ABSTRACT
Objective:To observe the effect of modified Shengxian Decoction on extravascular lung water index (EVLWI) and lung injury prediction score (LIPS) in patients with acute respiratory distress syndrome (ARDS) caused by sepsis.Methods:Prospective cohort study. A total of 200 patients with ARDS caused by sepsis who were hospitalized in Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2019 to May 2021 were selected and divided into the observation group and control group by random number table method, with 100 in each group. The patients in the control group were given rountin western medicine treatment according to the guidelines, and the patients in the observation group were treated with modified Shengxian Decoction on the basis of the treatment in the control group. Both groups were treated for 7 days as a course of treatment. The PH value, oxygen volume index (FiO 2), oxygen partial pressure (PaO 2), arterial carbon dioxide partial pressure (PaCO 2) of the two groups before and after treatment, calculate the oxygenation index (PaO 2/FiO 2) were observed and compared. The C-reactive protein (hs-CRP), interleukin-6 (IL-6) levels were observed by ELISA, the procalcitonin (PCT) levels was detected by double antibody sandwich immunoluminescence method. The APACHE Ⅱ score and LIPS score, EVLWI and cardiac index (CI) of the two groups were observed and compared. The mechanical ventilation time and ICU hospitalization time of the two groups were compared. Results:After treatment, the PaCO 2 level [(37.15 ± 5.42) mmHg vs. (38.24 ± 3.24) mmHg, t=2.03] of the observation group was significantly lower than that of the control group, and the oxygenation index (292.34 ± 78.91 vs. 236.54 ± 70.58, t=5.27) was significantly higher than that of the control group ( P<0.05). After treatment, the levels of hs-CRP [(35.21 ± 6.73) mg/L vs. (48.97 ± 8.52) mg/L, t=12.67], IL-6 [(40.57 ± 8.51) ng/L vs. (47.61 ± 9.97) ng/L, t=5.37] and PCT [(0.75 ± 0.21) μg/L vs. (1.14 ± 0.38) μg/L, t=8.98] in the observation group were significantly lower than those in the control group ( P<0.01). After treatment, the APACHE Ⅱscore (11.14 ± 0.54 vs. 14.67 ± 0.89, t=33.91], LIPS score (2.21 ± 0.73 vs. 4.59 ± 0.88, t=20.82), and EVLWI [(6.19 ± 0.42) ml/kg vs. (8.24 ± 0.78) ml/kg, t=23.14) of the observation group were significantly lower than those in the control group, and the CI level [(4.49 ± 1.27) L/(min?m 2) vs. (3.61 ± 0.88) L/(min?m 2), t=5.70] was significantly higher than that of the control group ( P<0.01). The mechanical ventilation time and ICU stay in the observation group were shorter than those in the control group ( t=3.66, 5.74, P<0.01). Conclusion:The modified Shengxian Decoction can reduce the level of inflammation indexes in patients with ARDS caused by sepsis, reduce EVLWI and LIPS scores, improve blood gas analysis indexes, and shorten the time of mechanical ventilation and ICU hospitalization.
ABSTRACT
Objective To explore the mechanism of Shengxian decoction in the treatment of heart failure by using metabolomic technology. Methods Rats were randomly divided into the control group, model group and administration group according to body weight, with 10 rats in each group. Rats in model group and administration group were induced by intraperitoneal injection of adriamycin to duplicate rat heart failure model. The rats in the treatment group were given Shengxian decoction 3.83 g/kg, while those in the control group and model group were given distilled water of equal volume once a day for 4 weeks. The levels of CK, AST, LDH and MDA in serum of rats were detected by ultraviolet spectrophotometer, and the metabolite profiles were collected by high resolution tandem mass spectrometry. The data were analyzed by principal component analysis and partial least squares discriminant analysis. Metabolic pathways were obtained by pathway enrichment analysis, focusing on key metabolic enzymes and metabolic pathways. Results Compared with the model group, the serum CK (1 015.44 ± 201.49 U/L vs. 1 301.89 ± 311.54 U/L), AST (210.59 ± 80.34 U/L vs. 421.56 ± 120.32 U/L), LDH (1 211.64 ± 416.61 U/L vs. 601.58 ± 311.74 U/L) in the administration group significantly decreased (P<0.05), and MDA (209.21 ± 151.15 nmol/ml vs. 1 251.15 ± 110.64 nmol/ml) levels significantly increased (P<0.05). The metabolic distribution of rats in the control group was significantly separated from that in the model group, and the administration group was between the two groups. After dimension reduction, blood biomarkers were obtained by partial least squares discriminant analysis, including citric acid, succinic acid, malic acid, arachidonic acid, canine uric acid, serine, sphingosine, Cer (d18:0/14:0), SM (d18:1/22:0), SM [d18:0/18:1 (11Z)], SM (d18:0/16:1). Metabo Analyst 4.0 analysis showed abnormal metabolism in heart failure rats, which mainly involved arachidonic acid metabolism, glycine, serine and threonine metabolism, sphingolipid metabolism, citric acid metabolism and aminoacyl-tRNA biosynthesis. Conclusions The Shengxian decoction has a good therapeutic effect on heart failure rats. Regulation of arachidonic acid metabolism, glycine, serine and threonine metabolism, sphingolipid metabolism, citric acid metabolism and aminoacyl-tRNA biosynthesis may be the key mechanisms for its treatment of heart failure.
ABSTRACT
Objective@#To explore the mechanism of Shengxian decoction in the treatment of heart failure by using metabolomic technology.@*Methods@#Rats were randomly divided into the control group, model group and administration group according to body weight, with 10 rats in each group. Rats in model group and administration group were induced by intraperitoneal injection of adriamycin to duplicate rat heart failure model. The rats in the treatment group were given Shengxian decoction 3.83 g/kg, while those in the control group and model group were given distilled water of equal volume once a day for 4 weeks. The levels of CK, AST, LDH and MDA in serum of rats were detected by ultraviolet spectrophotometer, and the metabolite profiles were collected by high resolution tandem mass spectrometry. The data were analyzed by principal component analysis and partial least squares discriminant analysis. Metabolic pathways were obtained by pathway enrichment analysis, focusing on key metabolic enzymes and metabolic pathways.@*Results@#Compared with the model group, the serum CK (1 015.44 ± 201.49 U/L vs. 1 301.89 ± 311.54 U/L), AST (210.59 ± 80.34 U/L vs. 421.56 ± 120.32 U/L), LDH (1 211.64 ± 416.61 U/L vs. 601.58 ± 311.74 U/L) in the administration group significantly decreased (P<0.05), and MDA (209.21 ± 151.15 nmol/ml vs. 1 251.15 ± 110.64 nmol/ml) levels significantly increased (P<0.05). The metabolic distribution of rats in the control group was significantly separated from that in the model group, and the administration group was between the two groups. After dimension reduction, blood biomarkers were obtained by partial least squares discriminant analysis, including citric acid, succinic acid, malic acid, arachidonic acid, canine uric acid, serine, sphingosine, Cer (d18:0/14:0), SM (d18:1/22:0), SM [d18:0/18:1 (11Z)], SM (d18:0/16:1). Metabo Analyst 4.0 analysis showed abnormal metabolism in heart failure rats, which mainly involved arachidonic acid metabolism, glycine, serine and threonine metabolism, sphingolipid metabolism, citric acid metabolism and aminoacyl-tRNA biosynthesis.@*Conclusions@#The Shengxian decoction has a good therapeutic effect on heart failure rats. Regulation of arachidonic acid metabolism, glycine, serine and threonine metabolism, sphingolipid metabolism, citric acid metabolism and aminoacyl-tRNA biosynthesis may be the key mechanisms for its treatment of heart failure.