| Objective: Multiple organ dysfunction syndrome in theelderly (MODSE) is one of the main mortal diseases in agedpatients with high mortality as 75%~100%, but its mechanism isnot yet fully understood. According to current studies, it is thekey to treat early stages of MODSE, like systemic inflammatoryresponse syndrome (SIRS) or sepsis, in order to achievesatisfactory curative effect. Pneumonia in the elderly is currentlyregarded as the main inducement of MODSE in which gut barrierfailure is likely to happen as a result of endotoxemia, long termusage of antibiotic, intestinal mucosa hypoxia, as well asgastrointestinal microflora changes caused by aging. Endotoxintranslocation following gut barrier failure can promote thedevelopment of MODSE. The study is conducted to investigatethe role of endotoxin in SIRS induced by pneumonia in agedpatients, whether gut barrier failure occurs in elderly patientswith pneumonia induced SIRS, the protective effect of BifidTriple Viable capsules on gut barrier, and to provide clinicalexperiential basis for the prevention of MODSE in early stageusing probiotics.Methods: From May 1st, 2004 to January 20th, 2005, 37aged patients (age ≥60y) with pneumonia admitted to therespiratory diseases division of Hebei Provincial People'sHospital were enrolled in the present study randomly. The studyexcluded those who had taken antipyretic –analgesic drugs onselecting day and those who were accompanied with major organfailure except respiratory failure and cor pulmonale. According toSIRS criteria, the patients were divided into SIRS group (n =27)and non-SIRS group (n=10). Then SIRS group was separated intotwo groups at random. One is control group (n=14) treated withgeneral therapy including antibiotic treatment, oxygen therapy,the use of antipyretics and antitussives and the like. Another isBTV group (n=13) treated with Bifid Triple Viable capsules inaddition to general therapy. In BTV group Bifid Triple Viablecapsules were taken orally continuously for 7 days in dosage oftwo capsules one time, three times one day. In addition to sputumculture examination, the venous blood in all of patients wasphlebotomized before therapy and after seven-day therapy. Theplasma was divided to determine endotoxin (ET) by kineticturbidimetric technique and to determine the level of diamineoxidase (DAO) by spectrophotometer. SAS 6.12 statisticalsoftware was used to analyze the data. All of the values areexpressed as mean±SD. Linear correlation, t test and chi-squaretest (Fisher's exact test) were used for statistical analysis.Differences were considered to be statistically significant when Pvalue was less than 0.05.Results: ⑴ET and DAO in SIRS group and non-SIRSgroup: The ET concentration is (0.316±0.237)EU/ml in SIRSgroup and (0.134±0.037)EU/ml in non-SIRS group. The level ofET in SIRS group is higher than non-SIRS group (P <0.01). Thelevel of DAO in SIRS group [(2.94±1.43) u/ml] was nosignificant difference compared with non-SIRS group [(2.92±1.58)u/ml](P>0.05). ⑵The correlation between ET and DAO inSIRS group: There exists a statistically significant linearcorrelation between ET and DAO in SIRS group after one-weektreatment (r=0.766, P<0.05), which isn't found in SIRS groupbefore treatment (r=-0.375, P>0.05). ⑶ET and DAO in BTVgroup before and after therapy: The ET level decreasedsignificantly from (0.341 ±0.264) EU/ml to (0.143 ±0.029)EU/ml (P<0.05). The DAO level after therapy [(2.57±0.34)u/ml] is similar with that before therapy [(3.16 ±1.53)u/ml](P>0.05). ⑷ET and DAO in control group before andafter therapy: The level of ET is no significant differencebetween before therapy [(0.293±0.216)EU/ml] and after therapy[(0.222±0.049)EU/ml](P>0.05), while the DAO level increasedmarkedly from (2.73±1.35)u/ml to (4.52±1.10)u/ml(P<0.05).⑸ET and DAO in BTV group and control group: The differencesof ET and DAO in two groups is not significant before therapy(P>0.05). The level of ET and DAO are significantly lower inBTV group than those in control group after therapy (P<0.01).Conclusion: Gut may be one of the important sources ofendotoxin that involves in the development of SIRS in elderlypatients with pneumonia, particularly at later stage. Bifid TripleViable capsules taken on the base of general therapy can preserve...
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