CN114767820A

CN114767820A - Traditional Chinese medicine formula for treating general inflammatory reaction after cardiac surgery

Info

Publication number: CN114767820A
Application number: CN202210319634.8A
Authority: CN
Inventors: 李平
Original assignee: Individual
Current assignee: Individual
Priority date: 2022-03-29
Filing date: 2022-03-29
Publication date: 2022-07-22

Abstract

The invention relates to a traditional Chinese medicine formula for treating systemic inflammatory response after cardiac surgery. The traditional Chinese medicine formula is a formula of prefabricated traditional Chinese medicine granules, and the formula comprises the following components: black sliced rhizoma Zingiberis, fructus Corni, rhizoma Coptidis, radix Et rhizoma Rhei, radix Salviae Miltiorrhizae, radix Angelicae sinensis, rhizoma Atractylodis Macrocephalae preparata, rhizoma Atractylodis, fructus Aurantii, cortex Magnoliae officinalis, pericarpium Citri Reticulatae, Poria, herba Lycopi, radix Clematidis, caulis Sargentodoxae, and cortex Cinnamomi.

Description

Traditional Chinese medicine formula for treating general inflammatory reaction after cardiac surgery

Technical Field

The invention belongs to the technical field of medical biology, and particularly relates to a traditional Chinese medicine formula for treating systemic inflammatory response after cardiac surgery.

Background

Cardiac surgery is an effective therapeutic intervention for cardiovascular diseases, but suffers from the problems of large trauma, postoperative complications, high mortality, and the like. One of the main reasons is that the heart operation can cause the organism to generate the Systemic Inflammatory Response Syndrome (SIRS), and the SIRS is the waterfall effect formed by the early inflammatory response and the production of endogenous immune inflammatory factors when the organism is struck by exogenous trauma; SIRS is thought to be closely related to the increased incidence of perioperative complications and mortality in patients. Inflammation-related complications existing before operation, operative trauma, extracorporeal circulation, ischemia-reperfusion injury during operation and the like are closely related to the occurrence of SIRS. Some studies have attempted to address the systemic inflammatory response with certain anti-inflammatory drugs, but the clinical effects of these drugs are not ideal, and the molecular cellular mechanisms of anti-inflammation still need further investigation.

After cardiac surgery, a series of inflammatory reactions caused by trauma, ischemia-reperfusion injury of each organ and the like are accompanied by the release of inflammatory cells in the process, various metabolites are generated, and the levels of inflammatory reaction markers such as interleukin-6, interleukin-2, Tumor Necrosis Factor (TNF), C-reactive protein (CRP) and the like in the circulatory system of a patient are obviously increased, so that the systemic multiple organ dysfunction is caused; meanwhile, due to various damage mechanisms such as activation of an inflammatory reaction system, neutrophil infiltration, massive production of proinflammatory cells, platelet activation in a natural immune system and a blood coagulation system and the like, multiple organ failure such as pulmonary insufficiency, gastrointestinal tract insufficiency and the like is caused, and the death risk is greatly increased.

Firstly, gastrointestinal tract function disorder, including general anesthesia, low perfusion and ischemia of gastrointestinal mucosa in perioperative period, and symptoms such as flatulence, nausea, vomiting, anorexia and the like appear in different degrees after heart operation, so that the intestinal tract of a patient is not enough to take so as to cause complications such as malnutrition, hypovolemia, poor incision healing and the like; the gastrointestinal dysfunction of severe patients is aggravated, and the intestinal flora imbalance is caused by the long-term use of large-dose antibiotics, so that the intestinal inflammation is caused; however, in the inflammatory state of the intestinal tract, the leakage of the intestinal vascular barrier is increased, and bacterial toxins in the intestinal lumen enter the blood circulation along with the leakage of the intestinal vascular barrier, so that a systemic inflammatory response is caused. At present, the clinical methods of indwelling stomach tube, gastrointestinal nutrition, anal tube exhaust and the like are adopted, but the curative effect is very little, and the pain of the patient is aggravated. Therefore, how to actively improve the gastrointestinal tract function of a patient after cardiac surgery is a problem currently faced by clinical surgery.

Secondly, acute lung injury is still one of the common complications after cardiac surgery, the incidence rate is about 2.1% -25%, serious patients even develop acute respiratory distress syndrome, and then patients die, and the death rate is about 45%; although mechanical ventilation, extracorporeal membrane lung (ECMO) support, fluid treatment strategies, as well as hormones, high doses of antibiotics, etc. can improve patient outcomes, the resulting complications and mortality remain high. How to strengthen lung protection and prevent and treat acute lung injury in perioperative period becomes a problem to be urgently solved by clinicians. Pulmonary complications after cardiac surgery vary in severity, but once they occur, they are the leading cause of death after surgery. The use of perioperative steroid hormones, while effective in reducing inflammatory responses associated with extracorporeal circulation, improving lung compliance, reducing pulmonary vascular resistance, and reducing extracellular edema, has limited effects on acute lung injury, and long-term, high-dose use can cause a risk of dysbacteriosis. Therefore, effective intervention measures for acute lung injury are lacking in clinical practice.

On the other hand, cardiac surgery is associated with a high complication rate of brain damage, including: stroke (1-3%), cognitive dysfunction (20%) and postoperative delirium (50%). The dysfunction caused by brain injury increases the burden of society and families, seriously reduces the life quality of patients and further increases the death rate of heart disease patients after operation. The reason for brain injury after heart operation is many, and inflammatory reaction caused by cerebral ischemia-reperfusion injury is also a considerable factor. Because the central nervous system has complex vascular barriers including blood-brain barrier and blood-cerebrospinal fluid barrier, under normal conditions, the cerebrovascular barrier can limit macromolecular substances in blood from entering the brain and maintain the internal environment of brain tissues in a stable state; however, researchers have observed that in the acute phase of colitis in mice, the number of macrophages in the brain of the mice is increased, and meanwhile, microglia and the main immune monitoring cells of the nervous system are also in an activated state, which indicates that intestinal inflammation can rapidly cause brain inflammatory reaction; in the state of intestinal inflammation, harmful substances enter blood, the cerebrovascular barrier feels the threat, the closing is selected to prevent the harmful substances from entering and maintain the homeostasis of the brain, however, the outward coming and going is isolated, the harmful substances cannot enter, the beneficial substances cannot enter, and meanwhile, metabolic products generated in the brain cannot be transported out, so that the brain complication is generated.

Therefore, the traditional Chinese medicine formula for regulating the gastrointestinal tract function regulates the gastrointestinal tract function, inhibits the systemic inflammatory reaction after the cardiac operation, and simultaneously solves the problem of pulmonary and cerebral complications, thereby reducing the perioperative complications and the mortality of patients with the cardiac operation.

The present invention has been made based on this.

Disclosure of Invention

The invention firstly relates to a traditional Chinese medicine formula LXHCF, which is a formula of prefabricated traditional Chinese medicine particles and comprises the following components: HEISHUN tablet, Zingiberis rhizoma, Corni fructus, Coptidis rhizoma, radix et rhizoma Rhei, Saviae Miltiorrhizae radix, radix Angelicae sinensis, parched Atractylodis rhizoma, rhizoma Atractylodis, fructus Aurantii, cortex Magnolia officinalis, pericarpium Citri Tangerinae, Poria, herba Lycopi, radix Clematidis, caulis Sargentodoxae, and cortex Cinnamomi;

the dosage and proportion of all the prefabricated traditional Chinese medicine granule components in the prefabricated formula are as follows:

6 parts of black shun slice, 6 parts of dried ginger, 10 parts of cornus officinalis, 6 parts of coptis chinensis, 3 parts of wine rhubarb, 15 parts of salvia miltiorrhiza, 10 parts of angelica, 10 parts of fried bighead atractylodes rhizome, 10 parts of rhizoma atractylodis, 10 parts of fructus aurantii, 10 parts of mangnolia officinalis, 6 parts of dried orange peel, 10 parts of poria cocos, 10 parts of herba lycopi, 10 parts of radix clematidis, 10 parts of sargentgloryvine stem and 5 parts of cinnamon.

The medicine formula LXHCF is prepared from traditional Chinese medicine formula particles produced by the same manufacturer according to the components of a prefabricated formula.

The invention also relates to the following application of the medicine formula:

(1) preparing a medicament for treating systemic inflammatory reaction after cardiac surgery;

(2) preparing a medicament for treating the postoperative recovery of cardiac surgery;

(3) preparing a combined medicament for treating systemic inflammatory response after cardiac surgery;

(4) preparing a combined medicament for treating the recovery after the cardiac surgery;

the combination drug is as follows: in combination with antibiotics; the antibiotic is a broad-spectrum antibiotic; preferably, the antibiotic is a cephalosporin antibiotic.

The cardiac surgery is a cardiac surgery which has myocardial ischemia injury process and simultaneously causes ischemia reperfusion injury to a plurality of organs of the whole body, and concretely comprises the following steps:

(1) general anesthesia coronary artery bypass grafting under non-extracorporeal circulation,

(2) coronary artery bypass transplantation under general anesthesia extracorporeal circulation,

(3) a heart valve repair or replacement operation under general anesthesia extracorporeal circulation,

(4) adult congenital heart disease correction under general anesthesia extracorporeal circulation.

The invention has the beneficial effects that:

(1) the medicine formula can effectively relieve the systemic inflammatory reaction after the cardiac surgery and improve the postoperative prognosis of the cardiac surgery patient;

(2) the drug formula of the invention can be used together with the traditional anti-inflammatory treatment by applying antibiotics after the cardiac surgery, and can effectively improve the prognosis of patients.

(3) In the medicine formula, three medicines are relatively more critical to the functions of the medicine:

1) the main components of the prepared aconite (black aconite) are alkaloid: diterpene alkaloid type, aconitine, mesaconine, hypaconitine, etc.;

2) the main components of the coptis are alkaloid: isoquinoline alkaloids, berberine, epiberberine, jateorhizine, palmatine, etc.;

3) the main components of the wine rhubarb are anthraquinone: emodin, chrysophanol, rhein and its glycosides, rhubarb dianthrone, sennoside, etc.

Drawings

Figure 1, LXHCF treatment significantly reduced the inflammatory response caused by AMI in model mice:

1A:

WBC content

1, 3, 7 days post-cardiac surgery;

1B:

MON content

1, 3, 7 days after heart surgery;

1C:

NEUT content

1, 3, 7 days after cardiac surgery;

1D: NEUT (%) after 1, 3, 7 days of cardiac surgery;

1E: heart was operated for 1, 3, 7 MON (%).

# P <0.01, # P <0.05vs. sham group; p <0.01, P <0.05vs. am model mouse group.

FIG. 2 shows the inhibitory effect of LXHCF administration on inflammatory response induced by cardiac surgery,

2A: CRP content 3 days post-cardiac surgery;

2B: CRP content 7 days post-cardiac surgery;

2C: IL-6 content 3 days after cardiac surgery;

2D: IL-6 content 7 days after cardiac surgery;

# P <0.01, # P <0.05vs. sham group, # P <0.01, # P <0.05vs. am model mouse group.

Fig. 3, effect of LXHCF administration on the pathological structure of the heart in mice 7 days after heart surgery: the arrow pointing in the left-lower direction in the figure is inflammatory cell infiltration or foreign body, and the arrow pointing in the right-upper direction is necrotic myocardium. Magnification, 400 times.

Detailed Description

1. Materials and reagents

ELISA kits comprising IL-6(282012331) and TNF-a (206101311) were purchased from Union organisms and mouse CRP detection kit (C080385) was purchased from Wuhan Huamei bioengineering, Inc.

The preparation of the medicine comprises the following steps: the LXHCF formula particles are ground into fine powder in a grinding bowl, then diluted to 0.5g/mL and 2.5g/mL by using sterilized distilled water, and refrigerated for standby.

The traditional Chinese medicine formula granule is prepared by using each traditional Chinese medicine extraction granule according to the proportion of a pre-prepared formula. The preparation process of the traditional Chinese medicine granule should meet the administrative regulations of the State drug administration of quality control and Standard establishment of the granule of traditional Chinese medicine.

2. Animal feeding

8-10 weeks old healthy C57BL/6 mice, male. Purchased from Beijing Weitonglihua laboratory animal technology Co., Ltd, animal license number: SCXK (Jing) 2016-. All animals involved in the experiment met the ethical and legal requirements. The animal is bred in the center of the institute of drug research of Chinese academy of medical sciences, all animals are placed in an environment with room temperature of 25 ℃ and relative humidity of 45-55%, and the light and shade alternate illumination period changes for 12 hours. All experimental studies were approved by the ethical committee for animal research of the chinese academy of medical sciences.

3. Establishment of acute myocardial infarction model

An acute myocardial infarction model is established by adopting a coronary artery left anterior descending ligation method. The operation method is briefly described as follows:

(1) mice were anesthetized with a 2% isoflurane inhalation and isoflurane delivery system, a small skin incision (1.2 cm) was made in the left chest, and after dissection and contraction of the pectoralis major and minor muscles, a fourth intercostal space was exposed. Then, a small hole is formed between the fourth ribs by using a curved hemostat, and the pleura and the pericardium are opened;

(2) the hemostat opens slightly and the heart springs out smoothly and gently from the gap. Ligating the left anterior descending branch of the coronary artery with 6-0 silk thread;

(3) when the anterior wall of the left ventricle whitens, indicating that ligation was successful.

Immediately after ligation, the heart was placed back into the chest cavity, the air was manually evacuated and the muscles and skin were sealed. The rats were then allowed to breathe room air and monitored during the recovery period.

The same procedure was used in the sham surgery groups except for the left anterior descending branch which was not ligated.

4. Administration of drugs

After 11 days of adaptive feeding of the animals, randomized groups (total 6 groups) were:

(1) a sham operation group;

(2) a model group;

(3) LXHCF-L (5g/kg) group;

(4) LXHCF-H (25g/kg) group;

(5) cefixime group (Cefixime, 0.08 g/kg);

(6) cefixime and LXHCF (Cefix 0.08g/kg + LXHCF 25 g/kg).

After the molding is successful, the corresponding medicines are respectively administered by intragastric administration. Deionized water, and corresponding drugs were administered by intragastric administration to the sham group (n ═ 13) and the model group (n ═ 13), the LXHCF-L group (5g/kg, n ═ 13), the LXHCF-H group (25g/kg, n ═ 13), the Cefixime group (Cefixime, 0.08g/kg), and the Cefixime + LXHCF-L group (Cefixime, 0.08g/kg + LXHCF-L25 g/kg). The gavage was performed 2 times daily for 7 consecutive days during the experiment.

5. Routine blood test

Mice were bled from the eye orbit on

days

3 and 7 of the administration, and 20. mu.L of whole blood was analyzed in a MEK-7222K cytometer from each mouse. The total white blood cell count (WBC), total mononuclear cell count (MON), total neutrophil count (NEUT), percent mononuclear cells (MON%) and percent neutrophil count (NEUT%) were calculated.

6. Enzyme linked immunosorbent assay for detecting IL-6 and CRP contents in blood plasma

After the experiment, mice were fasted overnight and anesthetized with pentobarbital. Blood is collected from the orbit, centrifuged at 3500rpm for 10min, and the activity of IL-6 and CRP in serum is detected. And (3) performing detection according to standard operation of the kit: 100 μ L of the sample was added to a 96-well plate, which was coated with the capture antibody. Then the 96-well plate was incubated at 37 ℃ for 60 minutes, the solution in the 96-well plate was discarded and washed 3 times with 1 × wash buffer [ modified after confirmation ], then the corresponding antibody reagent was added for incubation for 60min, then the plate was washed again, horseradish peroxidase solution was added for incubation for 20min, and finally the color reagent and stop buffer were added. The multifunctional microplate reader detects the OD value at 450 nm.

7. H & E staining for assessment of myocardial histopathology

After the experiment was completed, the mice were sacrificed and heart tissue was immediately isolated. A portion of the heart tissue was removed and fixed with paraformaldehyde and paraffin embedded. Sections of 4 μm myocardial tissue were cut for H & E staining to assess inflammatory lesions. The dyeing method was performed with reference to the literature.

8. Statistical analysis

All data are expressed as mean ± standard deviation, SPSS software checks homogeneity of variance, using one-way analysis of variance and LSD or

Dunnett's T3 performed a significance difference analysis. Differences were statistically significant when P <0.05 and P < 0.01.

Example 1 LXHCF treatment significantly reduces the inflammatory response in model mice caused by AMI

1 day after AMI molding, WBC, MON, NEUT, MON%, NEUT%

There were no significant changes in total white blood cell count (WBC), total mononuclear cell count (MON), total neutrophil count (NEUT), percent mononuclear cells (MON%) and percent neutrophils (NEUT%).

The results of the detection carried out 3 days after the operation show that:

(1) compared with a sham operation group, the WBC, MON and NEUT content of the model mice is remarkably increased (P <0.05 and 0.01).

(2) Compared with a model group, the LXHCF-L significantly reduces WBC, MON, NEUT and MON% (P <0.05, 0.01) of postoperative model mice, and the reduction rates are 37.8%, 82.5%, 50.3% and 70.6% respectively;

(3) the antibiotic group has no obvious influence on WBC, MON, NEUT, MON% and NEUT% of the model mice;

(4) antibiotic + LXHCF group, significantly decreased the above index (P <0.05, 0.01).

The results of the 7-day postoperation tests showed that the WBC, MON, NEUT, MON% and NEUT% values of the mice in each group fell back, and in addition:

(1) compared with a sham operation group, the model mice WBC, MON, NEUT, MON% and NEUT% have no significant difference (P is more than 0.05);

(2) LXHCF-L significantly reduced WBC content and NEUT% (P <0.05), LXHCF-H significantly reduced NEUT% (P <0.05) compared to the model group;

the results show that LXHCF has obvious inhibition effect on inflammatory reaction caused by AMI; the single application of the antibiotic cannot improve the inflammatory response caused by AMI, and the LXHCF is combined to obviously improve the inflammatory response after the intervention.

Example 2 LXHCF treatment significantly reduces the expression levels of CRP and IL-6 in AMI model mice

After 3 days of operation, CRP and IL-6 levels of each group of mice were measured according to the above method, and the results showed that:

(1) compared with the sham operation group, the plasma CRP of the mice in the model group is obviously increased (P < 0.01);

(2) compared with the model group, the antibiotic group has no obvious influence on the CRP level of the model mouse,

(3) LXHCF-H, LXHCF-L, antibiotic + LXHCF significantly reduced plasma CRP levels in model mice (P <0.05, 0.01).

After 7 days of operation, further detection is carried out, and the result shows,

(1) compared with a sham operation group, the CRP of the model group has no significant difference;

(2) LXHCF-L still significantly reduced plasma CRP levels in model mice compared to the model group (P <0.05)

The results show that the IL-6 level of the plasma of the mice in the model group is obviously increased (P is less than 0.05 and 0.01) in 3 and 7 days after the operation compared with the sham operation group; compared with a model group, the anti-biotic has no obvious influence on the IL-6 level of the postoperative model mouse, and LXHCF-L, Antibiotic + LXHCF remarkably reduces the IL-6 level of the model mouse (P is less than 0.05 and 0.01); LXHCF-H significantly reduced CRP levels (P <0.05) 7 days after cardiac surgery, suggesting that LXHCF has an inhibitory effect on inflammatory responses induced after cardiac surgery.

Example 3, LXHCF administration significantly improves myocardial histopathological conditions in AMI model mice

After the administration, to further observe the improvement effect of LXHCF on myocardial histopathology, H & E staining was performed on cardiac tissue according to the aforementioned method. The results show that it is possible to display,

(1) the model group can show myocardial focal degeneration necrosis, myocardial atrophy, rupture, inflammatory cell infiltration, fibroblast proliferation and early stage myocardial fibrosis;

(2) the Antibiotic (Antibiotic) group has myocardial focal degeneration necrosis, myocardial atrophy, rupture and inflammatory cell infiltration, and has no obvious improvement;

(3) LXHCF-H, LXHCF-L, Antibiotic + LXHCF can reduce the inflammatory reaction of heart, reduce the infiltration of inflammatory cell and improve the histopathological abnormality of model mouse.

Finally, it should be noted that the above embodiments are only used to help those skilled in the art understand the essence of the present invention, and are not used to limit the protection scope of the present invention.

Claims

1. A traditional Chinese medicine formula LXHCF is a prefabricated traditional Chinese medicine granule formula and comprises the following components: black sliced rhizoma Zingiberis, fructus Corni, rhizoma Coptidis, radix Et rhizoma Rhei, radix Salviae Miltiorrhizae, radix Angelicae sinensis, rhizoma Atractylodis Macrocephalae preparata, rhizoma Atractylodis, fructus Aurantii, cortex Magnoliae officinalis, pericarpium Citri Reticulatae, Poria, herba Lycopi, radix Clematidis, caulis Sargentodoxae, and cortex Cinnamomi.

2. The drug formulation LXHCF of claim 1, wherein the pre-formulated formulation comprises the following pre-formulated traditional Chinese medicine granule components in the following amounts:

3. The traditional Chinese medicine formula LXHCF as claimed in claim 1 or 2, wherein the traditional Chinese medicine formula granules produced by the same manufacturer are prepared according to the components of the pre-prepared formula.

4. A pharmaceutical formulation LXHCF according to any one of claims 1 to 3 for use as a medicament for treating a condition selected from the group consisting of:

(4) preparing the combined medicament for treating the recovery after the cardiac surgery.

5. The use according to claim 4, wherein the combination is: in combination with antibiotics; the antibiotic is a broad-spectrum antibiotic; preferably, the antibiotic is a cephalosporin antibiotic.

6. The use of claim 4 or 5, wherein the cardiac surgery is a cardiac surgery in which the ischemic injury of the heart muscle simultaneously causes ischemic reperfusion injury in a plurality of organs of the body, and comprises:

(1) coronary artery bypass transplantation under general anesthesia non-extracorporeal circulation,