל ביום.
תמצית יבשה בריכוז 5:1 – 300-1500 מ"ג ביום.
מרתח – 9-30 גרם ביום.
בפורמולה – 25-40%.

הערת המערכת: בחלק מהמחקרים שנערכו בסין ניתנה תמיסת אסטרגלוס בהזרקה או בעירוי, לרוב בריכוז של 2 גרם צמח למיליליטר תמיסת מלח, בטווח מינונים של 10-60 מ"ל ליום למבוגרים ובמינון של 0.5-1 מ"ל/ק"ג משקל גוף ליום לילדים. חשוב לציין כי לא ברורים ההבדלים בפעילות הרפואית בין נטילה פומית לבין עירוי של הצמח.

 

רגישות, תופעות לוואי ומינון יתר

אסטרגלוס נחשב לצמח למידע השלם למנויים

 

אזהרות וצעדי מנע

קיימת אזהרה תיאורטית לפיה אסטרגלוס עלול להגביר את הפעילות למידע השלם למנויים

 

התוויות נגד

למידע השלם למנויים

 

רעילות

למידע השלם למנויים

 

תגובות הדדיות עם תרופות / צמחי מרפא / תוספי תזונה

 

תרופות למחלת הסרְטן

צמחי מרפא ותוספי תזונה

 

השפעה על חילוף חומרים תרופתי

השפּעת אסטרגלוס על חילוף חומרים תרופתי כמעט ולא נבדקה. למעט מחקר קליני יחיד אשר שלל השפּעת הצמח על מנגנון למידע השלם למנויים

 

תרופות מדכאות חיסון (cyclophosphamide, methotrexate)
יש לנקוט זהירות בשילוב בין הצמח לתרופות אלו.

תיאורטית, אסטרגלוס עשוי להפחית יעילות תרופות מדכאות חיסון(4,14). לפיכך, מוטב להימנע משילוב הצמח בקרב מושתלי איברים.
במחקרים שנערכו בבעלי חיים ובמעבדה(27-33) נצפתה ברוב המקרים הפחתה של הדיכוי החיסוני שהושרה על ידי התרופה ציקלופוֹספמיד.

עם זאת, במחקרים קליניים(34-35) שנערכו בקרב חולי זאבת עם פגיעה כלייתית ובדיווח מקרה(36) על חולה עם תסמונת נפרוטית, שילוב של אסטרגלוס עם תרופות מדכאות חיסון נצפה שיפור בתסמינים, הפחתה של מינוני התרופות והפחתה של תופעות הלוואי התרופתיות.

במודל פגיעה בתימוס שהושרתה בעכברים(30) על ידי התרופה cyclophosphamide, מתן משלב הצמחים אסטרגלוס וארכובית סינית (Polygonum multiflorum) במינון 6 גרם/ק"ג ליום כל אחד במזון במשך שבועיים במקביל לתרופה, הפחית את הפגיעה המורפולוגית והתפקודית (p<0.01) על ידי הפחתת האפופטוזיס התאי. עוד נמצא כי משלב הצמחים היה יעיל יותר בהגנה על התימוס בהשוואה לכל אחד מהצמחים לבדם (p<0.01).
בקרב חולדות(29) שהושרה בהן דיכוי חיסוני באמצעות Cyclophosphamide, הזרקה תוך ורידית של נגזרת מבודדת (F3) שמוצתה מאסטרגלוס במינון 5.55 מ"ג במשך שמונה ימים ביטלה את הדיכוי החיסוני של התרופה והגבירה במובהק את התגובה החיסונית כנגד רקמה שהושתלה בחולדות 
בקרב עכברים(28) שהושרה בהם דיכוי חיסוני באמצעות Cyclophosphamide, מתן אסטרגלוס במינון 500 מ"ג/ק"ג בהזרקה לקרום הצפק במשך שישה ימים מנע דיכוי חיסוני על ידי שיפור השרידות והשגשוג של תאי גזע במוח העצם והשריית ייצור ציטוקינים (IL-6) וגורמי גידול (GM-CSF) המעודדים את ייצור תאי הדם.
בקרב חולדות(31) שהושרה בהן דיכוי חיסוני חלקי באמצעות Cyclophosphamide, השריית תאים חיסוניים מונונוקליארים מהדם הפריפרי שנדגמו מ-19 חולי סרטן במיצוי מימי מרוכז ומיובש בהקפאה של אסטרגלוס (במינון 82 גרם שווה ערך ל- 200 גרם צמח יבש, שדולל בתמיסת מלח בריכוז 0.1 מ"ג/מ"ל) והזרקתם לחולדות, עודדה תגובת דחיית שתל מקומית בחולדות (p<0.01), אשר השתוותה לתגובה שעוררו דגימות מ-15 נבדקים בריאים. פירוש הדבר שלאסטרגלוס יכולת לשקם את התגובה החיסונית שדוכאה על ידי Cyclophosphamide.
לעומת זאת, במחקר נוסף שנערך בקרב חולדות(30) שהושרה בהן דיכוי חיסוני באמצעות cyclophosphamide, מתן תמצית אסטרגלוס וליגוסטיקום במינון 240 מ"ג ליום במזון במשך 12 ימים לא מנע דיכוי של מח העצם ולא שיפר במובהק את ספירת הנויטרופילים וטסיות הדם.
עם זאת במחקרים קליניים שנערכו בקרב חולי זאבת עם פגיעה כלייתית ובדיווח מקרה על חולה עם תסמונת נפרוטית, שילוב של אסטרגלוס עם תרופות מדכאות חיסון נצפה שיפור בתסמינים, הפחתה של מינוני התרופות והפחתה של תופעות הלוואי התרופתיות.

במספר מחקרי מעבדה(32-33) אשר נערכו על תאים סרטניים אנושיים בהשוואה לתאים אנושיים בריאים נמצא שמיצויים של אסטרגלוס ופוליסכרידים שמוצו מאסטרגלוס מגבירים את היכולת החיסונית ומבטלים את הפגיעה החיסונית של התרופה ציקלוֹפוספמיד.

במחקר קליני(34) שנערך בקרב 43 נבדקים שאובחנו בזאבת אדמנתית מערכתית (SLE) בעלי פגיעה כלייתית, מתן מיצוי אסטרגלוס (ריכוז התמצית אינו ידוע) בעירוי במינון 20 מ"ל ליום במשך 12 יום בכל חודש בשילוב עם Cyclophosphamide בעירוי אחת לחודש במשך שלושה חודשים, היה יעיל יותר מהטיפול באמצעות ציקלופוֹספמיד לבדו בשיפור התסמינים הקליניים, בהפחתת פרוטאינוריה ובשיפור התפקוד החיסוני (ירידה ביחס בין CD4 ל- CD8 שמעיד על יותר ויסות חיסוני ופחות פעילות אוטואימונית, ירידה מופחתת בספירת תאי דם לבנים) של החולים. כמו כן נצפתה הפחתה בשיעור ההידבקות בזיהומים (4.35% בקבוצת הביקורת לעומת 25% בקבוצת ההתערבות), ועליה במדדים הכלליים של הנבדקים (עליה בספירת תאי הדם האדומים ועליה ברמות האלבומין בסרום) עם יתרון מובהק לקבוצת הטיפול באסטרגלוס.

מחקר קליני אקראי מבוקר(35) בדק את ההשפעה של טיפול משולב בשורש אסטרגלוס (Astragalus membranacus) ושורש רהמניה, בנוסף לטיפול בגלוקוקורטיקואידים, על חולי זאבת הסובלים ממעורבות כלייתית קשה (לופוס נפריטיס). במחקר שנמשך 6 חודשים השתתפו 52 חולים אשר חולקו אקראית לקבוצת ההתערבות שקיבלה טיפול רפואי מערבי + טיפול צמחי וקבוצת הביקורת שקיבלה רק טיפול רפואי מערבי (גלוקוקורטיקואידים ו- Cyclophosphamide). נמצא כי בקבוצת ההתערבות הפחתת מינון התרופות הייתה גדולה יותר (p<0.05), רמת החלבון בשתן הייתה נמוכה יותר (p<0.05) ושיעור תופעות הלוואי כגון נדודי שינה, חום, הזעה והשמנה היה נמוך יותר בהשוואה לקבוצת הביקורת (p<0.05). החוקרים מסכמים כי טיפול רפואי משולב עם אסטרגלוס ורהמניה עשוי לתרום להורדת מינוני התרופות ולהקל על תופעות הלוואי הנובעות מהטיפול.
דיווח מקרה(36) אודות גבר בן 63 שסבל מתסמונת נפרוטית. במשך שנתיים טופל באמצעות תרופות קונבנציונליות שכללו תרופות מדכאות חיסון (Prednisone, Cyclosporine) וכן מעכבי מערכת הרנין-אנגיוטנסין (מעכבי ACE, אנטגוניסטים לאנגיוטנסין, Aliskiren Spironolactone), אך אלו לא השיגו שיפור במצב הפרוטאינוריה. כעבור שנתיים הוסף לו טיפול במיצוי יבש של אסטרגלוס (Astragalus membranacus) (בריכוז 4:1) במינון השווה ל- 15 גרם ליום למשך 12 חודשים. בעקבות הטיפול חווה המטופל נסיגה מוחלטת של התסמונת הנפרוטית.

 

שאר האינטראקציות פתוחות למנויים בלבד.

 

 

תרופות להורדת סוכר למידע השלם למנויים

 

תרופות להורדת לחץ דם {תרופות משתנות, חוסמי הקולטן לאנגיוטנסין 2, חוסמי בטא, Perindopril (מעכבת ACE)} למידע השלם למנויים

 

אסטרגלוס ורמהנְיה בשילוב עם תרופות להורדת לחץ דם (מעכבי ACE, חוסמי הקולטן לאנגיוטנסין II) לטיפול בנפרופתיה סוּכרתית למידע השלם למנויים

 

אינטרפרון אלפא (IFN-α) למידע השלם למנויים 

 

תרופות אנטי רטרוויראליות לטיפול באיידְס (Zlcitabine, Zidovudine) למידע השלם למנויים

 

תרופות אנטי ויראליות (זובירקס) למידע השלם למנויים

 

אינטרלוקין 2 (IL-2) למידע השלם למנויים

 

טיפול קונבנציונאלי בשחפת למידע השלם למנויים

 

תרופות לטיפול בפעילות יתר של בלוטת התריס (Tapazole/Methimazole) למידע השלם למנויים

 

תרופות לטיפול באנמיה אפלסטית (Stanozolol) למידע השלם למנויים

 

גליקוזידים קרדיאלים (Digoxin) למידע השלם למנויים

 

תרופות נוגדות דלקת סטרואידליוֹת למידע השלם למנויים

 

תרופות הרגעה (Midazolam) למידע השלם למנויים

 

תרופות נוגדות קרישה למידע השלם למנויים

 

תרופות הורמונליות למידע השלם למנויים

 

ליתיום למידע השלם למנויים

 

תיאופילין למידע השלם למנויים

 

כימותרפיה - כללי למידע השלם למנויים

 

כימותרפיה מבוססת פלטינום (Cisplatin) למידע השלם למנויים

 

פרוטוקול MVP הכולל Mitomycin C, Vinblastine, Cisplatin למידע השלם למנויים

 

כימותרפיה מסוג וינקה אלקלואידים Vinorelbine,Vinblastine למידע השלם למנויים

 

תוספי סִידן למידע השלם למנויים

 

אנג'לִיקה סינית למידע השלם למנויים

 

רהמנְיה למידע השלם למנויים

 

מרווה סִינית למידע השלם למנויים

 

לפה גדוֹלה למידע השלם למנויים

 

ג'ינסנְג קוריאני למידע השלם למנויים

 

שוּש קירח למידע השלם למנויים

 

עוּזרר למידע השלם למנויים

 

אטרקטִילודס למידע השלם למנויים

 

שכִיזנדרה למידע השלם למנויים

 

לִיגוסטיקום למידע השלם למנויים

 

ארכובִית סינית למידע השלם למנויים

 

הריון

אסטרגלוס מתאים לשימוש בהריון(134).

 

הנקה

אין מספיק מידע בנושא, אך אסטרגלוס נחשב כבטוח לשימוש גם בהנקה.

 

מחקרים קליניים ומנגנוני פעולה

 

המחקרים הקליניים ומנגנוני הפעולה פתוחים למנויים בלבד.

 

 

מקורות

 

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