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Archive > Volume 17 Issue 3 > 2025,17(3):584-600. DOI:https://doi.org/10.1016/j.chmed.2024.12.002 Prev Next

中藥方劑通過改善微循環(huán)減輕急性胰腺炎：一項(xiàng)系統(tǒng)評價及meta分析

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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：微循環(huán)障礙是急性胰腺炎（AP）的關(guān)鍵病理因素，而活血類中藥方劑可有效改善微循環(huán)障礙。但目前尚缺乏相關(guān)循證醫(yī)學(xué)證據(jù)。因此，有必要通過系統(tǒng)評價和薈萃分析來闡明改善微循環(huán)對AP的治療轉(zhuǎn)化效益。本研究旨在驗(yàn)證中藥方劑的治療效果，并探索其對AP治療作用的潛在機(jī)制。 方法：從PubMed、Embase、Web of Science、Cochrane Library、中國知網(wǎng)（CNKI）、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）、萬方醫(yī)學(xué)網(wǎng)和維普數(shù)據(jù)庫（VIP）等8個數(shù)據(jù)庫中篩選符合條件的隨機(jī)對照試驗(yàn)（RCT）。以APACHE II評分和有效率為主要結(jié)局指標(biāo)，死亡率、并發(fā)癥發(fā)生率、總住院時間、血清淀粉酶恢復(fù)時間、腹痛消失時間、微循環(huán)指標(biāo)及炎癥指標(biāo)為次要結(jié)局指標(biāo)。隨后進(jìn)行系統(tǒng)評價和薈萃分析，并采用網(wǎng)絡(luò)藥理學(xué)方法分析活血類中藥方劑中核心藥物的潛在活性成分及其作用靶點(diǎn)。 結(jié)果: 共納入51篇RCT，包括3721例患者，meta分析結(jié)果顯示活血化瘀方劑聯(lián)合常規(guī)西藥治療可以有效降低APACHE II評分 (SMD = -1.36, 95% CI: ?2.01 to -0.71, P = 0.000)并提高治療有效率 (RR: 1.22, 95% CI: 1.18 to 1.26, P = 0.000)。同時，活血化瘀方劑在改善AP微循環(huán)指標(biāo)及炎癥結(jié)局指標(biāo)方面也具有良好療效。基于此，從納入活血化瘀方劑中篩選出6味核心中藥，包括使用頻次最多的大黃，枳實(shí)，赤芍，柴胡，丹參，延胡索。網(wǎng)絡(luò)藥理學(xué)篩選出這些核心藥物與AP之間的166個交叉關(guān)聯(lián)靶點(diǎn)，KEGG通路分析表明脂質(zhì)相關(guān)信號通路與活血化瘀核心中藥通過改善微循環(huán)來減輕AP具有密切聯(lián)系。 結(jié)論: 活血化瘀中藥可通過改善微循環(huán)有效減輕AP。但同時，還需要更多高質(zhì)量、設(shè)計(jì)完善的RCT研究和更多深入的中藥作用機(jī)制研究。 方法：從PubMed、Embase、Web of Science、Cochrane Library、中國知網(wǎng)（CNKI）、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）、萬方醫(yī)學(xué)網(wǎng)和維普數(shù)據(jù)庫（VIP）等8個數(shù)據(jù)庫中篩選符合條件的隨機(jī)對照試驗(yàn)（RCT）。以APACHE II評分和有效率為主要結(jié)局指標(biāo)，死亡率、并發(fā)癥發(fā)生率、總住院時間、血清淀粉酶恢復(fù)時間、腹痛消失時間、微循環(huán)指標(biāo)及炎癥指標(biāo)為次要結(jié)局指標(biāo)。隨后進(jìn)行系統(tǒng)評價和薈萃分析，并采用網(wǎng)絡(luò)藥理學(xué)方法分析活血類中藥方劑中核心藥物的潛在活性成分及其作用靶點(diǎn)。結(jié)果: 共納入51篇RCT，包括3721例患者，meta分析結(jié)果顯示活血化瘀方劑聯(lián)合常規(guī)西藥治療可以有效降低APACHE II評分 (SMD = -1.36, 95% CI: ?2.01 to -0.71, P = 0.000)并提高治療有效率 (RR: 1.22, 95% CI: 1.18 to 1.26, P = 0.000)。同時，活血化瘀方劑在改善AP微循環(huán)指標(biāo)及炎癥結(jié)局指標(biāo)方面也具有良好療效。基于此，從納入活血化瘀方劑中篩選出6味核心中藥，包括使用頻次最多的大黃，枳實(shí)，赤芍，柴胡，丹參，延胡索。網(wǎng)絡(luò)藥理學(xué)篩選出這些核心藥物與AP之間的166個交叉關(guān)聯(lián)靶點(diǎn)，KEGG通路分析表明脂質(zhì)相關(guān)信號通路與活血化瘀核心中藥通過改善微循環(huán)來減輕AP具有密切聯(lián)系。 結(jié)論: 活血化瘀中藥可通過改善微循環(huán)有效減輕AP。但同時，還需要更多高質(zhì)量、設(shè)計(jì)完善的RCT研究和更多深入的中藥作用機(jī)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.

    關(guān)鍵詞:
    急性胰腺炎;活血化瘀;微循環(huán)障礙;meta分析;網(wǎng)絡(luò)藥理學(xué);大黃

    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.).

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