Experimental and Clinical Study of Rhubarb Licorice Root Decoction ...

Abstract

Part I Experimental study of rhubarb licorice root decoction in rats with severe acute pancreatitis associated lung injuryObjective:To investigate the treatment effect of rhubarb licorice root decoction in severe acute pancreatitis associated Lung Injury and its mechanism of action.Methods:90 Wistar rats were equally divided between male and female, weight 220-280g, were randomly divided into 3 groups, namely sham-operated group (sham operation, SO), SAP group (SA), rhubarb licorice root decoction treatment group (RG).4% sodium taurocholate was injected into the pancreatic duct to induce SAP. Rhubarb licorice root decoction (0.25g/mL)0.6mL/100g was gavaged in the RG group,the quivalent normal saline was gavaged in the SO and SA group. After 6h、12h、24h, all being killed, observed the pathological changes of pancreas and lung tissues, and calculate pathology score. Measurement IL-6, IL-10, TNF-a expression levels of serum and lung tissue; detection the changes of TLR4 and NF-κB protein expression level of lung tissue by immunohistochemical.Results:The three groups of the pancreas and lungs pathology observed:SO group organizational structure of the lungs and pancreas normal; SA pancreas can be seen a large number of inflammatory cells infiltrating pancreatic mesenchyma and pancreatic lobules, diffuse hemorrhage and necrosis sheet; lung alveolar wall rupture can be seen, interstitial hyperemia, edema, a large number of infiltrating neutrophils; compared with the SA group, RG group significantly reduced in the pancreas and the lung changes(P<0.05). Amylase is gradually increased with time in SA group and RG group and RG group is significantly lower than SA group(P<0.05). Lung and pancreas injury was a positive correlation (r=0.807, P<0.01), and TLR4 protein expression level was a positive correlation(r=0.519, P<0.01), and NF-κBP65 protein expression level was a positive correlation (r=0.827, P<0.01); TLR4 and NF-κBP65 protein expression level was significantly increased 6h after the induction of SAP (P<0.01),12h to reach the peak, followed by a gradual decline; NF-κ1BP65 expression level gradually increased at three time points. RG expression levels were significantly lower than the SA group (P<0.05). TLR4 and NF-κBP65 protein expression level was a positive correlation (r=0.612, P<0.01). Compared with the SA group, the IL-6, TNF-αexpression levels of RG group significantly becomes lower (P<0.05), IL-10 level was significantly higher (P<0.05).Conclusion:Rhubarb licorice root decoction can improve Severe Acute Pancreatitis associated lung injury. And the mechanism has a relevantion with inhibiting the expression of TLR4 and NF-κB, lowering IL-6, TNF-a, increasing the expression of IL-10 level.Part II Clinical effect observation of rhubarb licorice root decoction on patients with severe acute pancreatitis associated lung injuryObjective:To investigate the treatment effect of Rhubarb licorice root decoction of severe acute pancreatitis and its mechanism of action.Methods:69 cases of severe acute pancreatitis were randomly divided into 2 groups: conventional treatment group (conventional treatment,CT, n=34) and rhubarb licorice root decoction treatment group (RG, n=35). RG group were additionaly administered rhubarb licorice root decoction based on the conventional treatment. The patients were observed with body temperature, heart rate, respiration, pH, HCO3-, PaO2/FiO2, Arterial partial pressure of oxygen (PaO2); liver function; plasma electrolytes, glucose and C-reactive protein; parallel APACHE II score; time of alleviate abdominal pain, anal exhaust time, length of stay in hospital; the levels of TNF-a, IL-10, MCP-1 in patient’s blood when they were admitted to the hospital, and after treated 24h,48h, and 96h respectively.Results:After treated 24h,48h,96h, CT group were significantly improved than RG group(P<0.05), including glucose, calcium, liver function, index of response to lung function (pH, HCO3, PaO2/FiO2) increased in varying degrees after treatment, and the RG group increased more significantly than CT group; APACHEⅡscore; TNF-a and MCP-1 level become lower (P<0.05), however IL-10 level becomes higher (P<0.05). Pain remission time, anal exhaust time, the number of days hospitalized were markly improved (P＜0.05); RG group were improved significantly than CT group in acute lung injury and acute respiratory distress syndrome after treatment (P<0.05).Conclusion:Rhubarb licorice root decoction can improve the lung function of patients with severe pancreatitis, and it will shorten hospitalization time, and improve the complications of severe pancreatitis.