Efficacy of Xuebijing Injection for Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background and Aim. Xuebijing injection is a traditional Chinese medicine compound for the improvement of systemic inflammation response. This meta-analysis of randomized controlled trials (RCTs) aimed to explore the clinical efficacy and safety of Xuebijing injection for the treatment of acute pancreatitis (AP). Methods. PubMed Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, VIP, and Wanfang databases were searched. 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. Results. 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 (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. Conclusions. Xuebijing injection added on the basis of conventional treatment has a potential benefit for improving the outcomes of AP.

Chinese herbal medicine xuebijing injection for acute pancreatitis: An overview of systematic reviews

“…A total of 27 duplicate references were excluded in Endnote X9.1; furthermore, three articles were excluded after reading the title and abstract, and six articles were excluded by reading the full text. Finally, a total of 9 SRs were included for data analysis ( Li et al, 2010 ; Dong and Huang, 2011 ; Jie et al, 2014 ; Zheng et al, 2015 ; Zhang and Ke, 2016 ; Ma et al, 2017 ; Chen et al, 2021a ; Xu et al, 2021 ; Zhou et al, 2021 ). The literature search and screening process is shown in Figure 1 .…”

“…There are two main diagnostic criteria: Guidelines for Diagnosis and Treatment of Acute Pancreatitis in China (Draft), 2004 and Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (2014 edition)-Chinese Medical Association. Xuebijing injection was used in the treatment group, among which three were combined with ulinastatin ( Jie et al, 2014 ; Ma et al, 2017 ; Zhou et al, 2021 ), and six were combined with routine treatment ( Li et al, 2010 ; Dong and Huang, 2011 ; Zheng et al, 2015 ; Zhang and Ke, 2016 ; Chen et al, 2021a ; Xu et al, 2021 ). The control group adopted the same method as the treatment group but without Xuebijing injection.…”

“…Secondary results included white blood cell recovery time, hospital stay, IL-6 level, IL-8 level, TNF-α level, and CRP. Regarding the methodological evaluation tool, five SRs used the Cochrane risk of bias tool ( Li et al, 2010 ; Zhang and Ke, 2016 ; Chen et al, 2021a ; Xu et al, 2021 ; Zhou et al, 2021 ), two SRs used the Jadad scale ( Jie et al, 2014 ; Zheng et al, 2015 ), and two SRs did not mention a specific tool ( Dong and Huang, 2011 ; Ma et al, 2017 ). Only two SRs mention adverse drug reactions (ADRs); see Table 1 for the characteristics of the included SRs.…”

“…For the content of different items, we summarized the advantages and disadvantages of all articles. The advantages included the following aspects: The research questions and inclusion criteria for the SRs based on PICO principle (Item 1): The data extraction was repeatable, meaning that this work was done independently by two reviewers [Item 5 and Item 6, except ( Dong and Huang, 2011 ; Jie et al, 2014 ; Chen et al, 2021a )]; The researchers used appropriate statistical analysis methods to synthesize the results (Item 11); The risk of bias in individual studies was considered in interpreting and discussing the results of the SRs [Item 13, except ( Dong and Huang, 2011 ; Jie et al, 2014 )]. The shortcomings were also obvious.…”

“…Seven SRs ( Li et al, 2010 ; Dong and Huang, 2011 ; Jie et al, 2014 ; Ma et al, 2017 ; Chen et al, 2021a ; Xu et al, 2021 ; Zhou et al, 2021 ) and four SRs ( Li et al, 2010 ; Chen et al, 2021a ; Xu et al, 2021 ; Zhou et al, 2021 ) reduced the relief time of abdominal pain and abdominal distention in AP patients, respectively. Seven SRs ( Li et al, 2010 ; Dong and Huang, 2011 ; Jie et al, 2014 ; Ma et al, 2017 ; Chen et al, 2021a ; Xu et al, 2021 ; Zhou et al, 2021 ) significantly reduced serum amylase levels. Other outcomes also showed significant differences compared with the control group as detailed in Table 4 .…”