基于Nrf2/HO-1信号通路探究胃复春胶囊辅助治疗重症肺炎合并应激性胃溃疡临床研究

Weifuchun capsules exhibit therapeutic effects in adjuvant treatment of severe pneumonia complicated with gastric stress ulcer by up-regulating the nuclear factor erythroid 2 related factor 2/heme oxygenase-1 signaling pathway

背景重症肺炎合并应激性溃疡发病机制并未完全阐述,尚无特效治疗方案,预后普遍较差,明确其发病机制,确定治疗靶点有望控制病情进展,促使疾病转归.目的探讨基于核因子E2相关因子2/血红素氧合酶-1(nuclear factor erythroid 2 related factor 2/heme oxygenase-1,Nrf2/HO-1)信号通路探究胃复春胶囊辅助治疗重症肺炎合并应激性胃溃疡效果.方法收集2021-01/2023-01舟山市中医医院108例重症肺炎合并应激性胃溃疡患者临床资料进行回顾性分析,根据治疗方案分为对照组(n=54)和研究组(n=54),分别采取奥美拉唑、奥美拉唑+胃复春胶囊,连续治疗1 wk.统计2组治疗总有效率、临床症状缓解时间、不良反应、复发率及治疗前后生长抑素(somatostatin,SS)、血管活性肠肽(vasoactive intestinal peptide,VIP)、胃泌素(gastrin,GAS)、Nrf2/HO-1信号通路相关mRNA、蛋白表达、氧化应激指标[丙二醛(malondialdehyde,MDA)、一氧化氮(nitric oxide,NO)、8-羟基脱氧鸟苷酸(8-Hydroxy-2'-deoxyguanine,8-OHdG)].结果研究组治疗总有效率较对照组高,临床症状缓解时间较对照组短(P<0.05);治疗1 wk后研究组VIP、GAS、SS含量及其差值均高于对照组(P<0.05);治疗1 wk后研究组Nrf2、HO-1 mRNA、蛋白及NO含量均高于对照组,MDA、8-OHdG含量低于对照组,差值均高于对照组(P<0.05);2组不良反应及复发率比较差异无统计学意义.结论胃复春胶囊辅助治疗重症肺炎合并应激性胃溃疡效果确切,有利于增加胃肠激素含量,缩短症状缓解时间,且安全性高,可能机制与上调Nrf2/HO-1信号通路有关.

BACKGROUND The pathogenesis of severe pneumonia combined with stress ulcers has not been fully elucidated,andh it has an overall poor prognosis due to the lack of specific treatment options.Clarifying its pathogenesis and identifying appropriate therapeutic targets are expected to control the progression of the disease and facilitate its regression.AIM To explore the effect of Weifuchun capsules in the adjuvant treatment of severe pneumonia complicated with gastric stress ulcer based on the nuclear factor erythroid 2 related factor 2/heme oxygenase-1(Nrf2/HO-1)signaling pathway.METHODS The clinical data of 108 patients with severe pneumonia complicated with gastric stress ulcer treated at the Zhoushan Traditional Chinese Medicine Hospital from January 2021 to January 2023 were retrospectively analyzed.According to the treatment plan,they were divided into either a control group(n=54)or a study group(n=54).The control group and study group were treated with omeprazole alone and omeprazole+Weifucun capsules for 1 week,respectively.The total effective rate,clinical symptom remission time,adverse reactions,and recurrence rate were compared between the two groups.Somatostatin(SS),vasoactive intestinal peptide(VIP),gastrin(GAS),mRNA and protein expression of Nrf2/HO-1 signaling pathway-related molecules,and oxidative stress markers[malondialdehyde(MDA),nitric oxide(NO),and glutathione peroxidase(8-OHdG)]before and after treatment were also compared between the two groups.RESULTS The total effective rate was significantly higher and the remission time of clinical symptoms was significantly shorter in the study group than in the control group(P<0.05).After 1 week of treatment,VIP,GAS,and SS contents and their differences between before and after treatment in the study group were significantly higher than those of the control group(P<0.05);the levels of Nrf2 and HO-1 mRNA and protein expression,and NO in the study group were significantly higher than those of the control group;and the contents of MDA and 8-OHdGp were significantly lower but their differences between before and after treatment were significantly higher in the study group than in the control group(P<0.05).There was no significant difference in the rates of adverse reactions and recurrence between the two groups(P>0.05).CONCLUSION Weifuchun capsules have a definite effect in the adjuvant treatment of severe pneumonia complicated with gastric stress ulcer with high safety,and such treatment is conducive to regulating gastrointestinal hormones,alleviating oxidative stress reaction,and shortening symptom remission time,which may be related to the up-regulation of the Nrf2/HO-1 signaling pathway.