[A systematic review and Meta-analysis of Tongfu Xiefei method in the treatment of acute respiratory distress syndrome].

OBJECTIVE: To systematically review the effect of Tongfu Xiefei method on prognosis and respiratory mechanics parameters in patients with acute respiratory distress syndrome (ARDS). METHODS: The randomized controlled trials (RCT) of Tongfu Xiefei method for ARDS published on PubMed, Web of Science, Embase, CNKI and Wanfang database from January 1st 2001 to June 30th 2019 were searched. Conventional treatment for ARDS that included mechanical ventilation, prone ventilation, anti-infection, organ function maintenance and nutritional therapy were used in the control group. While the Tongfu Xiefei method was applied in the experimental group based on the conventional treatment. The main outcome was in-hospital mortality, and the secondary outcomes included mechanic ventilation time, length of intensive care unit (ICU) stay and respiratory mechanics parameters. Two researchers independently searched the literature, collected data and assessed the risk of bias. The bias risk assessment was completed by RevMan 5.3 software. The Meta-analysis was completed by R software. The potential publication bias of main outcome was evaluation. RESULTS: A total of 27 RCTs were included. There were 1 763 patients, including 899 in the experimental group and 864 in the control group. Meta-analysis showed that, compared with the control group, the in-hospital mortality of the experimental group significantly decreased [relative risk (RR) = 0.46, 95% confidence interval (95%CI) was 0.36 to 0.59, P < 0.000 1], the mechanic ventilation time and the length of ICU stay were significantly shortened [mechanical ventilation time: standard mean difference (SMD) = -1.92, 95%CI was -2.56 to -1.29, P < 0.000 1; length of ICU stay: SMD = -1.84, 95%CI was -2.49 to -1.18, P < 0.000 1], oxygenation index was significantly improved (SMD = 2.26, 95%CI was 1.56 to 2.96, P < 0.000 1), airway peak pressure, airway platform pressure, mean airway pressure and airway resistance significantly decreased (airway peak pressure: SMD = -1.26, 95%CI was -2.35 to -0.18, P = 0.021 8; airway platform pressure: SMD = -0.61, 95%CI was -1.08 to -0.14, P = 0.010 7; mean airway pressure: SMD = - 1.67, 95%CI was - 2.93 to -0.42, P = 0.009 1; airway resistance: SMD = -0.88, 95%CI was -1.09 to -0.67, P < 0.000 1), while lung compliance increased (SMD = 1.57, 95%CI was 0.78 to 2.36, P < 0.000 1). The results of publication bias assessment showed that there was no potential publication bias (P = 0.499). CONCLUSIONS: Tongfu Xiefei method is capable of reducing the in-hospital mortality, shortening the mechanical ventilation time and the length of ICU stay, and improving respiratory mechanics parameters for patients with ARDS.

Xijiao Dihuang decoction improves prognosis of sepsis via inhibition of aerobic glycolysis.

Aerobic glycolysis is a key factor to aggravate progression of sepsis. Xijiao Dihuang decoction (XJDHT) has been proven to have favorable therapeutic effects on sepsis. Our previous study has shown that XJDHT is capable of improving survival from sepsis. In this study we investigated the effects of XJDHT on aerobic glycolysis. The rats were randomly divided into five groups, which included control group, model group, TAK-242 group, XJDHT (25 g/kg) group and XJDHT (12.5 g/kg) group. The contents of cytokines increased in the model group compared with control group, while XJDHT reduced expressions of cytokines. Furthermore, the expressions of TLR4, HIF-1α and PKM2 were reduced significantly in the XJDHT group compared with the model group. There were five groups, including control group, LPS group, siTLR4 group, XJDHT (4 mg/mL) group and XJDHT (2 mg/mL) group in vitro experiments. The IL-1ß and IL-6 were elevated significantly after LPS stimulation in the model group, while XJDHT reduced the expression of cytokines. Protein expressions of TLR4, HIF-1α and PKM2 were increased significantly by stimulation of LPS, while XJDHT down-regulated the expressions of key molecules in the signaling pathway. To conclude, our study implies that XJDHT is capable of improving the prognosis of sepsis by inhibiting aerobic glycolysis via down-regulation of TLR4/HIF-1α/PKM2 signaling pathway.