Clinical value of type III procollagen peptide in sequential treatment with Rheum officinale Ball.as a predominant agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning

Abstract

Objective To investigate the clinical value of type Ⅲ procollagen peptide (PⅢP) in sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning (APP). Methods A total of 104 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from March 2013 to December 2016 were divied into three groups: A group (n=30, routine therapeutic agents coupled with a single hemoperfusion), B group (n=34, treated by Rheum officinale Ball. as a main agent in a traditional Chinese medicine recipe coupled with a single hemoperfusion), C group (n=40, treated by Rheum officinale Ball.as a predominant agent in a traditional Chinese medicine recipe and sequential continuous hemoperfusion). Before and 3 days and 7 days after treatment, tumor necrosis factor α (TNF-α), interleukin-18 (IL-18), maleic dialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) of patients were detected, and the change of sequential organ failure assessment (SOFA) scores were observed. Before and 3 days, 7 days, 10 days and 14 days after treatment, PⅢP were detected, and the changes of lung CT in three groups were observed before and 7 days, 14 days after treatment. Pearson correlation test was used to analyze the correlation between PⅢP in patients with APP and the concentration of paraquat, and the outcomes in 28 days were compared with chi square test. Results At admission, there were no differences in the levels of plasma TNF-α, IL-18, MDA, PⅢP, SOD, GSH-PX and SOFA scores among three groups (P>0.05). At 3 days after treatment, the levels of plasma TNF-α, IL-18, MDA and SOFA scores were elevated in three groups compared with those at admission, especially in group A were increased significantly, whereas the activity of plasma SOD and GSH-PX were decreased in thress groups, especially in group A decreased most significantly (P 0.05). At 7 days after treatment, lung CT mainly manifested ground glass lesions in C group. At 14 days after treatment, lung CT mainly manifested small size of the exudative changes and the irregular line of pleura in C group with higher proportion of those changes than that in A, B group, while pulmonary interstitial changes were found in the lung CT of A and B groups with higher proportion of these changes than that in C group, and those A group was higher than those in B group(P<0.05). The level of serum PⅢP in patients with APP was positively correlated with the concentration of paraquat (r=0.310, P=0.001). The mortality rate of three groups were 53.33%, 44.12% and 25.00%, respectively, with significant difference among three groups (P<0.05). Conclusion The clinically therapeutic effect of sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine in patients with APP was distinct. It could decrease the levels of PⅢP, TNF-α, IL-18 and MDA, enhance the expression of SOD and GSH-PX, reduce pulmonary fibrosis in patients and the mortality rate of patients.The PⅢP is the evaluation index of pulmonary fibrosis and can provide useful clinical value for the treatment of patients with APP. Key words: Acute paraquat poisoning; Type Ⅲ procollagen peptide; Traditional Chinese medicine; Hemoperfusion; Pulmonary fibrosis; Oxidative stress