| To observe the safety and the clinical efficacy of early oral refeeding based on subjective sensation of hunger in patients with mild acute pancreatitis.Methods:One hundred and forty-nine patients with mild acute pancreatitis admitted in Pancreatic Research Group, Department of Integrated Traditional and Western Medicine at West China hospital, Sichuan,from January2011to December2011were enrolled and divided into early oral refeeding group and control group randomly.Patients for early oral refeeding group restarted oral refeeding when they felt hungry,while the control group restarted when the patient’s abdominal distension and abdominal pain were significantly relieved, and the serum amylase recovered to less than2times the upper limit of normal.The difference as the average days of oral refeeding after abdominal pain onset, number of patients with pain relapse or transitional abdominal distension after oral refeeding, number of patients with amylase and lipase became more higher, number of patients with glycemic change after oral refeeding, and the length of hospital stay (LOH) for total and post-refeeding in two groups were compared.Results:The average days of oral refeeding after abdominal pain onset were4.56±1.53days for early refeeding group and6.75±2.29days for control group (p<0.05);The LOH for total between the two groups were statistically different with6.8±2.1days and10.4±4.1days,respectively (p<0.01).;The LOH for post-refeeding were2.24±0.52days and3.27±0.61days (p<0.01). The mean level of blood glucose after oral refeeding in early refeeding group was lower than that before oral refeeding (p<0.01),which was statistically difference.There was no statistically difference in age, sex, number of patients with pain relapse or transitional abdominal distension after oral refeeding in two groups (p>0.05). There were no serious adverse events observed after oral refeeding during the study and there were no patients interrupting oral refeeding in both groups.Conclusion:Early oral refeeding based on the subjective hunger feeling is safe and effective in patients with mild acute pancreatitis,which could help to shorten the LOH and is beneficial for the blood glucose control. (1) To explore the targeting tissue distribution characteristics of the prepared rhubarb (five main monomers)in rats with acute pancreatitis(AP);(2)To identify the potential mechanism of the prepared rhubarb in promoting the regeneration of rat pancreatic tissue by increasing TGF-β1.Methods:(1) Pharmacokinetic study about targeted distribution of the prepared rhubarb:Ten male SD rats were divided into normal group and model group. There were no processes with the normal group, while the model group was given intraperitoneal injection with caerulin (50μg/kg) seven times to produce AP model. Rats in both groups were given same dose of prepared rhubarb granules (12g/kg) once by gavage at9:00the next morning,2hours later then, all rats were anesthetized by giving intraperitoneal injection with chloral hydrate (10%). We analyzed the tissue distribution of five main anthraquinone (Emodin, rhein, chrysophanol, aloe-emodin, emodin-Ether) in heart, liver, spleen, lung, kidney, pancreas with HPLC-MS/MS.(2) Pharmacodynamic study about the promotion of the regeneration:Sixty male SD rats were randomly divided into sham operation group, model group, low-dose group, middle dose group and high dose group, with12rats in each group. Of all the rats,48were given intraperitoneal injection with caerulin (50μg/kg) to produce AP model,12were given intraperitoneal injection with physiological saline. After giving three different dose of prepared rhubarb, we drew blood from abdominal aortic respectively in2,5,8days and got pancreas tissue. Blood Serum amylase, the pancreatic histopathology, the expression of TGF-β1in pancreas at various points and the biopsy blood perfusion in pancreas of live rats (with Laser Doppler Flowmetry) were detected. Results:(1)Pharmacokinetic section:①The five main components of prepared rhubarb in pancreas were not higher than in other organs in normal group. However, in AP model group.we found higher concentrations of emodin and rhein in pancreas, which implied these two components targeted pancreas rather than the other organs.②The concentrations of emodin and rhein from prepared rhubarb in pancreas of rats with AP were higher than those in the pancreas of normal rats. The concentration of emodin in kidney of rats with AP is higher than that in the normal rats. The concentrations of rhein and emodin in spleen with AP is higher than that in the normal rats. The concentrations of other components of prepared rhubarb showed no statistically difference in two groups.(2) Pharmacodynamic section:Prepared Rhubarb helps to decrease the blood amylase and histopathology lever of pancreas, increase the blood perfusion in the pancreas of live rats and promoted the expression of TGF-β1in extracellular matrix of pancreas.Conclusion:(1)This study proved that prepared rhubarb could promote the pancreatic regeneration in rats with AP through TGF-β1;(2) It was preliminarily confirmed that the prepared rhubarb could promote pancreatic regeneration with tissue targeted distribution of its components.(3) Emodin and rhein were the potential targeted pharmacodynamic materials in the course of pancreatic regeneration;(4) The study provided a scientific basis for clarifying the meridian tropism theory of Chinese herb from the perspective of therapy. |
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