Analysis Of The Efficacy Of Xuebijing Injection In Patients With Acute Pancreatiti

Purposes: 1.To evaluate the efficacy and safety of Xuebijing injection in the treatment of acute pancreatitis(AP);2.To collect the clinical data of consecutive patients with AP admitted to the Department of Gastroenterology,Northern Theater General Hospital,and to further verify the Efficacy of Xuebijing injection in the treatment of AP.Material and methods: Part Ⅰ.Pub Med,Embase,Cochrane Library,China National Knowledge Infrastructure,China Biology Medicine disc,VIP,and Wanfang databases were searched.The search items are as follows: “Xuebijing” AND “pancreatitis”.The last search was conducted on November 07,2020.The primary outcome was treatment response.The secondary outcomes included changes in clinical and laboratory indicators and incidence of AP-related complications.Meta-analyses were performed by using a random-effect model.Risk ratios(RRs)with 95% confidence intervals(CIs)or weighted mean differences(WMDs)with 95% CIs were calculated.Part Ⅱ.We retrospectively enrolled the patients who were diagnosed as AP and consecutively admitted to the Department of Gastroenterology of General Hospital of Northern Theater Command between August 2015 and August 2020.AP Patients were divided into Xuebijing injection group and conventional treatment group based on weather Xuebijing injection was used or not.The laboratory indexes at admission,the changes of laboratory indexes during hospitalization,the severity of AP,and the length of hospital stay were compared between those two groups.In addition,multivariate linear regression analysis was used to adjust the influence of Xuebijing injection on the changes of laboratory indexes.Results:Part Ⅰ.Overall,23 RCTs were included.The rates of overall(RR=1.16;95%CI=1.12 to 1.20;P<0.00001)and complete(RR=1.40;95%CI=1.30 to 1.50;P<0.00001)responses were significantly higher in the Xuebijing injection group.After treatment,the levels of interleukin-6(WMD=-18.22;95%CI=-23.36 to-13.08;P<0.00001),tumor necrosis factor-α(WMD=-16.44;95%CI=-20.49 to-12.40;P<0.00001),serum amylase(WMD=-105.61;95%CI=-173.77 to-37.46;P=0.002),white blood cell(WMD=-1.51;95%CI=-1.66 to-1.36;P<0.00001),and C-reactive protein(WMD=-11.05;95%CI=-14.32 to-7.78;P<0.00001)were significantly lower in the Xuebijing injection group.Abdominal pain(WMD=-1.74;95%CI=-1.96 to-1.52;P<0.00001),abdominal distension(WMD=-1.56;95%CI=-2.07 to-1.04;P<0.00001),gastrointestinal function(WMD=-2.60;95%CI=-3.07 to-2.13;P<0.00001),body temperature(WMD=-2.16;95%CI=-2.83 to-1.49;P<0.00001),serum amylase level(WMD=-1.81;95%CI=-2.66 to-0.96;P<0.0001),and white blood cell level(WMD=-2.16;95%CI=-2.99 to-1.32;P<0.00001)recovered more rapidly in the Xuebijing injection group.The incidence of multiple organ dysfunction syndrome(RR=0.18;95%CI=0.05 to 0.62;P=0.006),pancreatic pseudocyst(RR=0.17;95%CI=0.04 to 0.77;P=0.02),and renal failure(RR=0.16;95%CI=0.05 to 0.60;P=0.006)was significantly lower in the Xuebijing injection group.Part Ⅱ.A total of 658 AP patients were included in our study.On admission,compared with the conventional treatment group,Xuebijing injection group had significantly higher inflammatory indicators,i.e.,white blood cell(13.45±4.57 vs.11.72±4.25;P<0.001),neutrophils(11.21±4.47 vs.8.89±4.19: P<0.001),C-reactive protein(133.00±96.52 vs.77.68±101.81;P<0.001),and procalcitonin(0.86±1.90 vs.0.51±2.14;P<0.001)levels were significantly higher.In terms of the severity of AP,the proportion of moderately severe/severe AP in Xuebijing injection group was significantly higher than that in conventional treatment group(67.0% vs.32.0%;P<0.001),and the length of hospital stay(13.32±6.75 vs.11.63±5.42;P=0.040)was significantly longer.During hospitalization,compared with the conventional treatment group,Xuebijing injection group had significantly higher changes of inflammatory indexes,i.e.,Δ white blood cells(-6.32±4.64 vs.-4.38±4.42;P<0.001),Δ neutrophil absolute value(-6.65±4.60 vs.-4.60±4.42P<0.001),Δ C reactive protein(-110.70±88.57 vs.-57.21±100.76;P<0.001),and Δ calcitonin(-1.02±2.40 vs.0.70±14.58;P<0.001)were significantly lower.After adjusting for gender,age,the severity of AP,and the length of hospital stay,the results showed that Xuebijing injection was independently negatively correlated with Δ white blood cell(B=-1.628;P<0.001),Δ neutrophil(B=-4.307;P<0.001),and Δ C reactive protein(B=-46.165;P=0.037).Conclusion:1.Xuebijing injection added on the basis of conventional treatment has a potential benefit for improving the outcomes of AP.2.In clinical practice,Xuebijing injection was more used in patients with moderately severe/severe AP,and the application of Xuebijing injection on the basis of conventional treatment can significantly reduce the value of inflammatory indexes in AP patients.