Paradoxical systemic toxicity by inhaled paraquat poisoning: A case report

Rationale:Multi-organ failure is a symptom of paraquat poisoning,resulting in high mortality and morbidity rates.Though paraquat is widely available,poisoning through inhalation is rare.Patient’s Concern:A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work.Diagnosis:Paraquat poisoning.Interventions:Supportive management along with multiple sessions of hemodialysis.Outcomes:Renal complications caused by paraquat were improved after multiple sessions of hemodialysis.However,the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy,he succumbed to his illness.Lessons:Acute kidney injury is a complication of paraquat poisoning.However,kidney involvement with the inhalational mode is rare.It is caused by reduction and oxidation cycles,as well as the formation of reactive oxygen species,necessitating hemodialysis as the treatment.Without a clear history,a specific clinical trait,or a diagnostic test,diagnosis can be difficult.Our case thus highlights the inhaled paraquat poisoning,presenting with acute kidney injury with late respiratory impairment as a consequence.

Risk factors and optimal predictive scoring system of mortality for children with acute paraquat poisoning

BACKGROUND There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication(APP).AIM To optimize a predictive scoring system for mortality in children with APP.METHODS A total of 113 children with APP from January 1,2010 to January 1,2020 were enrolled in this study.These patients were divided into survivors and nonsurvivors.We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors.The survival rates of patients with different values of the pediatric critical illness score(PCIS)were assessed using kaplan-meier survival analysis.The best scoring system was established by using the area under the receiver operating characteristic curve analysis.RESULTS The overall mortality rate was 23.4%.All non-survivors died within 20 days;48.1%(13/27)died within 3 days,and 70.3%(19/27)died within 7 days.Compared to survivors,the non-survivors were older,had higher white blood cell count,alanine aminotransferase(ALT),aspartate aminotransferase,serum creatinine,blood urea nitrogen,glucose,and pediatric early warning score,and had lower platelet count,albumin,Serum sodium(Na+)and PCIS.ALT and PCIS were the independent prognostic risk factors for children with APP.The survival rate of children classified as extremely critical patients(100%)was lower than that of children classified as critical(60%)or noncritical(6.7%)patients.The specificity of ALT was high(96.51%),but the sensitivity was low(59.26%).The sensitivity and specificity of ALT combined with PCIS were high,92.59%and 87.21%,respectively.The difference in mortality was significantly higher for ALT combined with PCIS(area under the receiver operating characteristic:0.937;95%CI:0.875-0.974;P<0.05).CONCLUSION In our study,ALT and PCIS were independent prognostic risk factors for children with APP.ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.

Advances in molecular mechanism of lung injury induced by paraquat poisoning

Paraquat is a bipyridine dichloride non-selective herbicide,which was widely used in the world in the last century.Now,paraquat is banned in most countries because of the extremely high lethality and the lack of specific detoxification drugs.However,death due to paraquat poisoning still occurs frequently,thus it is of great clinical significance to explore the molecular mechanism of paraquat poisoning and the detoxification drugs.Paraquat poisoning causes multiple dysfunction of the lung,liver,kidney,heart,and brain through complex molecular mechanisms.About the mechanism there are excessive inflammatory reaction theory,REDOX reaction imbalance theory,oxidative stress free radical damage theory,calcium overload theory,NO molecular damage and cell apoptosis theory,etc.For the treatment of paraquat poisoning,paraquat antibody,pathway target blocker and related factor antibody have been developed in recent years.Although certain effects have been achieved,the treatment efficiency has not been significantly improved.This paper summarized the mechanism of signal transduction pathways involved in lung injury induced by paraquat poisoning in order to provide a theoretical basis for further research.

Ulinastatin suppresses endoplasmic reticulum stress and apoptosis in the hippocampus of rats with acute paraquat poisoning

Lung injury is the main manifestation of paraquat poisoning. Few studies have addressed brain damage after paraquat poisoning. Ulinastatin is a protease inhibitor that can effectively stabilize lysosomal membranes, prevent cell damage, and reduce the production of free radicals. This study assumed that ulinastatin would exert these effects on brain tissues that had been poisoned with paraquat. Rat models of paraquat poisoning were intraperitoneally injected with ulinastatin. Simultaneously, rats in the control group were administered normal saline. Hematoxylin-eosin staining showed that most hippocampal cells were contracted and nucleoli had disappeared in the paraquat group. Fewer cells in the hippocampus were concentrated and nucleoli had dis- appeared in the ulinastatin group. Western blot assay showed that expressions of GRP78 and cleaved-caspase-3 were significantly lower in the ulinastatin group than in the paraquat group. Immunohistochemical findings showed that CHOP immunoreactivity was significantly lower in the ulinastatin group than in the paraquat group. Terminal deoxynucleotidyl transferase-medi- ated dUTP nick end labeling staining showed that the number of apoptotic cells was reduced in the paraquat and ulinastatin groups. These data confirmed that endoplasmic reticular stress can be induced by acute paraqnat poisoning. Ulinastatin can effectively inhibit this stress as well as cell apoptosis, thereby exerting a neuroprotective effect.

Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model

BACKGROUND:Gastric lavage(GL)is one of the most critical early therapies for acute paraquat(PQ)poisoning;however,details of the treatment protocol remain to be established.METHODS:A rapid quantitative method involving sodium dithionite testing was developed.It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL,or without.The vital signs,laboratory testing,and PQ plasma concentrations were collected for therapeutic effect evaluation.RESULTS:The reaction conditions of the test were optimized for two types of samples.Early GL at one hour(H1)could improve the signs and symptoms after acute PQ poisoning at 24 hours(H24).In contrast,GL at 6 hours(H6)could only partially relieve the vital signs.The H1 GL group effectively reduced the peak of the plasma PQ concentration.In addition,the PQ concentrations in the plasma and the gastric juice were significantly decreased in both the GL groups as compared to the untreated group at H24.Moreover,there was no significant difference in the washing efficiencies calculated from the total eluates between the two GL groups.However,the washing efficiency of the first 10 L eluate is superior to that of the additional 10 L eluate.CONCLUSION:GL only at early stage may it benefit PQ poisoning in an animal model.The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate.The rapid quantitative method can be used for gastric juice sample and has a certain value for clinical GL practices.

Prognostic value of plasma C-reactive protein in the evaluation of paraquat poisoning patients

Objective: To investigate the prognostic value of plasma C-reactive protein(CRP) level in patients with paraquat poisoning.Methods: This study included 162 patients with paraquat poisoning. The data of plasma paraquat, CRP level and arterial blood gas were analyzed. Cox regression analysis was applied to evaluate the risk factors of prognosis. Receiver operating characteristics curve analysis and area under curve were used to calculate the predictive power of significant variable. Differences in patient survival were determined using the Kaplan–Meier method and a log-rank test.Results: Plasma CRP level was significantly increased in non-survival patients compared with survival patients(P < 0.05), and positively correlated with plasma paraquat level(P < 0.05). Cox regression analysis revealed that plasma CRP level was an independent prognostic marker of mortality within 30 days. The receiver operating characteristics curve analysis indicated that area under curve of plasma CRP level was0.867(95% CI: 0.81–0.93), and the cut-off value was 18 mg/L, and patients with CRP level over this value had a poor survival time compared with those with less than this value.Conclusions: These results suggest that plasma CRP level is distinct increased in patients with paraquat poisoning, and the plasma CRP level may be useful for the prediction of prognosis in paraquat poisoning.

Discernment scheme for paraquat poisoning: A five-year experience in Shiraz, Iran

AIM To evaluate various schemes for paraquat poisoning and different variables that influence the outcome of acute paraquat poisoning.METHODS In a cross-sectional study, the information about all cases of acute paraquat poisoning who were admitted to teaching hospitals affiliated to Shiraz University of Medical Sciences, in a five year period(September 2010 to September 2015) were evaluated. The variables included: Demographic data, medical assessment, therapeutic options, laboratory findings, and the outcomes. Data were analyzed using SPSS, version 22. Significant difference between groups was tested using t-test for continues outcomes and χ~2 test for categorical. The significance level was considered to be P < 0.05. RESULTS A total of 104 patients(66.3% male) were evaluated. The mean age of the female patients was 22.81 ± 9.87 years and the male patients' was 27.21 ± 11.06 years. Ninety seven(93.3%) of all the cases were suicide attempts with mortality rate of 43.2%. Despite the necessity for emergency hemodialysis during the first 6 h of intoxication, none of the patients had dialysis during this time. Immunosuppressive and corticosteroid medications were not administrated in adequate dosage in 31.1% and 60% of the patients, respectively. Ingestion of more than22.5 cc of paraquat and increase in creatinine level were the most important predictors of mortality.CONCLUSION Treatment should start immediately for these patients.Moreover, creating a clinical guideline according to the findings can have an impact on the treatment procedure which seems to be necessary.

Acute lung injury mechanism and therapy induced by paraquat poisoning

Paraquat (PQ, methyl viologen) was widely used in agricultural production throughout the world in 1962 for its efficient herbicidal activity. PQ was also highly toxic drug. About 5 mL medicine including 20% paraquat was life-threatening that can cause poisoning. In 1966, some people died because of PQ poisoning. Most patients had acute respiratory distress syndrome after 2 wk, and 70% of them died due to the lack of effective detoxification drugs. Thus, it was particularly important to understand the pathogenesis of PQ poisoning and give some effective treatments. This article will review the toxicological mechanism and treatment on PQ poisoning of acute lung injury.

Can kissing cause paraquat poisoning: A case report and review of literature

BACKGROUND Paraquat is an effective,broad-spectrum,highly toxic quaternary ammonium herbicide.Paraquat poisoning has been reported frequently in recent years.It has severe lung,kidney,liver,and nervous system toxicity,and there is currently no specific antidote.Paraquat poisoning may follow ingestion,inhalation,and skin contact.There have been no previous reports of paraquat poisoning that resulted from kissing.This rare case provides a new reference for the prevention of paraquat poisoning.CASE SUMMARY A 27-year-old man came to the emergency department complaining that he had come into contact with paraquat by kissing his girlfriend,who had taken 80-120 mL 20%paraquat.After admission,his lung computed tomography(CT)showed increased lung markings.Redness and a burning sensation developed on his tongue,which progressed to painful erosions and coalescent ulcers.The final diagnosis was mild paraquat poisoning.Anti-inflammatory,antioxidant,and symptomatic treatment were initiated and continued for 7 d.Dyspnea did not occur,subsequent lung CT showed no significant changes,and the tongue pain was slightly improved.One month after discharge,the tongue injury was resolved.CONCLUSION This case indicated that the tongue and lung tissues are particularly vulnerable to paraquat toxicity,even after a limited exposure.

Effects of ulinastatin combined with hemoperfusion on renal function, fibrosis indexes and oxidative stress indexes of patients with paraquat poisoning

Objective: To study the effects of ulinastatin combined with hemoperfusion on renal function, fibrosis indexes and oxidative stress indexes of patients with paraquat poisoning. Methods:Patients with paraquat poisoning who were treated in Qinghai Provincial People's Hospital between March 2014 and May 2017 were chosen as the research subjects, treated with hemoperfusion and divided into ulinastatin group and control group according to the use of ulinastatin or not in history data. The renal function markers, fibrosis indexes and oxidative stress indexes were measured before treatment and 1 week after treatment. Results: Compared with those of same group before treatment, serum Scr, BUN, Cys-C, β2-MG, TGF-β1, ICAM-1, MMP9, PICP, C-IV and MDA levels as well as peripheral blood Nrf2 and HO-1 expression intensity significantly decreased whereas serum CAT and SOD levels significantly increased after treatment, and serum Scr, BUN, Cys-C, β2-MG, TGF-β1, ICAM-1, MMP9, PICP, C-IV and MDA levels as well as peripheral blood Nrf2 and HO-1 expression intensity of ulinastatin group after treatment were significantly lower than those of control group whereas serum CAT and SOD levels were significantly higher than those of control group. Conclusion:Ulinastatin combined with hemoperfusion can improve the renal function, pulmonary fibrosis and oxidative stress in patients with paraquat poisoning.

Effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning

Objective: To investigate the effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning. Methods: A total of 42 patients with acute paraquat poisoning who were admitted and treated in our hospital between December 2013 and October 2017 were selected as the research subjects, and their therapies were reviewed and used to divide them into the control group (n=20) who received hemoperfusion alone and the combined treatment group (n=22) who received hemoperfusion combined with hemodialysis. The differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were compared between the two groups of patients immediately after admission, after 1 d of treatment and after 3 d of treatment. Results: Immediately after admission, the differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were not statistically significant between the two groups. After 1d of treatment and after 3 d of treatment, kidney function indexes Scr, BUN and β2-MG levels in peripheral blood of combined treatment group were lower than those of control group at corresponding time points respectively;liver function indexes ALT, AST, TB and ALP levels in peripheral blood were lower than those of control group at corresponding time points respectively;lung function indexes PaO2, BE and PCO3- levels in arterial blood were higher than those of control group at corresponding time points respectively whereas PaCO2 levels were lower than those of control group at corresponding time points respectively. Conclusion: Compared with hemoperfusion alone, hemoperfusion combined with hemodialysis is more advantageous in protecting the functions of liver, kidney, lungs and other target organs of patients with acute paraquat poisoning.

Effects of intensive hemoperfusion on the toxin clearance, target organ function and oxidative stress in patient with paraquat poisoning

Objective: To study the effects of intensive hemoperfusion on the toxin clearance, target organ function and oxidative stress in patient with paraquat poisoning. Methods: A total of 56 patients with paraquat poisoning who were treated in the People's Hospital of Hanchuan between November 2013 and January 2017 were reviewed and divided into the control group (n=30) and the intensive hemoperfusion group (n=26). Control group received conventional therapy, and intensive hemoperfusion group received conventional therapy combined with intensive hemoperfusion. The differences in paraquat clearance effect, target organ function and oxidative stress response were compared between the two groups. Results: Serum paraquat level in intensive hemoperfusion group was lower than that in control group, and the paraquat clearance rate was higher than that of control group. Serum pulmonary fibrosis indexes PⅠCP, CⅣ and HA levels in intensive hemoperfusion group were lower than those in control group;serum liver function indexes ALP, STB and ALT levels were lower than those in control group;serum oxidative stress index GSH-Px level was higher than that in control group whereas MDA level was lower than that in control group. Conclusion: Intensive hemoperfusion can significantly improve the paraquat clearance rate, protect the important organ function and suppress the systemic oxidative stress response in patient with paraquat poisoning.

Dienediamine:A safe surrogate for the herbicide paraquat

Paraquat(PQ)has been used as an herbicide worldwide because of its potent activity against weeds.However,it is highly toxic to humans.The very high fatality of PQ poisoning is due to its inherent toxicity and the lack of any effective treatment.Consequently,developing a non-toxic herbicide with comparable efficacy to PQ will contribute to global food security and help prevent PQ-related fatalities.Herein,we report a new herbicide called dienediamine,which was discovered from how to intervene the redox cycle of PQ,an inherent toxicity nature.Dienediamine,the“reduced"form of PQ with no function as an electron transfer agent,was shown to be non-toxic through comprehensive in vivo and in vitro experiments at molar concentrations equivalent to PQ's absolute lethal dose.Remarkably,dienediamine can undergo conversion to PQ under natural sunlight and ambient air conditions,exhibiting herbicidal activities that are comparable to those of PQ.The conversion of dienediamine to PQ,which is toxic to chloroplasts,is the key mechanism underlying its potent herbicidal activity.Our study discovers that dienediamine is a safe and superior alternative to PQ,possessing significant potential for application in sustainable agriculture globally.

Determination of Paraquat in Several Commercially Available Types of Rice

Introduction: Paraquat (1,1’-dimethyl-4,4’-bipyridine-dichloride) is a herbicide used to combat weeds and improve crop productivity. Its acute toxicity can cause fatal poisoning in humans and animals and several studies have shown a strong correlation between paraquat and Parkinson’s disease. Objective: To determine the concentration of paraquat in different types of rice in Brazil. Method: Paraquat quantification is based on a complexation reaction with sodium dithionite, which generates a blueish color compound, whose absorbance was read in a spectrophotometer at the 600 nm wavelength. Results: Five samples were found to be above the maximum allowed limit, while one sample had a concentration in the upper allowed limit. The method employed did not allow quantification of black rice. Conclusion: There is a need for identification of the type of pesticide used in each examined crop as well as their respective dates of remission in order to improve the safety of agricultural practices.

Comparative Paraquat Sensitivity of Newly Germinated and Mature Fronds of the Aquatic Macrophyte <i>Spirodela polyrhiza</i>

Here, we compared the intrinsic characteristics of 3-day-(newly germinated;“young”) and 8-week-old (“mature”) fronds of the aquatic plant Spirodela polyrhiza and their sensitivity to paraquat, a toxic herbicide. Endpoints measured were frond area and fresh weight, root length, chlorophyll a and b contents, and chlorophyll a fluorescence. Significant differences were detected in the intrinsic physiological traits between young and mature fronds. Young fronds showed higher root length, chlorophyll contents, maximum quantum yield (Fv/Fm), maximal relative electron transport rate (rETRmax) and saturating photon flux density (PFD), whereas mature fronds exhibited greater frond area and fresh weight. After a 72 h exposure to paraquat, root length and rETRmax were identified as the most sensitive endpoints of paraquat toxicity for both frond types, with EC50 values of 0.66 and 0.76 μg·L-1 for young fronds, respectively, and 5.53 and 2.28 μg·L-1 for mature fronds, respectively. Young fronds of S. polyrhiza showed significantly higher sensitivity to paraquat than mature fronds. A survey of other studies on paraquat toxicity to Lemna species revealed that EC50 values of paraquat-induced inhibition of root regrowth and rETRmax in both stages were the lowest, indicating that these two endpoints were the most sensitive to paraquat. In addition, EC50 values of both endpoints of mature fronds of S. polyrhiza appear to be similar to the current allowable concentrations in drinking water set by the World Health Organization (WHO), indicating that these values may have application for the assessment of toxicity risk of paraquat in aquatic ecosystems.

Anthrahydroquinone-2,6-disulfonate alleviates paraquat-induced kidney injury via the apelin-APJ pathway in rats

Objective:To explore the protective effects of anthrahydroquinone-2,6-disulfonate(AH_(2)QDS)on the kidneys of paraquat(PQ)poisoned rats via the apelin-APJ pathway.Methods:Male Sprague Dawley rats were divided into four experimental groups:control,PQ,PQ+sivelestat,and PQ+AH_(2)QDS.The PQ+sivelestat group served as the positive control group.The model of poisoning was established via intragastric treatment with a 20%PQ pesticide solution at 200 mg/kg.Two hours after poisoning,the PQ+sivelestat group was treated with sivelestat,while the PQ+AH_(2)QDS group was given AH_(2)QDS.Six rats were selected from each group on the first,third,and seventh days after poisoning and dissected after anesthesia.The PQ content of the kidneys was measured using the sodium disulfite method.Hematoxylin-eosin staining of renal tissues was performed to detect pathological changes.Apelin expression in the renal tissues was detected using immunofluorescence.Western blotting was used to detect the expression levels of the following proteins in the kidney tissues:IL-6,TNF-α,apelin-APJ(the apelin-angiotensin receptor),NF-κB p65,caspase-1,caspase-8,glucose-regulated protein 78(GRP78),and the C/EBP homologous protein(CHOP).In in vitro study,a PQ toxicity model was established using human tubular epithelial cells treated with standard PQ.Twenty-four hours after poisoning,sivelestat and AH_(2)QDS were administered.The levels of oxidative stress in human renal tubular epithelial cells were assessed using a reactive oxygen species fluorescence probe.Results:The PQ content in the kidney tissues of the PQ group was higher than that of the PQ+AH_(2)QDS group.Hematoxylin-eosin staining showed extensive hemorrhage and congestion in the renal parenchyma of the PQ group.Vacuolar degeneration of the renal tubule epithelial cells,deposition of crescent-like red staining material in renal follicles,infiltration by a few inflammatory cells,and a small number of cast formation were also observed.However,these pathological changes were less severe in the PQ+sivelestat group and the PQ+AH_(2)QDS group(P<0.05).On the third day after poisoning,immunofluorescence assay showed that the level of apelin in the renal tissues was significantly higher in the PQ+AH_(2)QDS group than in the PQ group.Western blotting analysis results showed that IL-6,TNF-α,NF-κB p65,caspase-1,caspase-8,GRP78,and CHOP protein levels in the PQ group were higher than in the PQ+AH_(2)QDS group(P<0.05).The expression of apelin-APJ proteins in the PQ+AH_(2)QDS group was higher than in the PQ+sivelestat and PQ groups(P<0.05);this difference was significant on Day 3 and Day 7.The level of oxidative stress in the renal tubular epithelial cells of the PQ+AH_(2)QDS group and the PQ+sivelestat group was significantly lower than in the PQ group(P<0.05).Conclusions:This study confirms that AH_(2)QDS has a protective effect on PQ-poisoned kidneys and its positive effect is superior to that of sivelestat.The mechanism of the protective effects of AH_(2)QDS may be linked to reduction in cellular oxidative stress,PQ content of renal tissue,inflammatory injury,endoplasmic reticulum stress,and apoptosis.AH_(2)QDS may play a role in the treatment of PQ poisoning by upregulating the expression of the apelin-APJ.

Edaravone attenuates paraquat-induced lung injury by inhibiting oxidative stress in human type Ⅱalveolar epithelial cells

BACKGROUND:Edaravone(3-methyl-1-penyl-2-pyrazolin-5-one) is a potent free-radical scavenger and has the antioxidant ability to inhibit lipid peroxidation.The study aimed to examine the effect of edaravone on protecting the acute injury of human type II alveolar epithelial cells(A549cells) induced by paraquat(PQ) and the change of production of reactive oxygen species(ROS),malondialdehyde(MDA),superoxide dismutase(SOD).METHODS:A549 cells were cultured and divided into PQ group(group P),edaravone-treated group(group E) and normal control group(group C).The cells in group P were exposed to paraquat(600 umol/L),and the cells in group E were treated with edaravone(100 umol/L) additionally,and no drug intervention was given to the cells in group C.Real-time monitoring by LSCM was used to detect the cell response and the intracellular dynamic change of ROS level in A549 cells after administration of PQ and edaravone.And the levels of SOD and MDA were detected respectively by biochemistry colorimetry.Data were expressed as mean ± standard error of the mean.Statistical analysis was carried out with the soft SPSS 16.0.RESULTS:The concentration of intracellular ROS significantly increased when PQ was given to A549 cells.But after administration of edaravone,the concentration of intracellular ROS was decreased.Compared to the PQ group,the levels of SOD in the edaravone group were significantly increased while the levels of MDA were markedly decreased.CONCLUSIONS:Paraquat can increase the oxidative stress,and induce the lipid peroxidation of A549 cells.Edaravone has the effect to scavenge reactive oxygen species,and to protect against the PQ-induced lung toxicity.

Therapeutic potential of intravenous Xuebijing on transforming growth factor β_1 and procollagen type III peptide in patients with acute paraquat poisoning

OBJECTIVE:Paraquat(PQ) poisoning-induced pulmonary fibrosis causes asphyxiation and death.The therapeutic potential of intravenous Xuebijing therapy in PQ poisoning patients and its underlying immunomodulatory effects on transforming growth factor(TGF)-β1 and procollagen type III peptide(PIIIP) were investigated.METHODS:Thirty-six acute PQ poisoning patients were randomly assigned to conventional therapy(Group A) and intravenous Xuebijing administration plus conventional therapy(Group B).Twenty volunteers served as controls(Group C).Blood samples were collected upon admission(day 0) and at post-treatment days 5,10,and 14.TGF-β1 and PIIIP concentrations were determined by ELISA and analyzed for intra-and inter-group differences over time.One-month follow-up was conducted for determining the mortality rate.RESULTS:TGF-β1 and PIIIP levels were significantly higher in PQ poisoning patients and increased over time(Groups A and B vs C,P<0.01).However,the TGF-β1 and PIIIP levels were consistently significantly lower in Group B compared with those of Group A(P<0.01).The 1-month mortality rate was also lower in Group B compared with that of Group A(P<0.05).PQ poisoning patients showed remarkably high levels of TGF-β1 and PIIIP,which increased as PQ-induced pulmonary fibrosis progressed.CONCLUSION:Treatment with intravenous Xuebijing plus conventional therapy significantly lowered TGF-β1 and PIIIP levels,which indicates therapeutic efficacy in the treatment of PQ poisoning patients.