Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China.
Institute of Integrative Medicine for Acute Abdominal Diseases, Tianjin 300100, China.
Curr Pharm Des. 2024;30(42):3322-3338. doi: 10.2174/0113816128319149240812103715.
Intestinal dysfunction plays an important role in the clinical progress and prognosis of severe acute pancreatitis (SAP). Qingyi decoction (QYD) has shown beneficial effects on intestinal function recovery, but the prevention actions of the QYD on intestinal paralysis and its mechanism have not been fully explored.
The possible molecular mechanism was unraveled by network pharmacology, including active ingredients and potential target prediction, as well as GO, KEGG, and REATCOME pathway enrichment analyses. The potential interactions between the main active ingredients of the QYD and core genes were explored by molecular docking. A retrospective cohort study on 137 patients with SAP from Tianjin Nankai Hospital was conducted to evaluate the preventive effect of QYD on intestinal paralysis.
A total of 110 active ingredients in QYD were screened out, and 37 key targets were predicted by network pharmacology. GO, KEGG, and REATCOME enrichment analyses showed that bioinformatics annotation of the hub genes was mainly involved in intestinal epithelial functions and inflammatory response pathways. The main components of QYD possessed good affinity with IL-6, TNF, CASP3, CXCL8, and CRP by molecular docking. Patients who used QYD plus usual care seemed to have fewer intestinal paralysis rates, lower risk of renal insufficiency, ARDS and blood purification therapy, and shorter hospital and ICU stays. The multivariable regression analyses indicated that the mode of nasogastric and enemas administration of QYD (P = 0.010) and timely intervention with QYD (P = 0.045) were the independent protective factors for intestinal paralysis prevention in patients with SAP.
In conclusion, QYD can be used as an effective adjuvant procedure to prevent the occurrence and development of intestinal paralysis in patients with SAP. The mechanisms may be involved in the anti-inflammatory response and maintenance of intestinal epithelial function.
肠道功能障碍在重症急性胰腺炎（SAP）的临床进展和预后中起着重要作用。清胰汤（QYD）已显示出对肠道功能恢复有益的作用，但 QYD 对肠麻痹的预防作用及其机制尚未得到充分探讨。
通过网络药理学，包括活性成分和潜在靶点预测，以及 GO、KEGG 和 REATCOME 途径富集分析，揭示了可能的分子机制。通过分子对接探索 QYD 主要活性成分与核心基因之间的潜在相互作用。对天津南开医院 137 例 SAP 患者进行回顾性队列研究，评估 QYD 对肠麻痹的预防作用。
筛选出 QYD 中的 110 种活性成分，通过网络药理学预测出 37 个关键靶点。GO、KEGG 和 REATCOME 富集分析表明，枢纽基因的生物信息学注释主要涉及肠上皮功能和炎症反应途径。QYD 的主要成分与 IL-6、TNF、CASP3、CXCL8 和 CRP 通过分子对接具有良好的亲和力。使用 QYD 加常规护理的患者似乎肠麻痹发生率较低、肾功能不全、ARDS 和血液净化治疗风险较低、住院和 ICU 停留时间较短。多变量回归分析表明，QYD 的鼻胃管和灌肠给药方式（P = 0.010）和及时干预 QYD（P = 0.045）是 SAP 患者预防肠麻痹的独立保护因素。
总之，QYD 可作为预防 SAP 患者肠麻痹发生和发展的有效辅助治疗方法。其机制可能涉及抗炎反应和维持肠上皮功能。
