The preventive effect of Chinese herbal preparation Xuebijing against hyperactive inflammation after hepato-pancreato-biliary surgery

Abstract

Background: Hepato-pancreato-biliary (HPB) surgery is a primary treatment for benign and malignant diseases of the liver, biliary tract, and pancreas. Hyperactive inflammation has been indicated as a critical risk factor of post-operation death after HPB surgery. Xuebijing is an anti-inflammatory intravenous herbal preparation made from traditional Chinese medicines. Emerging evidence has implicated a protective role of Xuebijing against hyperactive inflammation.

Methods: A retrospective cohort study was conducted. We analyzed a total of 638 cases of HPB surgery, including hepatectomy, Whipple's surgery, and surgeries for cholelithiasis, which were divided into a Xuebijing treatment group and a conventional treatment group according to whether they were treated with Xuebijing injection or not. Clinical data related to liver function and inflammation were compared between the two groups after operation, including liver function index, white blood cell (WBC) count, neutrophil percentage (NE%), C-reactive protein (CRP), serum interleukin-6 (IL-6), body temperature, mortality, incidence of adverse reaction, length of postoperative hospital stay, and hospitalization cost.

Results: Xuebijing injection was found to decrease the levels of inflammatory markers in the blood significantly, including WBC, NE%, CRP, IL-6, and reduce the incidence of postoperative fever without prolonging in-hospital length or increasing cost compared to the conventional treatment group. Moreover, our data demonstrated that Xuebijing injection did not impact liver function after hepatectomy.

Conclusions: These results suggest that Xuebijing injection alleviates hyperactive inflammation caused by HPB surgery, and support the application of Xuebijing injection as a safe therapeutic approach against hyperactive inflammation in patients with HPB surgery.

Keywords: Hepato-pancreato-biliary surgery (HPB surgery); Xuebijing; hyperactive inflammation.

Figure 1

Xuebijing injection alleviates systemic inflammation in patients after hepatectomy. (A,B,C) Levels of WBC (A), NE% (B), and CRP (C) in the Xuebijing injection group and control group. Xuebijing injection significantly lowered the levels of WBC, NE%, and CRP at POD 3 and POD 5; (D) levels of serum IL-6 measured by ELISA; (E) cumulative cases of fever 5 days after hepatectomy. Xuebijing injection significantly prevented fever; (F,G) length of postoperative hospital stay and cost; no significant difference was observed between the two groups. Data in A, B, C, E, F and G represent mean ± SD; n=101. The mean value was displayed. Data in D represent mean ± SD; n=10. *, P<0.05, **, P<0.01, ***, P<0.001. WBC, white blood cell; NE%, neutrophil percentage; CRP, C-reactive protein; IL-6, interleukin-6; ELISA, enzyme-linked immunosorbent assay; SD, standard deviation.

Figure 2

Xuebijing injection does not alter liver function after hepatectomy. Levels of ALT (A), AST (B), and TBIL (C) in the Xuebijing injection group and control group. No significant difference was observed between the two groups. Data represent mean ± SD, n=101. The mean value was displayed. ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBIL, total bilirubin; SD, standard deviation.

Figure 3

Xuebijing injection suppresses systemic inflammation after pancreaticoduodenectomy. (A,B,C) Levels of WBC (A), NE% (B), and CRP (C) in the Xuebijing injection group and control group. Xuebijing injection significantly decreased the levels of WBC, NE%, and CRP; (D) levels of serum IL-6 measured by ELISA; (E) cumulative cases of fever 5 days after pancreaticoduodenectomy. The incidence of postoperative fever was significantly lower in the Xuebijing group; (F,G) postoperative hospital days and cost; no significant difference was observed between the two groups. Data in A, B, C, E, F and G represent mean ± SD; n=101. The mean value was displayed. Data in D represent mean ± SD; n=10. *, P<0.05, **, P<0.01, ***, P<0.001. WBC, white blood cell; NE%, neutrophil percentage; CRP, C-reactive protein; IL-6, interleukin-6; ELISA, enzyme-linked immunosorbent assay; SD, standard deviation.

Figure 4

Xuebijing injection inhibits systemic inflammation in patients with cholelithiasis after surgery. (A,B,C) Levels of WBC (A), NE% (B), and CRP (C) in the Xuebijing injection group and control group. Xuebijing injection significantly decreased the levels of WBC, NE%, and CRP; (D) levels of serum IL-6 measured by ELISA; (E) cumulative cases of fever 5 days after surgery for cholelithiasis. No significant difference was observed between the two groups; (F,G) postoperative hospital days and cost; no significant difference was observed between two groups. Data in A, B, C, E, F and G represent mean ± SD; n=101. The mean value was displayed. Data in D represent mean ± SD; n=10. *, P<0.05, ***, P<0.001. WBC, white blood cell; NE%, neutrophil percentage; CRP, C-reactive protein; IL-6, interleukin-6; ELISA, enzyme-linked immunosorbent assay; SD, standard deviation.