[A prospective randomized control clinical study of the effect of Xuebijing injection on prognosis of acute respiratory distress syndrome patients].
OBJECTIVE
To study the effect of Xuebijing injection on prognosis, immune function, adrenal function and inflammatory reaction during the treatment of acute respiratory distress syndrome (ARDS).


METHODS
From January 2008 through December 2008, a clinical study was conducted on consecutive adult patients with ARDS in intensive care unit (ICU). The patients were divided into Xuebijing group (31 patients) and control group (30 patients). Both groups were treated with the routine therapy of ARDS, and in addition, Xuebijing injection was used in a dose of 100 ml twice a day for 7 days in Xuebijing group. Duration of mechanical ventilation (MV) and ICU length of stay, 28-day mortality, acute physiology and chronic health evaluation II (APACHE II), Murray and Marshall scores were recorded in both groups. Every patient was given one injection of corticotrophin 250 microg intravenously before and after treatment, and plasma cortisol level was detected by radio-immunoassay before the injection (T0) and 30 minutes (T30) and 60 minutes (T60) after the injection. The ratio of adrenal insufficiency was evaluated according to diagnostic criteria of relative adrenal insufficiency, which was defined as the difference between T0 and the highest value of T30 or T60 (Delta Tmax)< or =248.4 nmol/L. Human leukocyte antigen-DR (HLA-DR), subpopulations of T lymphocyte (CD4(+)/CD8(+)), interleukin-6 (IL-6), IL-10 in peripheral blood was also determined.


RESULTS
Murray (1.5+/-1.5) and Marshall score (2.9+/-2.7) and the level of IL-6 [(3.4+/-1.9) micromol/L], IL-10 [(1.5+/-0.8) micromol/L] in the Xuebijing group were decreased significantly after the use of Xuebijing compared with control group [4.3+/-3.1, 6.3+/-4.1, (8.9+/-10.2) micromol/L, (4.2+/-4.8) micromol/L, respectively, all P<0.01], while the values of HLA-DR (41.1+/-10.1), CD4(+) (58.0+/-10.7), CD4(+)/CD8(+) (1.9+/-0.3) were increased compared with control group [30.6+/-15.0, 50.5+/-16.2, 1.4+/-0.7, respectively, P<0.05 or P<0.01]. The ratio of adrenal insufficiency in Xuebijing group (45.2%) was lower than that of control group (83.3%), while that of Delta Tmax [(328.4+/-278.3) micromol/L] was higher than that of control group [(172.8+/-110.8) micromol/L, both P<0.01]. MV duration [(4.0+/-3.3) days] and ICU length of stay [(8.4+/-4.2) days] were less than those of control group [(5.9+/-3.8) days, (12.0+/-7.6) days, both P<0.05], and 28-day mortality in Xuebijing group was 35.5%, which was 11.2% less than that of control group (46.7%), but there was no statistically significant difference between two groups (P>0.05).


CONCLUSIONS
Xuebijing injection improves organ function, decreases MV duration and ICU length of stay in ARDS patients. The underlying mechanism may involve modulation of the immune function, decrease in the degree of adrenal insufficiency, and modulation of regulating inflammatory reaction.
Chen
Qi-hong
QH
Department of Critical Care Medicine, Subei Hospital of Jiangsu Province, Clinical Medical School, Yangzhou University, Yangzhou 225000, Jiangsu, China. chengqihong00@163.com
Zheng
Rui-qiang
RQ
Lin
Hua
H
Wang
Hua-ling
HL
Lu
Nian-fang
NF
Shao
Jun
J
Yu
Jiang-quan
JQ
D018806:APACHE; D000311:Adrenal Glands / Q000503:physiopathology; D000328:Adult; D000368:Aged; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology
D004365:Drugs, Chinese Herbal; D006854:Hydrocortisone