Clinical Efficacy Evaluation of Tanreqing Injection Combined with Ceftazidime in Treatment of Phlegm Heat Obstructing Lung Syndrome in Acute Exacerbation of Chronic Obstructive Pulmonary Disease / 中国实验方剂学杂志

ObjectiveTo explore the effect of Tanreqing injection combined with Ceftazide on the clinical efficacy， lung function， and laboratory inflammatory index of patients suffering from phlegm heat obstructing lung syndrome in acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. MethodFrom June 2021 to June 2023， 76 patients diagnosed with phlegm heat obstructing lung syndrome in AECOPD were enrolled in the respiratory and critical medical department of Jieshou Hospital of Traditional Chinese Medicine. They were randomly divided into a control group and an observation group with 38 cases each. The control group used Ceftazidime intravenous drip and other conventional oxygen inhalation and antispasmodic treatment measures of western medicine. The observation group received Tanreqing injection intravenous drip based on the treatment of the control group， with a course of 10 days. The changes of laboratory indicators such as hs-CRP， calcitonin （PCT）， and interleukin-6 （IL-6） before and after treatment were analyzed， and the improvement of forced expiratory volume in the first second （FEV1）， forced vital capacity （FVC）， one second rate （FEV1/FVC）， assessment and improvement of the British Medical Research Society’s dyspnea index （mMRC）， self-evaluation test of chronic obstructive pulmonary disease patients （CAT）， and traditional Chinese medicine syndrome score was compared. In addition， the total effective rate between the two groups after treatment was compared. ResultAfter treatment， the hs-CRP， PCT， IL-6， FEV1， FVC， FEV1/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation of both groups improved （P<0.01）. After treatment， compared with the control group， the observation group showed more significant improvements in hs-CRP， PCT， IL-6， FEV1， FVC， FEV1/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation， and the difference was statistically significant （P<0.05，P<0.01）. The total clinical effective rate of the control group was 86.84% （33/38）， while that of the observation group was 94.74% （36/38）. The therapeutic effect of the observation group was better than that of the control group （χ2=8.471， P<0.05）. ConclusionTanreqing injection combined with Ceftazidime has obvious efficacy in the treatment of phlegm heat obstructing lung syndrome in AECOPD， which is better than the treatment of Ceftazidime antibiotics alone. It can reduce the risk of acute exacerbation， alleviate clinical symptoms， and delay the decline of lung function.

Effects of Tanreqing Injection on ICU Mortality among ICU Patients Receiving Mechanical Ventilation: Time-Dependent Cox Regression Analysis of A Large Registry / 中国结合医学杂志

OBJECTIVE@#To assess whether the use of Tanreqing (TRQ) Injection could show improvements in time to extubation, intensive care unit (ICU) mortality, ventilator-associated events (VAEs) and infection-related ventilator associated complication (IVAC) among patients receiving mechanical ventilation (MV).@*METHODS@#A time-dependent cox-regression analysis was conducted using data from a well-established registry of healthcare-associated infections at ICUs in China. Patients receiving continuous MV for 3 days or more were included. A time-varying exposure definition was used for TRQ Injection, which were recorded on daily basis. The outcomes included time to extubation, ICU mortality, VAEs and IVAC. Time-dependent Cox models were used to compare the clinical outcomes between TRQ Injection and non-use, after controlling for the influence of comorbidities/conditions and other medications with both fixed and time-varying covariates. For the analyses of time to extubation and ICU mortality, Fine-Gray competing risk models were also used to measure competing risks and outcomes of interest.@*RESULTS@#Overall, 7,685 patients were included for the analyses of MV duration, and 7,273 patients for the analysis of ICU mortality. Compared to non-use, patients with TRQ Injection had a lower risk of ICU mortality (Hazards ratios (HR) 0.761, 95% CI, 0.581-0.997), and was associated with a higher hazard for time to extubation (HR 1.105, 95% CI, 1.005-1.216), suggesting a beneficial effect on shortened time to extubation. No significant differences were observed between TRQ Injection and non-use regarding VAEs (HR 1.057, 95% CI, 0.912-1.225) and IVAC (HR 1.177, 95% CI, 0.929-1.491). The effect estimates were robust when using alternative statistic models, applying alternative inclusion and exclusion criteria, and handling missing data by alternative approaches.@*CONCLUSION@#Our findings suggested that the use of TRQ Injection might lower mortality and improve time to extubation among patients receiving MV, even after controlling for the factor that the use of TRQ changed over time.

Study on Sub-minimal Inhibitory Concentration of Tanreqing Injection in Inhibiting Hemolytic Activity of Staphylococcus aureus α-hemolysin / 中国实验方剂学杂志

Objective:To study whether Tanreqing injection （TRQ） can alleviate the body injury in the process of infection by inhibiting the production and release of <italic>α</italic>-hemolysin of <italic>Staphylococcus aureus</italic> under sub-minimal inhibitory concentration， and to provide experimental basis for better guidance of clinical medication. Method:The effects of TRQ on the minimum inhibitory concentration （MIC） and bacterial growth of <italic>S.aureus</italic> were determined firstly by microplate method and time-growth curve. The different sub-minimal inhibitory concentrations of TRQ were co-cultured with bacteria or bacterial supernatants， and then co-incubated with defibrillated rabbit blood to detect the inhibitory and neutralizing effects of TRQ on <italic>S.aureus</italic> <italic>α</italic>-hemolysin. Cell counting kit-8 （CCK-8） cell viability assay was used to detect the protective effect of TRQ on <italic>S. aureus</italic>-mediated damage to human alveolar epithelial cells （A549）. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the effect of sub-minimal inhibitory concentration of TRQ on the mRNA expression of <italic>S.aureus</italic> <italic>α</italic>-hemolysin regulatory genes hla and agrA. Result:The MIC of TRQ to <italic>S.aureus </italic>was 1/8 of the stock solution， and the sub-minimal inhibitory concentration （1/64MIC-1/16MIC） TRQ used in this study did not affect the growth of bacteria. 1/64MIC-1/16 MIC TRQ had the effect of inhibiting and neutralizing the hemolytic activity of <italic>α</italic>-hemolysin， with a protective effect on <italic>S.aureus</italic> supernatant-mediated A549 cell damage， and its inhibitory effect on <italic>α</italic>-hemolysin was closely related to the inhibition of hla and agrA mRNA expression. Conclusion:The sub-minimal inhibitory concentration TRQ can inhibit and neutralize the hemolytic activity of <italic>α</italic>-hemolysin of <italic>S.aureus</italic>， with a protective effect on A549 cell damage mediated by <italic>S.aureus</italic> infection， and its mechanism of inhibiting <italic>α</italic>-hemolysin is closely related to the interference with agr regulatory system.

Meta-analysis on Clinical Effect and Safety of Tanreqing Injection in Treatment of Elderly Chronic Bronchitis / 中国实验方剂学杂志

Objective:To systematically evaluate the clinical efficacy of Tanreqing injection in the treatment of elderly chronic bronchitis. Method:CBM，CNKI，WanFang Data，VIP，PubMed，The Cochrane Library，Embase and other databases were retrieved by computer to screen out randomized controlled trials of Tanreqing injection in the treatment of elderly chronic bronchitis. The retrieval time was from the establishment to December 2019. After two researchers independently screened out the literatures according to the inclusion and exclusion criteria，extracted data and evaluated the literature quality，made meta-analysis using RevMan 5.3 software，and performed Egger test by Stata 14.0 software to evaluate publication bias. In case of any publication bias，clipping and supplementation method was further used to evaluate the effect of bias on the results. Result:A total of 48 studies were included，including 4 356 patients with diabetic nephropathy. The results of Meta-analysis showed that compared with conventional antibiotic therapy，the group of combination with Tanreqing injection was better than the control group in effective rate and lowering serum c-reactive protein （CRP） level，with statistically significant differences. The results of the publication bias test showed that a developmental bias in the effective rate. Further analysis based on the non-parametric clipping and supplementation method showed stable results of meta-analysis and no impact from potential publication bias. The adverse reactions had no statistically significance. Conclusion:This study shows that Tanreqing injection has a significant effect in treating chronic bronchitis in the elderly，and can reduce the serum CRP level of the patients. Compared with the conventional therapy group，the incidence of adverse reactions is not significantly increased，and the results need further clinical tests.

Chronic Toxicity of Tanreqing Injection in Beagle Dogs / 中国实验方剂学杂志

Objective:To observe the possible toxicity of long-term intravenous injection of Tanreqing injection in Beagle dogs， so as to provide experimental data for its clinical safe medication. Method:A total of 32 Beagle dogs （16 males and 16 females） were randomly divided into the low- （2.5 mL·kg^-1）， medium- （5.0 mL·kg^-1）， and high-dose （10.0 mL·kg^-1） Tanreqing injection groups and control group according to their body mass indices， with eight dogs in each group. In the waking state， the dogs were treated with intravenous injection of corresponding drugs into the medial cephalic vein of forelimb for 13 weeks， followed by four-week drug withdrawal. After the observation of general condition， body mass， and food consumption， the Beagle dogs were subjected to electrocardiography， ophthalmoscopy， hematological examination， serum biochemistry， and blood coagulation test in the middle of medication （week 6）， at the end of medication （week 13）， and during recovery （week 17）. Then the gross anatomy was conducted for calculating the major organ coefficients and observing the histopathological changes. Result:No obvious toxic reaction was found in each group， but the decreased fibrinogen and increased Kupffer's cells phagocytizing yellow-brown pigment in hepatic sinusoids were observed in the high-dose Tanreqing injection group following three months of medication. Reduction of fibrinogen was not observed in recovery period， but Kupffer's cells that phagocytized yellow-brown pigment still existed. Conclusion:The intravenous injection of Tanreqing injection at 2.50 mL·kg^-1（low dose）， 5.00 mL·kg^-1 （medium dose） or 10.00 mL·kg^-1（high dose） for three months in Beagle dogs resulted in no obvious toxic reaction. However， it is still suggested to test the liver function and blood coagulation after long-term administration of high-dose Tanreqing injection.

Clinical Efficacy of Tanreqing Injection Combined with Western Medicine in Treatment of Pneumonia Caused by Multi-drug Resistant Bacteria in Elderly Patients / 中国实验方剂学杂志

Objective:To observe the clinical effect of Tanreqing injection combined with western medicine on pneumonia caused by multi-drug resistant bacteria （MDRB） in elderly patients. Method:A total of 140 MDRB-induced pneumonia inpatients with the syndrome of phlegm-heat obstructing lung in the intensive care unit （ICU） of Dalian Hospital of Traditional Chinese Medicine from December 2018 to December 2020 were divided into an observation group （70 cases） and a control group （70 cases）） according to the random number table method. The patients in the control group received conventional treatment by western medicine， and those in the observation group received conventional treatment by western medicine combined with Tanreqing injection. The course of treatment was 7 days. The main efficacy indexes of the two groups before and after treatment were recorded，including the total clinical efficacy of traditional Chinese medicine （TCM） syndrome，total TCM syndrome score，clinical pulmonary infection score （CPIS）， and the clearance rate of MDRB. Secondary efficacy indexes included temperature recovery and cough remission time，procalcitonin （PCT），C-reactive protein （CRP），white blood cell count （WBC），interleukin-6 （IL-6），interleukin-8 （IL-8）， and oxygen partial pressure （PO₂）. Result:The total effective rates of the observation group and the control group were 90.00% （63/70） and 75.70% （53/70），respectively，and the observation group had superior curative efficacy （<italic>Z</italic>=-2.147，<italic>P</italic><0.05）. After treatment，CPIS and total TCM syndrome scores in both groups decreased compared with those before treatment，and the decrease was more significant in the observation group （<italic>P</italic><0.01）. The clearance rate of MDRB in the observation group was 67.1% （47/70），superior to 48.6% （34/70） in the control group （<italic>χ</italic>²=4.951，<italic>P</italic><0.05）. The temperature recovery and cough remission time in the observation group was shorter than that in the control group （<italic>P</italic><0.01）. After treatment，the levels of PCT，CRP，WBC，IL-6， and IL-8 in both groups were reduced compared with those before treatment，while the levels of PO₂ increased （<italic>P</italic><0.01）. The improvement of various inflammatory indexes and the PO₂ level in the observation group was better than that in the control group （<italic>P</italic><0.01）. Conclusion:The clinical efficacy of Tanreqing injection combined with western medicine in the treatment of MDRB-induced pneumonia in elderly patients is significant，which can control infection，reduce inflammatory damage，improve the clearance rate of MDRB and PO₂，and alleviate clinical symptoms. It is worthy of clinical application.

Effects of Tanreqing Capsule on the negative conversion time of nucleic acid in patients with COVID-19: A retrospective cohort study / 中西医结合学报

OBJECTIVE@#Traditional Chinese medicine plays a significant role in the treatment of the pandemic of coronavirus disease 2019 (COVID-19). Tanreqing Capsule (TRQC) was used in the treatment of COVID-19 patients in the Shanghai Public Health Clinical Center. This study aimed to investigate the clinical efficacy of TRQC in the treatment of COVID-19.@*METHODS@#A retrospective cohort study was conducted on 82 patients who had laboratory-confirmed mild and moderate COVID-19; patients were treated with TRQC in one designated hospital. The treatment and control groups consisted of 25 and 57 cases, respectively. The treatment group was given TRQC orally three times a day, three pills each time, in addition to conventional Western medicine treatments which were also administered to the control group. The clinical efficacy indicators, such as the negative conversion time of pharyngeal swab nucleic acid, the negative conversion time of fecal nucleic acid, the duration of negative conversion of pharyngeal-fecal nucleic acid, and the improvement in the level of immune indicators such as T-cell subsets (CD3, CD4 and CD45) were monitored.@*RESULTS@#COVID-19 patients in the treatment group, compared to the control group, had a shorter negative conversion time of fecal nucleic acid (4 vs. 9 days, P = 0.047) and a shorter interval of negative conversion of pharyngeal-fecal nucleic acid (0 vs. 2 days, P = 0.042). The level of CD3@*CONCLUSION@#Significant reductions in the negative conversion time of fecal nucleic acid and the duration of negative conversion of pharyngeal-fecal nucleic acid were identified in the treatment group as compared to the control group, illustrating the potential therapeutic benefits of using TRQC as a complement to conventional medicine in patients with mild and moderate COVID-19. The underlying mechanism may be related to the improved levels of the immune indicator CD3

Mechanism of Tanreqing Injection in treatment of acute lung injury based on network pharmacology and molecular docking / 中国中药杂志

This study aimed to explore the mechanism of Tanreqing Injection in the treatment of acute lung injury(ALI) based on network pharmacology and molecular docking. The active components and action targets of Tanreqing Injection were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP), PubChem, and SwissTargetPrediction databases, as well as available literature reports. The ALI-related targets were obtained from the GeneCards database and then mapped with Tanreqing Injection targets. Following the construction of "drug-component-potential target" network with Cytoscape 3.6.1, the potential targets were input into STRING to yield the protein-protein interaction(PPI) network, which was plotted using Cytoscape 3.6.1. Then the screened key targets were subjected to gene ontology(GO) and Kyoto encyclopedia of genes and genomes(KEGG) enrichment analysis based on DAVID database. The top three key targets RAC-alpha serine/threonine-protein kinase(AKT1), albumin(ALB) and interleukin-6(IL6) were docked to the top three key compounds by PyMOL and AutoDock vina. A total of 58 active components of Tanreqing Injection, 597 corresponding targets and 503 common targets shared by Tanreqing Injection and ALI were fi-gured out, with the key targets AKT1, ALB and IL6 involved. GO and KEGG enrichment analysis yielded 1 445 biological processes and 148 signaling pathways, respectively. Molecular docking verified a good binding ability of the top three key targets to the top three key compounds. The analysis based on network pharmacology and molecular docking uncovered that Tanreqing Injection directly or indirectly regulated the pulmonary capillary endothelial cells and alveolar epithelial cells via anti-inflammation, thus alleviating ALI.

Pharmacokinetic comparison between Tanreqing Capsules Substitute and Tanreqing Capsules in rats by LC-MS/MS / 中国中药杂志

Due to the limited resource of bear bile powder, the major raw material of Tanreqing Capsules(TRQ), cultured bear bile powder is used as a replacement to develop the Tanreqing Capsules Substitute(TRQS). An LC-MS/MS method was established in this study for simultaneous quantitation of 8 compounds from TRQS in rat plasma: tauroursodeoxycholic acid(TUDCA), taurocheno-deoxycholic acid(TCDCA), ursodeoxycholic acid(UDCA), chenodeoxycholic acid(CDCA), ferulic acid, wogonoside, baicalin, and forsythoside A. Thereby, the pharmacokinetic behaviors of TRQ and TRQS were evaluated. Concentration of endogenous compounds TUDCA, TCDCA, UDCA, and CDCA was determined with the stable isotope surrogate analytes: D4-TUDCA, D4-TCDCA, D4-UDCA, and D4-CDCA. Plasma samples were extracted by acetonitrile-induced protein precipitation. The LC conditions are as follows: Waters BEH C_(18) column(2.1 mm×100 mm, 1.7 μm), mobile phase of 10 mmol·L~(-1) ammonium formate aqueous solution(containing 0.01% formic acid) and acetonitrile-methanol mixture(1∶5). MS conditions are as below: multiple reaction monitoring(MRM), ESI~(+/-). Concentration of UDCA, CDCA, TUDCA, and TCDCA was corrected with a response factor, which is the ratio between the responses recorded for the surrogate and the authentic analyte at the equal concentration. Each of the plasma components showed good linearity(r > 0.995 1). Accuracy and precision met the criteria(inter-day RSD<7.0%, RE 89.98%-112.0%; intra-day RSD<12%, RE 90.41%-111.2%). The recovery was 64.83%-119.9% and matrix effect was 87.15%-113.8%. The validated method was applied for pharmacokinetic study of TRQS and TRQ(po, 0.94 g·kg~(-1)). There was no significant difference in C_(max) and AUC_(0-24 h) of baicalin, UDCA, TUDCA, and TCDCA between the two groups, indicating similar pharmacokinetic behaviors between TRQS and TRQ in rats.

Meta-analysis of Tanreqing Injection in adjuvant treatment of stroke-associated pneumonia / 中国中药杂志

To systematically evaluate the efficiency and safety of Tanreqing Injection in the treatment of stroke-associated pneumonia(SAP). Seven domestic and foreign databases(CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, EMbase) were retrieved from the establishment to July 2020. According to the inclusion and exclusion criteria, randomized controlled trial of the effect of Tanreqing Injection in the treatment of SAP was selected. NoteExpress software was used to screen out literatures. RevMan 5.4 software was used for data analysis. GRADE system was used to evaluate the evidence quality of the outcome indicators. A total of 1 755 cases in 21 studies were retrieved, including 879 cases in experimental group and 876 cases in control group. In general, the quality of stu-dies received was not high. According to Meta-analysis,(1) in terms of shortening the length of hospital stay, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD=-4.04, 95%CI[-4.43,-3.65], P<0.000 01);(2) in terms of increasing effective rate, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(RR=1.22, 95%CI[1.17, 1.27], P<0.000 01);(3) in terms of reducing inflammation indicators, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD_(CRP)=-10.75, 95%CI[-15.61,-5.88], P<0.000 01; MD_(WBC count)=-1.62, 95%CI[-2.55,-0.69], P=0.000 6; MD_(PCT)=-0.58, 95%CI[-0.89,-0.26], P=0.000 3];(4) in terms of improving symptoms and signs, Tanreqing Injection combined with conventional wes-tern medicine was better than conventional western medicine(MD_(cough)=-2.73, 95%CI[-4.93,-0.53], P=0.02; MD_(antipyretic)=-1.07, 95%CI[-1.17,-0.98), P<0.000 01];(5) in terms of decreasing the NIHSS scores, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD=-3.02, 95%CI[-4.91,-1.13], P=0.002);(6) in terms of adverse reactions, there was no statistically significant difference between Tanreqing Injection combined with conventio-nal western medicine compared with conventional western medicine treatment(RR=1.19, 95%CI[0.61,2.29], P=0.61). GRADE system showed that the evidence levels of above outcome indicators were low and extremely low. The results proved that Tanreqing Injection combined with conventional western medicine had a good advantage in the treatment of SAP, with better observation indicators better than western medicine conventional treatment, and no increase in the incidence of adverse reactions. However, this study had certain limitations. The overall quality of the included studies was low, which affected the reliability of the results. Therefore, the conclusions of this study shall be used cautiously.

Tanreqing Injection () for Patients with Influenza: A Systematic Review and Meta-analysis of Randomized Controlled Trials / 中国结合医学杂志

OBJECTIVE@#To systematically evaluate the efficacy and safety of Tanreqing Injection (, TRQI) combined with conventional treatment on clinical outcomes in the treatment of patients with influenza.@*METHODS@#The electronic databases searched were Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (PubMed), EMbase (OvidSP), Chinese Bio-medical Literature and Retrieval System (Sinomed), China National Knowledge Infrastructure Database (CNKI), China Science and Technology Journal Database (VIP) and WanFang Data Knowledge Service Platform, and we checked the reference sections of the retrieved articles as well. The search was performed in October 2018, and we used the randomized controlled trials (RCTs) that corresponded to the new diagnostic criteria for influenza. Two review authors independently screened the internalized articles in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement checklist. We evaluated the quality of the articles and extracted the data from the studies using the Revmen5.3 software.@*RESULTS@#We included 12 RCTs of over 882 cases in this meta-analysis. Compared to conventional treatment, TRQI combined with conventional treatment could increase the total effective rate [9 RCTs, n=648, odds ratio (OR): 4.92, 95% confidence interval (CI): 2.94, 8.24, P<0.0001, random effects model], decrease the average time for fever clearance [7 RCTs, n=564, mean difference (MD): -1.08, 95% CI: -1.68, -0.48, P=0.0004, random effects model] and decrease the time for resolution of cough (5 RCTs, n=362, MD: -1.76, 95% CI: -2.63, -0.90, P<0.0001, random effects model).@*CONCLUSION@#Based on this meta-analysis of RCTs, TRQI combined with conventional treatment had a statistically significant benefit in increasing the total effective treatment rate and reducing the time for fever clearance as well as time for resolution of cough.

Effect of Tanreqing Injection and Antibiotics on Multi-drug Resistant Pseudomonas aeruginosa Efflux Pump / 中国实验方剂学杂志

Objective:To study the interaction between Tanreqing injection and commonly used antibiotics against multi-drug resistant Pseudomonas aeruginosa (MDR-PA) and the effect on bacterial efflux pump. Method:Antibiotic susceptibility test was performed with bacteria. Paper diffusion method (Kirby-Bauer, KB) combined with efflux pump inhibitor (50 mg·L-1) was used to measure the diameter of the inhibition zone, and real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) was used to detect gene expression of efflux pump Positive efflux pump strain. KB method was used to observe the changes of Tanreqing (final concentration 3 g·L-1) and antibiotics on the diameter of the zone of inhibition. Strains were co-cultured with Tanreqing and antibiotic sub-inhibitory concentrations for Real-time PCR detection. KB method was used to observe the effect of Tanreqing on the diameter of bacteriostatic ring after the continuous use of efflux pump-positive bacteria. Result:Two MDR-PA efflux pump-positive strains were identified and screened. Tanreqing has synergistic antibacterial effect with aloxicillin, aztreonam, meropenem, ceftazidime, cefoperazone, and Shupushen. In inhibiting the expression levels of bacterial efflux pump genes, the four drugs were compared by the effect: cefoperazone>Tanreqing>ceftazidime>Shupushen. After Tanreqing continued to act on efflux pump-positive strains, it could have a better effect in combination with ceftazidime, cefoperazone, and Shupushen. Conclusion:Tanreqing, ceftazidime, cefoperazone, and Shupushen can reduce the drug resistance of bacteria by down-regulating the expressions of bacterial efflux pump genes, and reducing the clinical dose of antibiotics, and thus play a bacteriostatic effect.

Research progress on chemical constituents, pharmacological effects and clinical application of Tanreqing Injection / 中草药

Tanreqing Injection has the functions of clearing heat, resolving phlegm and detoxifying. It mainly contains amino acids, iridoids, flavonoids, phenylethanoid glycosides, steroids and other chemical components. Studies show that Tanreqing Injection has many pharmacological activities such as anti-inflammation, anti-bacteria, anti-virus, inhibition of liver injury and etc. Numerous domestic and foreign research efforts have been focused on the study of Tanreqing Injection. This paper comprehensively reviewed the recent progress in research on chemical constituents, pharmacological actions and clinical application of Tanreqing Injection, so as to provide some reference for its further study.

Functional prediction of Tanreqing Injection in brain diseases / 中国中药杂志

The study explores the application of Tanreqing Injection into brain components in brain diseases. The components of Tanreqing Injection and its existing components in rat cerebrospinal fluid were qualitatively analyzed by liquid chromatography-mass spectrometry(LC-MS). The possible mechanism of action of Tanreqing Injection into brain on brain diseases was predicted by network pharmacological theory. In this study, 17 brain-entry components of Tanreqing Injection were founded, and 222 core targets were obtained from network pharmacological results. The biological processes include 31 items such as negative regulation of apoptotic process, MAPK cascade, Ras protein signal transduction, and 22 items such as PI3 K-Akt signal transduction, MAPK signal transduction and neurotrophic factor signal transduction. Nine brain diseases including stroke, migraine and meningioma were screened out by predicting the effect of Tanreqing Injection on brain components, which provide ideas and directions for further study of a certain encephalopathy and lay a theoretical foundation for further revealing its molecular mechanism.

Atomization Characteristics of Baicalin， Ursodeoxycholic Acid and Caffeic Acid in Tanreqing Inhalation Solution / 中国实验方剂学杂志

Objective:To investigate the effect of different angles of atomizer on the delivery rates and total delivery quantities of Tanreqing inhalation solution， so as to provide reference for the clinical use of this preparation. Method:Taking baicalin， ursodeoxycholic acid， caffeic acid as indexes， PARI Boy SX compression atomization inhaler （equipped with red core atomizing cup） and BRS2000 respiratory simulator were used， the effects of different angles of the atomizer （upper 15 degree， lower 15 degree， upper 30 degree， lower 30 degree， partial 15 degree， partial 30 degree， vertical） on the delivery rates and total delivery quantities of Tanreqing inhalation solution were investigated. The respiratory patterns of adults， children， infants and young children were selected to determine the delivery rates and total delivery quantities of three components in Tanreqing inhalation solution. Result:In the same atomization time， the delivery rates and the total delivery quantities of caffeic acid and ursodeoxycholic acid in Tanreqing inhalation solution were not significantly affected by the atomizer from different angles， but significantly affected baicalin. At the vertical angle， the delivery rate and total delivery quantity of baicalin were higher than the other angles. Under different respiratory modes， there were significant differences in the delivery rates and total delivery quantities of these three components in the inhalation solution. Compared with other respiratory modes， the delivery rates and total delivery quantities of baicalin， ursodeoxycholic acid and caffeic acid were the highest in the adult respiratory mode， with delivery rates of （555.5±16.61）， （226.3±6.54）， （26.1±0.32） μg·min-1 and total delivery quantities of （4 001.1±82.97）， （1 754.9±63.73）， （167.6±1.42） μg， respectively. Conclusion:The use angle of atomizer has a certain effect on the delivery rate and total delivery quantity of Tanreqing inhalation solution， so it is suggested that the vertical angle should be kept as far as possible in clinical use. Under the four respiratory patterns， the delivery rate and total delivery quantity of Tanreqing inhalation solution are different， suggesting that the atomization dose or atomization time should be adjusted according to the respiratory characteristics of the patients to ensure the safety and effectiveness of clinical medication.

Pharmacodynamic Evaluation of Tanreqing Inhalation Solution / 中国实验方剂学杂志

Objective: To clarify the antitussive, expectorant, antipyretic and anti-inflammatory effects of Tanreqing inhalation solution, and provide basis and data support for further research and development of this preparation. Method: The methods of cough induced by ammonia and tracheal phenol red excretion were used to observe the antitussive and expectorant effects of Tanreqing inhalation solution in mice. The fever model of rats was established by intraperitoneal injection of bacterial lipopolysaccharide(LPS) to observe the antipyretic effect of the Tanreqing inhalation solution, the acute pneumonia model of rats was established by atomizing LPS inhalation, and the anti-inflammatory effect of Tanreqing inhalation solution was observed. Result: Tanreqing inhalation solution could reduce the number of coughs in mice induced by ammonia water, increase the amount of phenol red excretion in mouse trachea, decrease the levels of body temperature and its related regulatory factors of prostaglandin E2(PGE2) and cyclic adenosine monophosphate(cAMP) of rats induced by LPS, decrease the white blood cell(WBC) count and the neutrophil ratio(NEUT) in bronchoalveolar lavage fluid(BALF) of rats with LPS-induced acute pneumonia, and reduce the levels of nuclear transcription factor-κB(NF-κB) and interleukin-1β(IL-1β) in lung tissue. Conclusion: Tanreqing inhalation solution has obvious antitussive, expectorant, antipyretic and anti-inflammatory effects, which is worthy of further development and promotion.

Effect of Tanreqing Injection Combined with Imipenem-cilastatin in Inhibiting Extensively-drug Resistant Pseudomonas aeruginosa / 中国实验方剂学杂志

Objective:To observe the effect of combination of Tanreqing injection(Tanreqing) and imipenem-cilastatin on extensively-drug resistant Pseudomonas aeruginosa (XDPA), and study the mechanism of the combination. Method:The minimum inhibitory concentrations (MICs) of Tanreqing and imipenem-cilastatin against planktonic XDPA strain isolated in clinic were determined by the broth microdilution method. The checkerboard method was used to evaluate the combination effect. The bacterial metabolic activity in mature biofilm was studied by microtiter-plate test. The destructive effect of combination drugs on dynamic biofilm was observed by using BioFlux system, and viable cells were examined by confocal laser scanning microscope (CLSM) after treatment. The scanning electron microscopy (SEM) was used for observing Pseudomonas aeruginosa and length measurement. Result:The MIC values of imipenem-cilastatin and Tanreqing were 512 mg·L-1 and more than 16 500 mg·L-1. The checkerboard analysis showed that Tanreqing could enhance the sensitivity of imipenem-cilastatin, while the combination drugs synergistically inhibited the growth of bacteria. Compared with the control group or the imipenem-cilastatin individual group, the combined drugs significantly reduced the amount of living bacteria in the biofilm (PPPConclusion:Tanreqing and imipenem-cilastatin synergistically inhibit the bacterial growth in planktonic and biofilm states, and destruct biofilms.

Literature Analysis of ADE Induced by Tanreqing Injection / 中国药房

OBJECTIVE： To analyze the regularity and characteristics of ADE induced by Tanreqing injection， and to lay the foundation for ADE mechanism study. METHODS： Using “Tanreqing injection” and “ADE” as keywords， the literatures about ADE induced by Tanreqing injection were retrieved from CJFD， VIP， CBM and Wanfang database during Jan. 1st， 2014 to Oct. 30th， 2018. Patient’s gender， age， drug allergy history， primary diseases， drug dosage， solvent， organs or systems involved， main clinical manifestation of ADE， occurrence time， drug combination were all analyzed statistically. RESULTS： A total of 126 literatures were included， involving 1 577 patients. There were 906 male （57.45％） and 671 female （42.55％）； the age ranged from 6 months to 98 years old， of which 625 cases （39.63％） were aged from 0 to 10 years. Among 1 577 patients， primary diseases of 537 patients were recorded and mainly were bronchitis and pneumonia （323 cases， 60.15％）. Drug dosages of 687 patients were recorded， among which there were 612 cases of normal dose （89.08％）， 75 cases of off-label dose （10.92％）. 779 cases of solvent （mainly containing 5％ Glucose injection or 0.9％ Sodium chloride injection， 715 cases， 91.78％）. 1 960 case times of ADE were recorded， mainly including lesion of skin and its appendents （930 case times， 47.45％）， followed by systemic response （231 case times， 11.79％）， digestive system （221 case times， 11.28％） and cardiovascular system （220 case times， 11.22％）. Occurrence time of ADE was recorded in 1 172 cases， mainly 10-30 min after medication （434 cases）. Detailed drug use was recorded in 1 356 patients， among which there were 521 cases of drug combination， mainly containing antibiotics， followed by TCM injection for clearing away heat and toxic material and antiviral drugs， etc. CONCLUSIONS： Attention should be paid to ADE induced by Tanreqing injection. On the one hand， ADE monitoring should be strengthened to summarize， analyze and evaluate ADE； on the other hand， attention should be paied when patients have above situations， so as to promote rational and effective clinical measures and to ensure drug safety of patients.

Meta-analysis of randomized controlled trials on effect of Tanreqing Injection combined with Western medicine on acute exacerbation of chronic bronchitis / 中国中药杂志

To systematically review the effectiveness and safety of Tanreqing Injection in treating acute exacerbation of chronic bronchitis( AECB). CNKI,Wan Fang,VIP,CBM,Medline,Cochrane Library,EMbase and Web of Science were retrieved,and randomized controlled trials for the effect of Tanreqing Injection in the treatment of acute exacerbation of chronic bronchitis were screened. The quality of the included studies was evaluated according to the Cochrane Handbook's evaluation criteria. The data was analyzed by RevMan 5.3. Totally 23 RCTs involving 1 901 patients were included,including 952 in the experimental group and 949 in the control group. The Meta-analysis demonstrated that in terms of the disappearance time of fever,the group of Tanreqing Injection combined with the conventional therapy was superior to conventional therapy group( RR =-1. 03,95%CI[-1. 45,-0. 62],P<0. 000 01); compared with the conventional therapy group,the group of Tanreqing Injection combined with conventional therapy had a higher cure rate for AECB( RR = 1. 17,95% CI[1. 13,1. 23],P < 0. 000 01). The group of Tanreqing Injection combined with levofloxacin had a higher cure rate for AECB than the levofloxacin group( RR = 1. 23,95% CI[1. 08,1. 41],P = 0. 002). The group of Tanreqing Injection combined with cefuroxime had a higher cure rate for AECB than the cefuroxime group( RR = 1. 22,95%CI[1. 05,1. 42],P = 0. 01).The group of Tanreqing Injection combined with cefoperazone sodium and sulbactam sodium had a higher cure rate for AECB than the group of cefoperazone sodium and sulbactam sodium( RR = 1. 22,95% CI[1. 04,1. 44],P = 0. 02). The outcomes of disappearance time of cough and expectoration had a huge heterogeneity,so were used for descriptive analysis. The adverse reactions mainly included skin rash,dizziness,gastrointestinal reactions. Based on the available data and the results of the analysis,the group of Tanreqing Injection combined with Western medicine has a higher cure rate for acute exacerbation of chronic bronchitis,and the effect in reducing symptoms disappearance time. In view of the limited number of included studies,small sample size and low methodological quality,the results of this study need to be confirmed with high-level clinical trials.

Clinical research of the Tanreqing injection combined with Danshen-Chuanxiongqin injection for the patients with acute exacerbation of chronic obstructive pulmonary disease / 国际中医中药杂志

Objective To study the clinical effects of the Tanreqing injection combined with Danshen-Chuanxiongqin injection for the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its effects on plasma NO and endothelin-1 (ET-1) levels. Methods A total of 79 patients with AECOPD in our hospital from May 2014 to January 2017 were enrolled in this study. The subjects were randomly divided into the control group (n=39) and the combined therapy group (n=40). The control group were treated with Tanreqing injection, the combined therapy group were treated with Tanreqing injection combined with Danshen-Chuanxiongqin injection.The two groups were treated for 10 days.The clinical effects of the two groups after treatment were compared. The MPAP, PASP, PADP, PaO2, PaCO2, SaO2, NO and ET-1 of the two groups before and after treatment were compared. Results The total efficacy rate of the combined therapy group was 97.5% (39/40), which was significantly higher than 82.1% (32/39) of the control group (x2=5.178,P=0.023).After treatment,the MPAP(25.19 ± 8.71 mmHg vs.35.28 ± 9.52 mmHg,t=4.917),PASP (44.35 ± 12.26 mmHg vs.57.24 ± 11.17 mmHg,t=4.881),PADP(17.16 ± 4.05 mmHg vs.26.40 ± 3.85 mmHg, t=10.38),PaCO2(42.70 ± 6.31 mmHg vs. 51.44 ± 6.83 mmHg, t=5.910)of the combined therapy group were significantly lower than those of the control group(P<0.05).After treatment,the PaO2(73.95 ± 7.82 mmHg vs. 67.21 ± 7.16 mmHg,t=3.993),SaO2(94.86% ± 5.11% vs.83.63% ± 4.27%,t=10.586)of the combined therapy group were significantly higher than those of the control group (P<0.05). After treatment, the plasma NO (55.82 ± 10.08 μmol/L vs.46.34 ± 8.50 μmol/L,t=4.513)of the combined therapy groupwas significantly higher than the control group(P<0.05)and the plasma ET-1(80.41 ± 8.95 ng/L vs.87.68 ± 9.24 ng/L,t=3.552)of the combined therapy groupwere significantly lower than the control group (P<0.05). Conclusions The Tanreqing injection combined with Danshen-Chuanxiongqin injection showed good efficacy for the patients with AECOPD,and the therapy can reduce the pulmonary arterial hypertension and ET-1, improve the lung tissue oxygen supply and NO release, and improve the cardiopulmonary function.