Original ArticleEffects of QingYi decoction on inflammatory markers in patients with acute pancreatitis: A meta-analysis
Graphical abstract
Introduction
Many recent studies have focused on acute pancreatitis (AP), which is one of the most common gastrointestinal diseases. The most likely causes of AP are gallstones and binge alcohol consumption. Other factors such as duct obstruction, metabolic aberrations (e.g., hypertriglyceridemia), drug exposure (e.g., thiazides, azathioprine, and estrogens), smoking, and trauma also play a role in the pathogenesis of AP. Although nearly 80% of patients with acute pancreatitis have mild symptoms and require no more than supportive measures, 20% of them have severe attacks and develop multiple organ dysfunction syndrome (Xiang et al., 2017). Acute pancreatitis can be divided into three subtypes: mild (usually interstitial), moderate (local complications, no persistent organ failure), and severe (persistent organ failure), according to the recently revised Atlanta classification (Banks et al., 2013).
It is widely accepted that the inflammatory response, mediated by a variety of pro-inflammatory cytokines and anti-inflammatory cytokines, plays a key role in AP. Numerous experiments have demonstrated that the inflammatory response is activated in the early stage of AP. The uncontrolled inflammatory response could contribute to systemic inflammatory response syndrome and even multiple organ dysfunctions (Lankisch et al., 2015; Banks et al., 2013). It has been established that the severity of AP is associated with inflammation level; thus, the early control of the inflammatory response is vital for the protection of important organ functions (Bertilsson et al., 2016).
According to the theoretical basis of Traditional Chinese medicine, AP is categorized as epigastric pain, splenic precordial pain, splenopyretic disease, and knotted chest disease. The principle of treatment in Traditional Chinese medicine is to get rid of the heat-evil, drive out superficial evils, replenish qi (vital energy), nourish yin (body fluid), invigorate blood, and dredge purgation (Li et al., 2017). QingYi decoction, a Chinese herbal medicine composed of Radix Bupleuri (Chaihu, Bupleurum scorzonerifolium Willd.), Scutellariae Radix (Huangqin, Scutellaria baicalensis Georgi), Aucklandia lappa Aucklandiae Radix (Muxiang, Aucklandia lappa Decne.), Corydalis Rhizoma (Yanhusuo, Cordalis ambigua Cham.et Schlecht.), Coptidis Rhizoma (Huanglian, Coptis chinensis Franch.), Paeoniae Radix Alba (Baishao, Paeonia lactiflora Pall.), Rhei Radix Et Rhizoma (Dahuang, Rheum palmatum, L.) and Natrii Sulfas (Mangxiao, Mirabilite) has been used in China for several years. QingYi decoction could be altered based on the chief complaint and accompanying symptoms of the patient, in accordance with the personalized treatment principle in Traditional Chinese Medicine basic theory. Various chemical compounds, such as paeoniflorin, Amphicoside II, Amphicoside I, baicalin, baicalein, aloe-emodin, rhein, saikoside B2, emodin, and chrysophanol are contained in QingYi decoction (Lan, 2019). QingYi decoction is generally well tolerated by patients and has exhibited sound therapeutic effects for AP, as illustrated in many clinical studies.
Several studies have evaluated the effects of QingYi decoction on inflammatory markers in the treatment of AP (Ye, 2016; Ma and Li, 2015; Yao, 2018), but the results were inconclusive because the studies varied widely in terms of sample size and treatment duration. The purpose of this study was to assess the effects of QingYi decoction on inflammatory markers in patients with AP.
Section snippets
Methods
The current systematic review and meta-analysis was conducted in accordance with the guidelines provided by Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009).
Literature search and study characteristics
The process of identifying relevant studies is shown in Fig. 1. A total of 241 articles were obtained from the database search. After excluding duplicates and irrelevant studies, 49 potentially eligible articles were selected. After a detailed evaluation, 25 articles were selected for the final meta-analysis, which were published between 2006 and 2019. Thirty-nine RCTs from the 25 articles examined the impact of QingYi decoction on inflammatory markers; 25 RCTs assessed IL-6, 19 RCTs assessed
Discussion
Acute pancreatitis refers to an acute abdominal disease characterized by rapid onset, rapid progression, and a high fatality rate. In the course of AP, the premature activation of digestive enzymes within pancreatic acinar cells can contribute to pancreatic autodigestion (Shah et al., 2009). A local inflammatory process is initiated, and the monocyte-macrophage system is activated. Many types of pro-inflammatory cytokines and inflammatory mediators are secreted by stimulated neutrophils, which
Limitation
These data must be interpreted with caution due to several limitations. First, there was a high degree of heterogeneity between studies. Different clinical settings, varied laboratory procedures, and altered treatment durations may contribute to the high level of heterogeneity. Second, the methodological quality of the eligible studies was evaluated using the Cochrane Collaboration risk of bias tool. However, these results were not very encouraging, especially in the random sequence generation
Conclusions
The present study was designed to comprehensively investigate the changes in IL-6, IL-8, IL-10, TNF-α IL-1, and IL-1β levels after QingYi decoction treatment. Due to the high heterogeneity across studies, the results must be interpreted with caution, but the results of this investigation show that QingYi decoction treatment has moderate immunomodulating effects for AP patients. The pooled effect estimates demonstrated that QingYi decoction treatment decreased the levels of pro-inflammatory
Funding
This work was supported by grants from National Natural Science Foundation of China (82074158), Project funded by China Postdoctoral Science Foundation (2018M631793), Natural Science Foundation of Liaoning Province (2019-ZD-0624), and Dalian Traditional Chinese medicine-related scientific research project (18Z2002).
All data were generated in-house, and no paper mill was used. All authors agree to be accountable for all aspects of work ensuring integrity and accuracy.
CRediT authorship contribution statement
Guanyu Wang: Conceptualization, Methodology, Software, Visualization, Investigation, Software, Validation, Writing – review & editing. Dong Shang: Conceptualization, Methodology, Software. Guixin Zhang: Data curation, Writing – original draft. Shenglin Zhang: Data curation, Writing – original draft. Nan Jiang: Visualization, Investigation. Huanhuan Liu: Visualization, Investigation. Hailong Chen: Conceptualization, Methodology, Software, Supervision, Software, Validation, Writing – review &
Declaration of Competing Interest
The authors declare no conflicts of interest.
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