| Paper OneThe Study on the Mechanism of Human Immune Imbalance Induced by the Severe Intra-abdominal InfectionsObjective:To explore the mechanism and rule of the immune imbalance of the patients who have multiple organ dysfunction syndrome (MODS) induced by the severe intra-abdominal infections.Object and method:46 patients with MODS, who are 24 males and 22 females with a median age of 57.4±10.5 years old(range 36～73 years), have been continuously observed. It has been fund that their average APACHE-Ⅱscore are 14.5±5.62. Based on their APACHE-Ⅱscores, the patients were divided into the light, medium, severe and extreme severe groups on the first day after they were internalized. All the cases were applied with etiological and syndrome differential treatment in the way of combining the TCM with Western medicine. On the 1st, 3rd and 7th day after they were internalized, we observe their APACHE-Ⅱscore; the examination of the endotoxin (ET), the tumor necrosis factor-α(TNF-α), the interleukin-6(IL-6), the interleukin10 (IL-10), the human leucocyte antigen DR site (HLA-DR), the helper T lymphocyte 1/2(Th1/Th2) and the regulatory T lymphocyte in the peripheral blood; the examination of the lactulose/mannitol (L/M) in the urine. Besides, we record the patients' recovery to calculate the ultimate indexes, such as the mortality in the 28 days, the hospital days in the SICU, the total hospital days and the cost of the hospitalization.Result:The average hospital days in the SICU are 11.06±5.40, and the average total hospital days are 18.58±5.61. Addtionaly, the cost of the hospitalization is 9.73±4.23 and the mortality in the 28 days is 13.04%. But the mortality of the patients whose APACHE-Ⅱscores exceed 15 increases sharply. The prognosis, such as length of hospital stay(L.O.S.) in the SICU, the total hospital days and the cost of hospitalization and so on, of the patients whose APACHE-Ⅱscore exceeds 10 is comparatively bad. The L/M and ET of the patients whose APACHE-Ⅱscores are less than 16 in the light and medium group decreases in one week, but the patients in the severe group descend unclearly.As the pathogenic condition aggravates, the level of the TNF-αand IL-6 increases, otherwise the level of the IL-10 does not descend obviously as expected for the patients in the severe group and the HLA-DR antigen presentation decreases for the critically ill patients. The level of the Treg increases as the ratio of the Th1/Th2 descends.Conclusion:The intestinal barrier dysfunction and the intestinal endotoxemia induced by the severe intra-abdominal infections aggravate the systematic inflammatory response and lead to severe immune imbalance. It is shown in the clinical cases that the immune function of the patients in the light group recovers slightly, however, for the patients in the middle group, it has a downturn in a week, and the patients in the severe group have a significant immune dysfunction, which aggravates unceasingly. When it turns to the patients in the extreme severe group, it stays in a severe inhibitory state. All of these above make the infections hard to be controlled further and eventually cause the impairment of the multi-organ function other than the intestinal tract, which forms and aggravates MODS. Paper TwoThe Syndrome Differentiation and the Treatment Effects of TCM and Western Medicine of Severe Intra-abdominal InfectionsObjective:To conduct an exploratory study on the distribution rule of the TCM pattern of the syndrome and their changing characteristics of the patients with MODS induced by the severe intra-abdominal infections, and to observe the Efficacy of the syndrome differentiation and treatment variation in the way of combining the TCM with western medicine.Object and mothod:We apply the eight principal syndrome differentiation to observe the 46 patients with MODS induced by the severe intra-abdominal infections in the SICU, and use the syndrome differentiation and treatment variation in the TCM based on the different pattern of syndrome at the same time of the etiological and symptomatic treatment①The treatment of the sthenia syndrome is mainly achieved by TongliGongxia and uses complex DaChendQi powder preparation for infusion;②The treatment of the asthenia syndrome is achieved by enhancing immunity and adopts ShenQiFuZheng injection;③The treatment of the asthenia mixed with sthenia syndrome is achieved by enhancing immunity so as to eliminate pathogens and simultaneously apply purging-tonifying therapy and uses DaChendQi powder preparation for infusion and ShenQiFuZheng injection;④The treatment of the Yin exhaustion is achieved by retonifying Qi to retain Yin so as to produce body fluid that greatly nourish the renal Qi, and uses ShenMai injection;⑤The treatment of the Yang exhaustion is also achieved by boosting the Qi to prevent collapse and restore the Yang, and use ShenFu injection. We observe and record the changes of the TCM pattern of syndrome on the 1st,3rd,7th day after being internalized and add up the case fatality rate of all the patients in the 28 days.Result:On the 1st day, all the patients are characterized by interior-sthenia-heat syndrome and asthenia mingled with sthenia syndrome. Besides, on the 3rd and 7th days, they have major asthenia and sthenia syndrome, and then the interior-sthenia-heat syndrome and the interior-asthenia-heat syndrome. The cold syndrome with internal asthenia and the Yin exhaustion/Yang exhaustion are few and interior-sthenia-cold syndrome is rarely seen; On the 3rd day,39.13% sthenia syndromes transforms to asthenia syndromes and 34.78% sthenia syndromes transform to asthenia mingled with sthenia syndromes.15.79% asthenia mixed with sthenia syndromes transforms to asthenia syndromes. On the 7th day,28.57% asthenia syndromes transforms to asthenia mingled with sthenia syndromes. The interior-sthenia-heat syndromes decrease gradually following the aggravation of the pathogenic conditions, and the interior-asthenia-heat syndromes have a tendency of increasing. The patients with sthenia syndrome on the 1st day has a high mortality in 28 days, and the patients with asthenia syndrome on the 7th day has a high mortality in 28 days, and he patients with asthenia syndrome on the 7th day has a obviously high APACHE-Ⅱscore.Conclusion:It has some clinical significance to predict the development tendency and the prognosis of the septic MODS induced by the severe intra-abdominal infections. It draws a conclusion that Chinese herbal medicine effectively cures the patients, who has MODS induced by the severe intra-abdominal infections in abdominal surgery, based on differentiation of symptoms and signs. Paper ThreeThe Study on the Relationship between Immune Imbalance Induced by Severe Intra-abdominal Infections and Syndrome DifferentiationObjective:To explore the connections between the immune imbalance characteristics of the patients with MODS induced by the.severe intra-abdominal infections and the rule of differentiation of symptoms and signs for classification of syndrome in TCM, which integrate fully their both advantages and contribute to the instruction in clinical treatment.Object and approach:The 46 adult patients, who have MODS induced by the severe intra-abdominal infections, have been observed continuously and we apply the etiological and syndrome differentiation treatments in the way of combining the TCM and Western medicine to them. On the 1st,3rd and 7th day, we examine the ratio of the interleukin-6 and interleukin-10 (IL-6/IL-10, the human leukocyte antigen DR site(HLA-DR), the helper T lymphocyte1/2(Th1/Th2), and the regulatory T lymphocyte (Treg). In the meantime, we aslo observe the distribution rule of the TCM pattern of syndrome, such as sthenia syndrome, asthenia syndrome, asthenia syndrome mingled with sthenia syndrome and so on.Result:The. IL-6/IL-10 bears no clear difference in any time between the sthenia syndrome and asthenia syndrome and it decreases for the asthenia syndrome on the 7th day, compared with the 1st day. The comparison of the same time point indicates that the IL-6/IL-10 descends sequentially from the sthenia syndrome, asthenia syndrome mingled with sthenia syndrome to asthenia syndrome. The level of the HLA-DR descends sequentially from the sthenia syndrome, asthenia syndrome mixed with sthenia syndrome to asthenia syndrome. But there is no patients whose HLA-DR is less than 30% in the sthenia syndrome and asthenia syndrome mingled with sthenia syndrome and all the HLA-DR is less than 30% on the 7th day and has a predominant difference compared with the 1st day for the patients with asthenia syndrome. The Th1/Th2 has no specific difference in the former three days in the sthenia syndrome and asthenia syndrome, and it descends on the 7th day compared with the 1st day, and the asthenia syndrome mingled with sthenia syndrome has no change in one week. The comparison of the same time point finds that the Th1/Th2 descends sequentially from the sthenia syndrome, asthenia syndrome mingled with sthenia syndrome to asthenia syndrome. The level of the Treg has no obvious difference in the previous three days in the sthenia syndrome and asthenia syndrome mingled with sthenia syndrome and it rises up for the asthenia syndrome on the 3rd day compared with the 1st day, and there is no big difference between the 3rd day and the 7th day. The comparison of the same time points proves that the level of the Treg increases sequentially from the sthenia syndrome, asthenia syndrome mingling with sthenia syndrome to asthenia syndrome.Conclusion:In the pathological process of the MODS induced by the severe intra-abdominal infections, the IL-6/IL-10 which reflects the balance of the pro/anti-inflammatory cytokine and the HLA-DR, Thl/Th2 and Treg which shows that the immune function can all exactly reflect the change of the asthenia-sthenia pattern of syndrome of the TCM, and the IL-6/IL-10, HLA-DR and Th1/Th2 descend in order but the Treg increases in order among the sthenia syndrome, asthenia syndrome mingled with sthenia syndrome and asthenia syndrome.
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