Effect Of SB203580 On Pathologic Change Of Pancreatic Tissue And Expression Of TNF-α、IL-1β In Rats With Severe Acute Pancreatitis & Meta-Analysis Of The Adjuvant Treatment Of Severe Acute Pancreatitis With Rhubarb

Part one Effect of SB203580 on pathologic change of pancreatic tissue and expression of TNF-α and IL-1β in rats with severe acute pancreatitisObjective: To investigate the effect of SB203580 which is the inhibitor of P38 mitogen-activated protein kinase on pathologic change of pancreatic tissue and expression of tumor necrosis factor-alpha(TNF-α) and interleukin-1-beta(IL-1β) in rats with severe acute pancreatitis(SAP).Methods: 45 Wistar rats were randomly divided into three groups(n=15), control group: pancreatic duct given normal saline + intraperitoneal normal saline injection; SAP + NS group: pancreatic duct given sodium taurocholate + intraperitoneal normal saline injection; SAP + SB group: pancreatic duct given sodium taurocholate + intraperitoneal SB203580 injection. SAP rats using the method of retrograde pancreaticobiliary duct injection of sodium taurocholate. Then, 6h, 12 h, 24 h post operation, serum amylase been detected respectively, and pancreatic pathology been observed, while RT-PCR, Western-blot and immunohistochemical methods been used to detected the expression of TNF-α and IL-1β in pancreatic tissue. These were in order to understand the effect of P38 MAPK inhibitor SB203580 on SAP rat pancreatic pathological and expression of TNF-α and IL-1β, so as to explore the role of P38 MAPK signaling pathway in the pathogenesis of SAP rats.Results: Compared with the control group, SAP + NS group was significantly elevated serum amylase, SAP + SB group amylase levels is higher than normal, but significantly lower than the SAP+ NS group(P<0.05). Pancreatic tissue pathology show, SAP + NS group and SAP + SB group appeared interstitial edema, hemorrhage, necrosis, inflammatory infiltration, and gradually more severe prolonged with time.Pancreatic pathological changes were slight in SAP + SB compared with SAP + NS group. RT-PCR, Western-blot and immunohistochemistry showed that the expression of TNF-α group and IL-1β in pancreatic tissue were increased in SAP + NS group and SAP + SB group, but the expression of the latter is weaker than the former, pancreas histopathological scores were significantly reduced(P<0.05).Conclusion: p38 MAPK signal pathway inhibitor SB203580 can reduce severe acute pancreatitis pathological changes and decrease the expression of TNF-α and IL-1β, indicating that p38 MAPK signaling pathway may be concerned with the development of SAP, by regulating the expression of cytokines TNF-α and IL-1β through signaling pathway, SB203580 reduce the inflammatory response in acute pancreatitis..Part two Meta-Analysis of the adjuvant treatment of severe acute pancreatitis with rhubarbObjective: To compare and evaluate the clinical efficacy of rhubarb in the adjuvant treatment of SAP.Methods: Search the randomized controlled trials(RCT) articles about the clinical efficacy of rhubarb in the adjuvant treatment of SAP from the following electronic biological databases: Medline(2010-2015), Cochrane Database(2010-2015), China National Knowledge Infrastructure,(CNKI, 2010-2015), China Biology Medicine disc(CBM, 2010-2015), CQVIP(2010-2015) and Wan Fang Data(2010-2015). The data were collected by two separated doctors, then use Rev Man 5.3 softwareto to analyze them.Results of researching documents: After screening, there are sixteen randomized controlled trials of a total of 1145 cases included into the analysis.Results of meta-analysis: Compared with control group, the APACHE II score of the patients adjunctively treated with rhubarb lower value significantly after treating with the same time, [WMD:-2.82, 95%CI:(-3.26,-2.38, P<0.05)]; the patients adjunctively treated with rhubarb had significantly faster relief of abdominal bloating, [WMD:-2.22,95%CI:(-2.84,-1.59, P<0.05)]; the patients adjunctively treated with rhubarb had significantly faster relief of abdominal pain, [WMD:-1.86, 95%CI:(-2.55,-1.17, P<0.05)]; the recovery time of serum amylase were also shorter, [WMD:-2.93, 95%CI:(-3.65,-2.21, P<0.05)]; lower mortality rate of treated group, [OR: 0.18, 95%CI:(0.09, 0.35, P>0.05)]; and less time of length of stay in hospital, [WMD:-5.29, 95%CI:(-6.83,-3.75, P<0.05)].Conclusion: Adjunctive therapy of SAP with rhubarb has the better effect than the control group.