Chaiqin Chengqi Decoction as an adjuvant treatment for mild/moderately severe hypertriglyceridemic acute pancreatitis: A retrospective study

Hypertriglyceridemia is the third leading cause of acute pancreatitis(AP),and its incidence is increasing.Due to its relatively insidious etiology,it is easy to be ignored in the early stages.In China,Chaiqin Chengqi Decoction(CQCQD)has long been employed for treating AP.AIM To evaluate the effectiveness of CQCQD in patients diagnosed with mild/moderately severe hypertriglyceridemic AP(HTG-AP).METHODS In this study,the clinical data of 39 patients with HTG-AP admitted from January 2019 to November 2022 were collected.The changes of blood lipids,gastrointestinal symptoms,and abdominal pain before and after treatment were analyzed and compared between the two groups.RESULTS Twenty patients were treated with the conventional HTG-AP regimen,and 19 patients were additionally treated with CQCQD.After receiving treatment,the triglycerides(TG)level of the CQCQD group was lower than that of the CQCQD group(3.14±0.25 mmol/L vs 4.96±0.47 mmol/L,P<0.01).After 3 d of treatment,the patients in the CQCQD group had more bowel movements than the control group(2.51±0.25 times vs 1.00±0.17 times,P=0.01).The gastrointestinal function of most patients returned to normal,and the acute gastrointestinal injury score was significantly lower than that of the control group(0.11±0.07 vs 0.42±0.11,P<0.01).CONCLUSION In patients with HTG-AP,CQCQD can significantly reduce the TG level,shorten the recovery time of defecation,significantly improve the gastrointestinal function.

Changes of Neuronal Acetylcholine Receptor Alpha 7 of Peritoneal Macrophage in Experimental Acute Pancreatitis Treated by Chaiqin Chengqi Decoction(柴芩承气汤)

Objective：To investigate effect of Chaiqin Chengqi Decoction（柴芩承气汤,CQCQD） on changes of neuronal acetylcholine receptor alpha 7（nAChRα7） of peritoneal macrophages in acute pancreatitis（AP）.Methods：Eighteen Kunming mice were equally randomized into the control group,AP group and CQCQD treatment group.AP was induced by two intraperitoneal injections of 4 g/kg L-arginine at 1 h apart,while control mice received saline injections.At 72 h after the first injection of L-arginine,mice in the treatment group were intragastrically administered 0.1 mL/10 g CQCQD every 2 h for 3 times,whilst mice in the other two groups received the same amount of saline feeding.Mice were sacrificed by cervical dislocation 2 h after the last feeding of either CQCQD or saline.Peritoneal macrophages were collected for determination of nAChRα7 mRNA and protein expression.Serum was collected for detection of interleukin-6（IL-6）,IL-10 and acetylcholine（ACh）levels,and pancreas was for histopathology analysis.Results：The CQCQD treatment significantly ameliorated the severity of AP as evidenced by reducing the pancreatic histopathology score（4.5 ± 0.5 vs.6.2 ± 1.7,P〈0.05）and the serum IL-6 levels（1228.31419.2 pg/mL vs.1589.6 ±337.3 pg/mL,P〈0.05）.The mRNA and protein expression of nAChRα7 of the peritoneal macrophages in the AP group were similar to the control group（P〉0.05）,but were significantly up-regulated after the CQCQD treatment（P〈0.05）.The serum ACh levels in the AP group were significantly lower than those in the control group（3.1 ± 0.6 μg/mL vs 4.8 ± 0.7 μg/mL P〈0.05）,but were significantly increased after the CQCQD treatment（5.6±1.5 μg/mL vs 3.1 ±0.6 μg/mL,P〈0.05）.Conclusion：CQCQD is protective against L-arginine-induced AP through mechanisms involving nAChR α 7 of peritoneal macrophages.

Chaiqin Chengqi Decoction decreases IL-6 levels in patients with acute pancreatitis

Objective:In this paper,we investigated the effect of the traditional Chinese medicine Chaiqin Chengqi Decoction(CQCQD) on serum cytokines in acute pancreatitis(AP) patients.Methods:Peripheral blood samples from 107 AP patients were collected within the first 48 h of AP onset and on the 10th day of CQCQD treatment.Control samples were collected from 20 healthy individuals.Serum proinflammatory cytokines tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6),and anti-inflammatory cytokines IL-10 and IL-1β receptor antagonist(IL-1ra) were examined using the Luminex 100 system.Results:Within the first 48 h of AP onset,IL-6 and IL-1ra levels in severe AP(SAP) patients were significantly higher than those in mild AP(MAP) patients,but IL-10 levels in SAP patients were significantly lower than those in MAP patients.Proinflammatory cytokine IL-6 was significantly decreased after CQCQD treatment(P<0.05),especially in SAP patients(n=25 of 36,P<0.05).The hospitalization time of SAP patients was shortened significantly when serum IL-6 decreased after CQCQD treatment(P<0.05).Conclusions:CQCQD decreased proinflammatory cytokine IL-6 levels in AP patients.

The Effect of Chaiqin Chengqi Decoction(柴芩承气汤) on Modulating Serum Matrix Metalloproteinase 9 in Patients with Severe Acute Pancreatitis

Objective： To investigate the effect of Chaiqin Chengqi Decoction （柴芩承气汤, CQCQD） on regulating serum matrix metalloproteinase 9 （MMP-9） in patients with severe acute pancreatitis （SAP）. Methods： Thirty-five SAP patients hospitalized in West China Hospital from September 1, 2008 to February 28, 2009 were randomly assigned to two groups using a computer-derived random number sequence in a ratio of 1：1, treatment group （18 patients） and the placebo control group （17 patients）. The patients in the treatment group were administered with CQCQD by gastric parfusion （50 mL/2 h） and retention enema （200 mL/6 h） for 7 days. The two groups had similar baseline information. The clinical indicators, including the initial Balthazar＇s computed tomography （CT） score, acute physiology and chronic health evaluation I1 （APACHE II） scores on 1st, 3rd, 5th and 7th day, incidences and durations of complications and the serum C-reactive protein （CRP）, levels of MMP-9 on the 1st, 3rd, 5th and 7th day, were recorded and compared between the two groups. Resalts： The serum MMP-9, CRP and the APACHE I1 scores on the 3rd, 5th and 7th day in the treatment group were lower than those in the control group （P〈0.05）. The serum MMP-9 was positively correlated with the APACHE II score on the 1st day （r=0.430, P=0.01）. The durations of acute respiratory distress syndrome （5.4± 2.4 vs. 2.9± 1.3）, acute hepatitis （4.6± 0.8 vs. 1.9 ± 0.6） and acute heart failure （3.9 ± 1.6 vs. 1.3 ± 0.6, P〈0.05） in the control group were longer than those in the treatment group. Conclusion： CQCQD could decrease the serum MMP-9 to relieve the severity of clinical symptoms and prevent the development of multiple organ dysfunction syndrome in patients with SAP.

Effect of Chaiqin Chengqi Decoction(柴芩承气汤) on Cholecystokinin Receptor 1-Mediated Signal Transduction of Pancreatic Acinar Cells in Acute Necrotizing Pancreatitis Rats

Objective： To investigate the effect of Chaiqin Chengqi Decoction （柴芩承气汤,CQCQD） on cholecystokinin receptor 1 （CCKR1）-mediated signal transduction of pancreatic acinar cell in rats with acute necrotic pancreatitis （ANP）. Methods： Twenty-seven Sprague-Dawley rats were randomized into three groups： the control group, the ANP group, and the CQCQD group （9 in each group）. ANP rats were induced by two intraperitoneal injections of 8% L-arginine （pH=7.0, 4.4 g/kg） over a 2-h period. Rats were treated with 1.5 mL/100 g body weight of CQCQD （CQCQD group） or physiological saline （control and ANP groups） at 2 h interval. And 6 h after induction, pancreatic tissues were collected for histopathological examination. Pancreatic acinar cells were isolated for determination of CCKR1 mRNA and protein expression, phospholipase C （PLC） and inositol-1,4,5-triphosphate （IP3）, and determination of fluorescence intensity （FI） as a measure of intracellular calcium ion concentration [Ca2＋]i. Results： The pancreatic histopathological score （6.2± 1.1） and the levels of PLC （1,187.2±228.2μg/mL） and IP3 （872.2±88.4 μg/mL） of acinar cells in the ANP group were higher than those in the control （2.8± 0.4, 682.5± 121.8 μ g/mL, 518.4 ± 115.8 μ g/mL） and the CQCQD （3.8± 0.8, 905.3± 78.5 μ g/mL, 611.0±42.5μ g/mL） groups （P〈0.05）. [Ca2＋]i FI for the ANP group （34.8± 27.0） was higher than that in the control （5.1 ± 2.2） and CQCQD （12.6± 2.5） groups （P〈0.05）. The expression of pancreatic acinar cell CCKR1 mRNA in the ANP group was up-regulated （expression ratio=1.761; ,0=0.024） compared with the control group. The expression of pancreatic acinar cell CCKR1 mRNA in the CQCQD group was down-regulated （expression ratio=0.311; P=0.035） compared with the ANP group. The ratio of gray values of the CCKR1 and β-actin in the ANP group （1.43±0.17） was higher than those in the control （0.70 ± 0.15） and CQCQD （0.79± 0.11） groups （P〈0.05）. Conclusions： Pancreatic acinar ceil calcium overload of ANP induced by L-arginine was related to the up-regulated expressions of pancreatic acinar cell CCKR1 mRNA and protein. CQCQD can down-regulate expressions of pancreatic acinar cell CCKR1 mRNA and protein to reduce the PLC and IP3 of pancreatic acinar cells, relieving the calcium overload and reducing the pathological changes in rats with ANP.