Traditional Chinese medicine formulas alleviated acute pancreatitis via improvement of microcirculation: A systematic review and meta-analysis
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摘要:
目的：微循环障碍是急性胰腺炎（AP）的关键病理因素，而活血类中药方剂可有效改善微循环障碍。但目前尚缺乏相关循证医学证据。因此，有必要通过系统评价和荟萃分析来阐明改善微循环对AP的治疗转化效益。本研究旨在验证中药方剂的治疗效果，并探索其对AP治疗作用的潜在机制。 方法：从PubMed、Embase、Web of Science、Cochrane Library、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方医学网和维普数据库（VIP）等8个数据库中筛选符合条件的随机对照试验（RCT）。以APACHE II评分和有效率为主要结局指标，死亡率、并发症发生率、总住院时间、血清淀粉酶恢复时间、腹痛消失时间、微循环指标及炎症指标为次要结局指标。随后进行系统评价和荟萃分析，并采用网络药理学方法分析活血类中药方剂中核心药物的潜在活性成分及其作用靶点。 结果: 共纳入51篇RCT，包括3721例患者，meta分析结果显示活血化瘀方剂联合常规西药治疗可以有效降低APACHE II评分 (SMD = -1.36, 95% CI: ?2.01 to -0.71, P = 0.000)并提高治疗有效率 (RR: 1.22, 95% CI: 1.18 to 1.26, P = 0.000)。同时，活血化瘀方剂在改善AP微循环指标及炎症结局指标方面也具有良好疗效。基于此，从纳入活血化瘀方剂中筛选出6味核心中药，包括使用频次最多的大黄，枳实，赤芍，柴胡，丹参，延胡索。网络药理学筛选出这些核心药物与AP之间的166个交叉关联靶点，KEGG通路分析表明脂质相关信号通路与活血化瘀核心中药通过改善微循环来减轻AP具有密切联系。 结论: 活血化瘀中药可通过改善微循环有效减轻AP。但同时，还需要更多高质量、设计完善的RCT研究和更多深入的中药作用机制研究。 方法：从PubMed、Embase、Web of Science、Cochrane Library、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方医学网和维普数据库（VIP）等8个数据库中筛选符合条件的随机对照试验（RCT）。以APACHE II评分和有效率为主要结局指标，死亡率、并发症发生率、总住院时间、血清淀粉酶恢复时间、腹痛消失时间、微循环指标及炎症指标为次要结局指标。随后进行系统评价和荟萃分析，并采用网络药理学方法分析活血类中药方剂中核心药物的潜在活性成分及其作用靶点。结果: 共纳入51篇RCT，包括3721例患者，meta分析结果显示活血化瘀方剂联合常规西药治疗可以有效降低APACHE II评分 (SMD = -1.36, 95% CI: ?2.01 to -0.71, P = 0.000)并提高治疗有效率 (RR: 1.22, 95% CI: 1.18 to 1.26, P = 0.000)。同时，活血化瘀方剂在改善AP微循环指标及炎症结局指标方面也具有良好疗效。基于此，从纳入活血化瘀方剂中筛选出6味核心中药，包括使用频次最多的大黄，枳实，赤芍，柴胡，丹参，延胡索。网络药理学筛选出这些核心药物与AP之间的166个交叉关联靶点，KEGG通路分析表明脂质相关信号通路与活血化瘀核心中药通过改善微循环来减轻AP具有密切联系。 结论: 活血化瘀中药可通过改善微循环有效减轻AP。但同时，还需要更多高质量、设计完善的RCT研究和更多深入的中药作用机制研究。
Abstract:
Objective: Microcirculatory disturbance is pathologically critical to acute pancreatitis (AP), which can be effectively alleviated by traditional Chinese medicine (TCM) formulas that activate blood flow. However, there has been no evidence-based research to date. Therefore, a well-designed systematic review and meta-analysis is necessary to elucidate the therapeutic transformative benefit of improving microcirculation during AP. This study aims to confirm the therapeutic efficacy of TCM formulas and explore the potential mechanisms underlying their effects on AP treatment. Methods: Studies from eight databases including Pubmed, Embase, Web of Science, Cochrane Library, CNKI, CBM, Wanfang, and Chinese VIP, were screened for the eligible randomized controlled trials (RCTs). The APACHE II score and effectiveness rate were set as primary outcomes, while mortality rate, complications, total hospital stays, serum amylase recovery time, the time until the disappearance of abdominal pain, microcirculation indicators, and inflammation indicators were chosen as secondary outcomes. A systematic review and meta-analysis were subsequently conducted. Network pharmacology analysis was performed to analyze potential bioactive components with relevant targets of the core herbs included in the TCM formulas for activating blood flow. Results: A total of 51 RCTs (n = 3 721) were included. Compared with conventional western medical treatments alone, TCM groups were associated with lower APACHE II score (SMD = 1.36, 95% CI: 2.01 to 0.71, P = 0.000) and higher effectiveness rate (RR: 1.22, 95% CI: 1.18 to 1.26, P = 0.000). Furthermore, the formulas for activating blood flow demonstrated significant efficacy in improving both microcirculation and inflammation indicators. Additionally, six core Chinese herbal medicines including Rhei Radix et Rhizoma with the highest frequency, Aurantii Fructus Immaturus, Paeoniae Radix Rubra, Bupleuri Radix, Salviae Miltiorrhizae Radix et Rhizoma, and Corydalis Rhizoma were filtered out from the adopted TCM formulas. Finally, 166 shared targets between the six herbs and AP were identified. KEGG analysis indicated that lipid and atherosclerosis pathway is highly related to microcirculation. Conclusion: TCM formulas for activating blood flow significantly improve microcirculation and alleviate AP. Further high-quality, well-designed RCTs and deep mechanism exploration are required.
关键词:
急性胰腺炎;活血化瘀;微循环障碍;meta分析;网络药理学;大黄
Keywords:
Project Supported:
The study was supported by National Natural Science Foundation of China (No. 82274321 to Q. X., No. 82374256 to D. D., No. 82104598 to C. H.) and the Sichuan Provincial Natural Science Foundation (No. 2022NSFSC0641 to Q. X.).
Ji Gao a,, Chenxia Han a,, Ning Dai b, Wen Wang c, Tao Jin a, Dan Du d,*, Qing Xia a,*. Traditional Chinese medicine formulas alleviated acute pancreatitis via improvement of microcirculation: A systematic review and meta-analysis[J]. Chinese Herbal Medicines (CHM),2025,17(3):584-600
