1.Research and application progress on recognition components of surface plasmon resonance sensors in the pharmaceutical field
Xiaofei WANG ; Ying ZHANG ; Jiayu GU ; Xiner HU ; Hai ZHANG ; Yan CAO
Journal of Pharmaceutical Practice and Service 2025;43(5):205-212
Surface plasmon resonance (SPR) sensor is an optical detection technique enables real-time and dynamic monitoring of biological samples. SPR-based biosensors have remarkable characteristics such as label-free detection and high sensitivity, making them important tools for studying molecular interactions. The recognition element, which plays a critical role in SPR sensors,which could specifically identify and capture of target analytes, closely influencing the selectivity performance of the sensor. The progress on SPR sensors in pharmaceutical research were reviewed, which focused on the application of recognition elements such as antibodies, aptamers, molecularly imprinted polymers, and metal nanoparticles.
2.Danggui Shaoyaosan Regulates Nrf2/SLC7A11/GPX4 Signaling Pathway to Inhibit Ferroptosis in Rat Model of Non-alcoholic Fatty Liver Disease
Xinqiao CHU ; Yaning BIAO ; Ying GU ; Meng LI ; Tiantong JIANG ; Yuan DING ; Xiaping TAO ; Shaoli WANG ; Ziheng WEI ; Zhen LIU ; Yixin ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(16):35-42
ObjectiveTo investigate the effect of Danggui Shaoyaosan on ferroptosis in the rat model of non-alcoholic fatty liver disease (NAFLD) and explore the underlying mechanism based on the nuclear factor E2-related factor 2 (Nrf2)/solute carrier family 7 member 11 (SLC7A11)/glutathione peroxidase 4 (GPX4) signaling pathway. MethodsThe sixty SD rats were randomly grouped as follows: control, model, Yishanfu (0.144 g·kg-1), and low-, medium-, and high-dose (2.44, 4.88, and 9.76 g·kg-1, respectively) Danggui Shaoyaosan. A high-fat diet was used to establish the rat model of NAFLD. After 12 weeks of modeling, rats were treated with corresponding agents for 4 weeks. Then, the body weight and liver weight were measured, and the liver index was calculated. At the same time, serum and liver samples were collected. The levels or activities of total cholesterol (TC), triglycerides (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and Fe2+ in the serum and TC, TG, free fatty acids (FFA), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPX), and Fe2+ in the liver were measured. Hematoxylin-eosin staining and oil red O staining were employed to observe the pathological changes in the liver. Immunofluorescence was used to assess the reactive oxygen species (ROS) content in the liver. Mitochondrial morphology was observed by transmission electron microscopy. The protein levels of Nrf2, SLC7A11, GPX4, transferrin receptor 1 (TFR1), and divalent metal transporter 1 (DMT1) in the liver were determined by Western blot. ResultsCompared with the control group, the model group showed increases in the body weight, liver weight, liver index, levels or activities of TC, TG, ALT, AST, and Fe2+ in the serum, levels of TC, TG, FFA, MDA, Fe2+, and ROS in the liver, and protein levels of TFR1 and DMT1 in the liver (P<0.01), and decreases in the activities of SOD, GPX and the protein levels of Nrf2, SLC7A11, and GPX4 in the liver (P<0.05, P<0.01). Meanwhile, the liver tissue in the model group presented steatosis, iron deposition, mitochondrial shrinkage, and blurred or swollen mitochondrial cristae. Compared with the model group, all doses of Danggui Shaoyaosan reduced the body weight, liver weight, liver index, levels or activities of TC, TG, ALT, AST, and Fe2+ in the serum, levels of TC, TG, FFA, MDA, Fe2+, and ROS in the liver, and protein levels of TFR1 and DMT1 in the liver (P<0.01), while increasing the activities of SOD and GPX and the protein levels of Nrf2, SLC7A11, and GPX4 in the liver (P<0.01). Furthermore, Danggui Shaoyaosan alleviated steatosis, iron deposition, and mitochondrial damage in the liver. ConclusionDanggui Shaoyaosan may inhibit lipid peroxidation and ferroptosis by activating the Nrf2/SLC7A11/GPX4 signaling pathway to treat NAFLD.
3.Driving effect of P16 methylation on telomerase reverse transcriptase-mediated immortalization and transformation of normal human fibroblasts.
Xuehong ZHANG ; Paiyun LI ; Ying GAN ; Shengyan XIANG ; Liankun GU ; Jing ZHOU ; Xiaorui ZHOU ; Peihuang WU ; Baozhen ZHANG ; Dajun DENG
Chinese Medical Journal 2025;138(3):332-342
BACKGROUND:
P16 inactivation is frequently accompanied by telomerase reverse transcriptase ( TERT ) amplification in human cancer genomes. P16 inactivation by DNA methylation often occurs automatically during immortalization of normal cells by TERT . However, direct evidence remains to be obtained to support the causal effect of epigenetic changes, such as P16 methylation, on cancer development. This study aimed to provide experimental evidence that P16 methylation directly drives cancer development.
METHODS:
A zinc finger protein-based P16 -specific DNA methyltransferase (P16-Dnmt) vector containing a "Tet-On" switch was used to induce extensive methylation of P16 CpG islands in normal human fibroblast CCD-18Co cells. Battery assays were used to evaluate cell immortalization and transformation throughout their lifespan. Cell subcloning and DNA barcoding were used to track the diversity of cell evolution.
RESULTS:
Leaking P16-Dnmt expression (without doxycycline-induction) could specifically inactivate P16 expression by DNA methylation. P16 methylation only promoted proliferation and prolonged lifespan but did not induce immortalization of CCD-18Co cells. Notably, cell immortalization, loss of contact inhibition, and anchorage-independent growth were always prevalent in P16-Dnmt&TERT cells, indicating cell transformation. In contrast, almost all TERT cells died in the replicative crisis. Only a few TERT cells recovered from the crisis, in which spontaneous P16 inactivation by DNA methylation occurred. Furthermore, the subclone formation capacity of P16-Dnmt&TERT cells was two-fold that of TERT cells. DNA barcoding analysis showed that the diversity of the P16-Dnmt&TERT cell population was much greater than that of the TERT cell population.
CONCLUSION
P16 methylation drives TERT -mediated immortalization and transformation of normal human cells that may contribute to cancer development.
Humans
;
Telomerase/genetics*
;
DNA Methylation/physiology*
;
Fibroblasts/cytology*
;
Cyclin-Dependent Kinase Inhibitor p16/metabolism*
;
Cell Line
;
Cell Transformation, Neoplastic/genetics*
4.Rubioncolin C targets cathepsin D to induce autophagosome accumulation and suppress gastric cancer.
Liang ZHANG ; Jun-Jie CHEN ; Man-Xiang GU ; Yi-Fan ZHONG ; Yuan SI ; Ying LIU
China Journal of Chinese Materia Medica 2025;50(5):1267-1275
This study aimed to explore the molecular mechanism of rubioncolin C(RuC) in inhibiting gastric cancer(GC). AGS and MGC803 cell lines were selected as cellular models. After treating the cells with RuC at different concentrations, the effects of RuC on the proliferation ability of GC cells were assessed using the CCK-8 method, real-time cellular analysis(RTCA), and colony formation assays. Transmission electron microscopy was used to observe subcellular structural changes. Immunofluorescence was applied to detect LC3 fluorescent foci. Acridine orange staining was used to evaluate the state of intracellular lysosomes. Western blot was employed to detect the expression of autophagy-related proteins LC3Ⅱ, P62, and lysosomal cathepsin D(CTSD). The SuperPred online tool was used to predict the target proteins that bound to RuC, and molecular docking analysis was conducted to identify the interaction sites between RuC and CTSD. The drug affinity responsive target stability(DARTS) assay was performed to detect the direct binding interaction between RuC and CTSD. The results showed that RuC significantly inhibited the proliferation and colony formation of GC cells at low concentrations, with 24-hour half-maximal inhibitory concentrations(IC_(50)) of 3.422 and 2.697 μmol·L~(-1) for AGS and MGC803 cells, respectively. After 24 hours of treatment with RuC at concentrations of 1, 2, and 3 μmol·L~(-1), the colony formation rates for AGS cells were 61.0%±1.5%, 28.0%±0.5%, and 18.2%±0.5%, respectively, while the rates for MGC803 cells were 56.0%±0.5%, 23.3%±1.0%, and 11.8%±1.0%, all of which were significantly reduced. Transmission electron microscopy revealed that RuC promoted an increase in autophagosome formation in GC cells. Immunofluorescence detection showed that LC3 fluorescent foci of GC cells increased with the increase in RuC dose. RuC up-regulated the expression of autophagy-related proteins LC3Ⅱ and P62 in GC cells. Acridine orange staining indicated that RuC altered the acidic environment of lysosomes. SuperPred online prediction identified CTSD as a potential target protein of RuC. Western blot analysis revealed that RuC induced the up-regulation of the inactive precursor of CTSD in GC cells. CTSD activity assays indicated that RuC reduced the activity of CTSD. Molecular docking simulations found that RuC bound to the substrate-binding region of CTSD, forming hydrogen bonds with the Tyr205 and Asp231 residues. Microscale thermophoresis and DARTS assays further confirmed that RuC directly bound to CTSD. In summary, RuC inhibits lysosomal activity by targeting and down-regulating the expression of CTSD, thereby inducing autophagosome accumulation in GC cells.
Humans
;
Stomach Neoplasms/enzymology*
;
Cathepsin D/chemistry*
;
Cell Line, Tumor
;
Molecular Docking Simulation
;
Cell Proliferation/drug effects*
;
Autophagosomes/metabolism*
;
Autophagy/drug effects*
5.Mechanism of Cyanotis arachnoidea Gel in improving melasma based on network pharmacology and transcriptomics.
Mamattursun MARZIYA ; Li-Ying QIU ; Wan-Quan BAI ; Amar DLRABA ; Chen MA ; Le ZHANG ; Jian GU
China Journal of Chinese Materia Medica 2025;50(13):3775-3790
Through a comprehensive analysis combining network pharmacology prediction and transcriptomics, this study systematically explained the multi-target mechanism of Cyanotis arachnoidea(CA) Gel in improving melasma. A melasma model was induced in female SD rats by progesterone injection combined with ultraviolet B(UVB) irradiation for 40 consecutive days, while the blank control group was only fed routinely. After successful model establishment, the rats were randomly divided into five groups and administered different doses of CA ethanol extract gel(high, medium, and low doses) or arbutin Gel(positive control), which were applied once daily for 28 consecutive days. Subsequently, the levels of superoxide dismutase(SOD), malondialdehyde(MDA), and tyrosinase(TYR) in the skin, serum, and liver tissues were measured. Hematoxylin-eosin(HE) staining and Masson-Fontana staining were used to observe the pathological changes in the tissues. Network pharmacology combined with transcriptomics was employed to identify core targets and pathways, and the differential gene expression was validated by quantitative real-time PCR(qPCR). Pharmacodynamic experiments showed that CA Gel significantly increased SOD activity and decreased MDA and TYR levels in the skin, serum, and liver of model rats. It also improved epidermal thickening, inflammatory infiltration, collagen loss, and melanin deposition. Network pharmacology analysis showed that CA mainly regulated core targets such as signal transducer and activator of transcription 3(STAT3), epidermal growth factor receptor(EGFR), and interleukin-6(IL-6), and modulated the phosphatidylinositol 3-kinase(PI3K)-protein kinase B(AKT) and interleukin-17(IL-17) signaling pathways. Transcriptomic analysis showed that CA Gel significantly downregulated the gene expression of heat shock protein 90β family member 1(Hsp90b1), heat shock protein 90α family member 1(Hsp90aa1), and the key steroid synthesis enzyme cytochrome P450 family 17 subfamily A member 1(Cyp17a1), while upregulating thioredoxin 1(Txn1). qPCR results confirmed that CA Gel regulated oxidative stress and inflammatory response by inhibiting the IL-17 signaling pathway and steroid hormone synthesis. This study, for the first time, reveals the molecular mechanism of CA Gel in improving melasma through multi-target synergistic regulation of oxidative stress, inflammatory response, and hormone metabolism pathways, providing a scientific basis for the treatment of pigmentation diseases with traditional Chinese medicine.
Animals
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Rats
;
Female
;
Rats, Sprague-Dawley
;
Network Pharmacology
;
Drugs, Chinese Herbal/administration & dosage*
;
Melanosis/metabolism*
;
Transcriptome/drug effects*
;
Humans
;
Superoxide Dismutase/genetics*
;
Signal Transduction/drug effects*
;
Malondialdehyde/metabolism*
6.Association relation of C0-C2 Cobb angle and cervical disc herniation.
Zhuo-Heng MAI ; Yuan-Li GU ; Hai-Ling WANG ; Li-Ying ZHANG ; Sheng-Qiang ZHANG
China Journal of Orthopaedics and Traumatology 2025;38(5):494-499
OBJECTIVE:
Objective To investigate the relationship between cervical disc herniation and C0-C2 Cobb angle.
METHODS:
The clinical data of 301 patients with cervical disc herniation from 2020 to 2024 were retrospectively analyzed. The median value of C0-C2 Cobb angle measurements from 301 patients was used as the boundary, cervical disc herniation patients were divided into two groups, C0-C2 Cobb angle <28.50 group and 151 patients with C0-C2 Cobb angle≥28.50 group. Among them, 150 patients in C0-C2 Cobb angle <28.50 group included 53 males and 97 females, aged 23 to 76 (57.32±12.55) years, with a disease duration of 7 to 19 (13.81±5.32) months;the othor 151 patients with C0-C2 Cobb angle≥28.50 group including 61 males and 90 females, aged 25 to 74 (56.86±12.51) years, with a disease duration of 8 to 18 (14.13±5.56) months. The cervical lordosis angle (C0-C2 Cobb angle and C2-C7 Cobb angle), T1 inclination slope (T1S) and cervical sagittal axial distance (C2-C7 SVA) were measured on the lateral cervical radiographs. The correlation between C0-C2 Cobb angle and cervical disc herniation range, protrusion position, average protrusion size and other parameters was analyzed.
RESULTS:
When the C0-C2 Cobb angle<28.50°, the average protrusion size was (2.21±0.56) mm, the C2-C7 Cobb angle was (19.92±12.06)° and the C2-C7 SVA was (1.10±1.20) mm. When the C0-C2 Cobb angle≥28.50°, the average protrusion size was (2.38±0.60) mm, the C2-C7 Cobb angle was (12.01±13.09 )°, the C2-C7 SVA was (1.53±1.36) mm, and the difference was statistically significant (P<0.05). Between the two groups of patients with C0-C2 Cobb angle < 28.50° and C0-C2 Cobb angle≥28.50°, there were significant differences in the size of C3,4, C4,5, C5,6, C6,7, C7, T1 disc herniation in single segment (P<0.05 ). C0-C2 Cobb angle was correlated with age(r=-0.135, P<0.05 ), C2-C7 Cobb angle (r=-0.382, P<0.01 ), C2-C7 SVA (r=0.293, P<0.01), average protrusion size (r=0.139, P<0.05), and the size of C3,4 (r=0.215, P<0.01 ), C4,5 (r=0.176, P<0.01 ), C5,6 (r=0.144, P<0.05 ), C6,7 (r=0.158, P<0.05 ), C7T1 (r=0.535, P<0.05) disc herniation.
CONCLUSION
There is a positive correlation between C0-C2 Cobb angle and the size of cervical disc herniation. C0-C2 Cobb angle can reflect the degree of cervical disc herniation. Previous studies have shown that the biomechanical changes between C0-C2 Cobb angle, C2-C7 Cobb angle, C2-C7 SVA and cervical extensor muscle group may be risk factors for accelerating cervical disc herniation and this may be one of the mechanisms that C0-C2 Cobb angle is positively correlated with the size of cervical disc herniation.
Humans
;
Male
;
Female
;
Middle Aged
;
Intervertebral Disc Displacement/physiopathology*
;
Adult
;
Cervical Vertebrae/diagnostic imaging*
;
Aged
;
Retrospective Studies
;
Young Adult
7.Clinical characteristics and outcomes of 11 neonates with venous thrombosis.
Xi-Ge GU ; Li-Ying DAI ; Xiao-Qing SHI ; Wen-Chao ZHANG ; Yong-Li ZHANG
Chinese Journal of Contemporary Pediatrics 2025;27(5):588-594
OBJECTIVES:
To summarize the clinical characteristics, diagnosis, and treatment outcomes of neonatal venous thrombosis.
METHODS:
A retrospective analysis was conducted on the clinical data of 11 neonates with venous thrombosis admitted to the Department of Neonatology of Anhui Children's Hospital from January 2019 to September 2024. The clinical characteristics, diagnostic approaches, treatments, and outcomes were analyzed.
RESULTS:
Among the 11 neonates diagnosed with venous thrombosis, 5 were male, and 6 were preterm infants, with a median gestational age of 35+6 weeks, birth weight of (2 322±1 069) g, and admission temperature of (36.6±0.4)°C. The median age at symptom onset was 6 days. Of the 11 cases, 8 limb venous thromboses and 1 portal vein thrombosis were confirmed by vascular ultrasound, and 2 cases of intracranial venous sinus thrombosis were confirmed by magnetic resonance imaging. Ten cases received low molecular weight heparin for anticoagulation, with a treatment duration of (24±15) days; 2 cases were treated with urokinase thrombolysis, and 4 cases received fresh frozen plasma transfusion. Thrombosis resolved in 7 cases before discharge. Partial resolution occurred in 2 cases before discharge (1 continued outpatient treatment until resolution and 1 resolved during follow-up). One case was transferred to another hospital after 1 day of treatment and was discharged after thrombosis reduction. No adverse reactions such as bleeding were observed. One neonate with cerebral infarction at admission did not receive heparin anticoagulation and was followed up as an outpatient.
CONCLUSIONS
Vascular ultrasound is the most commonly used diagnostic method for neonatal venous thrombosis. Heparin anticoagulation is the recommended treatment. The overall prognosis of neonatal venous thrombosis is favorable.
Humans
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Male
;
Venous Thrombosis/drug therapy*
;
Infant, Newborn
;
Female
;
Retrospective Studies
8.Effects of Prognostic Nutritional Index and Systemic Inflammatory Response Index on Short-Term Efficacy and Prognosis in Patients with Peripheral T-Cell Lymphoma.
Zi-Qing HUANG ; Yan-Hui LI ; Bin LYU ; Xue-Jiao GU ; Ming-Xi TIAN ; Xin-Yi LI ; Yan ZHANG ; Xiao-Qian LI ; Ying WANG ; Feng ZHU
Journal of Experimental Hematology 2025;33(5):1350-1357
OBJECTIVE:
To investigate the predictive value of the prognostic nutritional index (PNI) and systemic inflammatory response index (SIRI) for short-term efficacy and prognosis in newly treated patients with peripheral T-cell lymphoma (PTCL).
METHODS:
The general data, laboratory indicators, disease stage and other clinical data of 91 newly treated PTCL patients admitted to the Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2023 were retrospectively analyzed. The optimal cutoff values for PNI and SIRI were determined using receiver operating characteristic (ROC) curves, and the patients were stratified into groups based on these cutoffs to compare clinical features and short-term efficacy between the different groups. Kaplan-Meier method was used to plot survival curves, and univariate and multivariate analyses were performed to identify the factors affecting overall survival (OS).
RESULTS:
The optimal cutoff values for PNI and SIRI were 45.30 and 1.74×109/L, respectively. Patients in different PNI groups showed statistically significant differences in age, Ann Arbor stage, lactate dehydrogenase (LDH) level, international prognostic index (IPI), prognostic index for PTCL-not otherwise specified (PIT), pathological subtypes, and complete response (CR) rate (P < 0.05). PTCL patients in different SIRI groups exhibited significant differences in Ann Arbor stage, LDH level, IPI score, PIT score, and CR rate (P < 0.05). Logistic regression analysis showed that age ≥60 years old (OR =2.750), Ann Arbor stage Ⅲ-Ⅳ (OR =5.200), IPI score ≥2 (OR =7.650), low PNI (OR =3.296), and high SIRI (OR =3.130) were independent risk factors affecting treatment efficacy in PTCL patients (P < 0.05). Cox proportional hazards regression model analysis showed that low PNI and elevated β2-microglobulin (β2-MG) levels were independent risk factors affecting OS (P < 0.05).
CONCLUSION
PNI and SIRI have certain application value in evaluating short-term efficacy and prognosis in patients with PTCL. Compared with SIRI, PNI demonstrates greater predictive value for patient prognosis.
Humans
;
Prognosis
;
Lymphoma, T-Cell, Peripheral/therapy*
;
Retrospective Studies
;
Nutrition Assessment
;
Male
;
Female
;
Middle Aged
;
ROC Curve
;
Inflammation
9.Effect of Hesperidin on Chronic Unpredictable Mild Stress-Related Depression in Rats through Gut-Brain Axis Pathway.
Hui-Qing LIANG ; Shao-Dong CHEN ; Yu-Jie WANG ; Xiao-Ting ZHENG ; Yao-Yu LIU ; Zhen-Ying GUO ; Chun-Fang ZHANG ; Hong-Li ZHUANG ; Si-Jie CHENG ; Xiao-Hong GU
Chinese journal of integrative medicine 2025;31(10):908-917
OBJECTIVES:
To determine the pharmacological impact of hesperidin, the main component of Citri Reticulatae Pericarpium, on depressive behavior and elucidate the mechanism by which hesperidin treats depression, focusing on the gut-brain axis.
METHODS:
Fifty-four Sprague Dawley male rats were randomly allocated to 6 groups using a random number table, including control, model, hesperidin, probiotics, fluoxetine, and Citri Reticulatae Pericarpium groups. Except for the control group, rats in the remaining 5 groups were challenged with chronic unpredictable mild stress (CUMS) for 21 days and housed in single cages. The sucrose preference test (SPT), immobility time in the forced swim test (FST), and number in the open field test (OFT) were performed to measure the behavioral changes in the rats. Enzyme-linked immunosorbent assay was used to determine the levels of 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) in brain tissue, and the histopathology was performed to evaluate the changes of colon tissue, together with sequencing of the V3-V4 regions of 16S rRNA gene on feces to explore the changes of intestinal flora in the rats.
RESULTS:
Compared to the control group, the rats in the model group showed notable reductions in body weight, SPF, and number in OFT (P<0.01). Hesperidin was found to ameliorate depression induced by CUMS, as seen by improvements in body weight, SPT, immobility time in FST, and number in OFT (P<0.05 or P<0.01). Regarding neurotransmitters, it was found that at a dose of 50 mg/kg hesperidin treatment upregulated the levels of 5-HT and BDNF in depressed rats (P<0.05). Compared to the control group, the colon tissue of the model group exhibited greater inflammatory cell infiltration, with markedly reduced numbers of goblet cells and crypts and were significantly improved following treatment with hesperidin. Simultaneously, the administration of hesperidin demonstrated a positive impact on the gut microbiome of rats treated with CUMS, such as Shannon index increased and Simpson index decreased (P<0.01), while the abundance of Pseudomonadota and Bacteroidota increased in the hesperidin-treated group (P<0.05).
CONCLUSION
The mechanism responsible for the beneficial effects of hesperidin on depressive behavior in rats may be related to inhibition of the expressions of BDNF and 5-HT and preservation of the gut microbiota.
Animals
;
Hesperidin/therapeutic use*
;
Rats, Sprague-Dawley
;
Depression/drug therapy*
;
Male
;
Stress, Psychological/drug therapy*
;
Brain/metabolism*
;
Brain-Derived Neurotrophic Factor/metabolism*
;
Serotonin/metabolism*
;
Gastrointestinal Microbiome/drug effects*
;
Behavior, Animal/drug effects*
;
Rats
;
Brain-Gut Axis/drug effects*
;
Chronic Disease
;
Colon/drug effects*
10.Meta-analysis of hydrocortisone in the treatment of severe community-acquired pneumonia.
Xue GU ; Penglei YANG ; Lina YU ; Jun YUAN ; Zhou YUAN ; Xiaoli ZHANG ; Lianxin CHEN ; Ying ZHANG ; Jikuan HU ; Yu HUANG ; Qihong CHEN
Chinese Critical Care Medicine 2025;37(6):542-548
OBJECTIVE:
To explore whether hydrocortisone can improve the prognosis of patients with severe community-acquired pneumonia (sCAP) by Meta-analysis.
METHODS:
Randomized controlled trial (RCT) on hydrocortisone in the treatment of sCAP were extracted from the database including PubMed, Cochrane library, Web of Science, and Embase, and the search time was up to April 29, 2023. The patients in the standard treatment group received standard treatment such as antibiotics and supportive care, while those in the hydrocortisone group received hydrocortisone treatment on the basis of standard treatment. Meta-analysis was used to compare the mortality, duration of mechanical ventilation, mechanical ventilation rate and incidence of adverse reactions (hyperglycemia, gastrointestinal bleeding, secondary infection) between the two groups. The risk of literature bias was assessed. The studies that might have publication bias were corrected by the subtraction and complementation method. At the same time, trial sequential analysis (TSA) was conducted.
RESULTS:
A total of 5 RCTs involving 1 031 patients were finally enrolled, including 494 patients in the standard treatment group and 537 patients in the hydrocortisone group. Among the 5 studies, the research site of 2 studies was in the mixed ward. Considering the inclusion characteristics of the study population, there was doubt whether its research object was sCAP patients, which might have a certain impact on the results and introduce potential bias. Meta-analysis showed that the mortality in the hydrocortisone group was significantly lower than that in the standard treatment group [6.0% vs. 14.0%; odds ratio (OR) = 0.38, 95% confidence interval (95%CI) was 0.25-0.59, P < 0.01; I2 = 9%]. The studies that were asymmetric were corrected by the reduction and supplementation method. Even after filling the missing studies, hydrocortisone could still reduce the death risk of the patient (OR = 0.49, 95%CI was 0.32-0.73, P < 0.01; I2 = 31%). TSA showed that the average mortality of the standard treatment group was about 14.0%, and that of the hydrocortisone group was about 6.0%, with a relative risk reduction (RRR) = 57%. The calculated sample size was 699 cases, and the actual sample size was 1 031 cases. The actual sample size exceeded the required sample size, and the Z-curve crossed the O'Brien-Fleming boundary and the curve corresponding to P = 0.05, it meant that hydrocortisone could effectively reduce the mortality of sCAP. Compared with the standard treatment group, no statistical difference in the duration of mechanical ventilation was found in the hydrocortisone group [mean difference (MD) = -3.26, 95%CI was -6.72-0.21, P = 0.07; I2 = 0%], but the 8-day mechanical ventilation rate was significantly lowered (19.5% vs. 55.4%; OR = 0.24, 95%CI was 0.12-0.45, P < 0.01; I2 = 0%), and also no significantly difference was found in the incidence of hyperglycemia (54.3% vs. 44.6%, OR = 1.26, 95%CI was 0.56-2.84, P = 0.58; I2 = 61%), gastrointestinal bleeding (2.5% vs. 3.6%; OR = 0.70, 95%CI was 0.34-1.46, P = 0.34; I2 = 0%) and secondary infection (9.2% vs. 11.5%; OR = 0.46, 95%CI was 0.06-3.35, P = 0.45; I2 = 53%).
CONCLUSION
Hydrocortisone can reduce the mortality rate of sCAP patients, decrease their need for mechanical ventilation, and does not increase the risk of hyperglycemia, gastrointestinal bleeding, or secondary infections.
Humans
;
Hydrocortisone/therapeutic use*
;
Community-Acquired Infections/drug therapy*
;
Pneumonia/drug therapy*
;
Randomized Controlled Trials as Topic
;
Respiration, Artificial
;
Community-Acquired Pneumonia

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