| Background: Multiple organ dysfunction syndrome (MODS) is a clini- cal syndrome, which may be induced by severe infection, trauma, shock and major operation. In MODS there are two or more organs dysfunction simultaneously or successively, MODS is characterizing with hypermetab- olizability, hyper-circulation, immoderate and out of controlled infla- mmatory response and organ dysfunction, and is a main cause of the death of patients with abdominal surgical diseases. Modern viewpoint about MODS is that it develops from systemic inflammation response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CA-RS). The gastrointestinal tract is considered the initiation and target organ and position, and the condition of gastrointestinal motility is thought to be the criterion of evaluation the prognosis of severely injured pat- ients. So, restoring the function of gastrointestinal motility can effectively prevent the development of MODS. Interstitial cells of Cajal (ICC), which exten- sively distribution in the each segment and muscular laye of gastrointestinal tract, connects with eacg other, forming network-like struction. As far, it is believed that there are three major functions in ICC. The first, ICC is the pacemaker cells of the gastrointestinal tract, which can produce and condunt the physiological slow wave, and controll the smooth muscle of the gastrointestinal tract. The second, ICC is the medium of the nerve singal conveying from the enteric nerve system (ENS) to the smooth muscle of the gastrointestinal tract. The third, ICC facilitates the propagation of electricity activity.The nerve ending of ENS, ICC and smooth muscle cell (SMC) connecte each other, form network struction, and constitute the basic functional unit ofgastrointestinal motility (BFUGM). ENS-ICC-SMC network has important relationship with gastrointestinal motility dysfunction.Objective: to make the model of MODS in rats induced with bacterial peritonitis, observing the morphological changes of ENS-ICC-SMC network in the model of rats with MODS, and the therapeutic effects of Da-Cheng- Qi-Tang (DCQT).Methods: One handred Wistar rats of both sexes weighing 200 to 250g were randomly divided into three groups:control group (n=20), MODS group (n=40) and DCQT treated group (n=40). The model of MODS was esta- blished according to previous study. Briefly, 1 ml suspension of 8×108 cfu/ml of Escherichia coli strain O127H6, which contained 10% BaSO4, was injected under sterile conditions into the abdominal cavity of the rats in the MODS and DCQT group.The rats of control group were injected 1ml of normal saline.The rats of DCQT treated group were administrated by gavage with DCQT (twice a day) before the suspension was injected. Twenty-four hours after injection, the proximal 10cm segment of jejunum beginning 2cm distal to the pylorus,was studied using the antibody of c-kit, vesicular acetylcholine transporter (VAChT), substance P (SP), vasoactive intestinal polypeptide (VIP), substance P (SP), and neuronal nitric oxide synthase (nNOS), and immunohistochemical double- staining with wholemount preparation technique. The confocal laser scanning microscopy and trans- mission electron microscope were used.Results: Anatomical changes Compared with those in control group, the gastrointestinal tracts were distended significantly in the rats with MODS. Compared with the MODS group, the changes in rats with DCQT was markedly alleviated.Immunofluorescence Compared with the control group, the quantity and the integrity optical density (IOD) of ICC-DMP of intestine in MODS group were significantly decreased (P<0.01), the ICC-DMP network was significantly disrupted. After treatment with DCQT, the ICC-DMP network was significantly recovered. Compared with MODS group, the quantity and the IOD of ICC-DMP of intestine in DCQT group were significantly increased (P<0.01). The ICC network was basicly maintained. Compared the MODS group with the control group, the quantity and the IOD of cholinergic nerves (ach)/substance P (SP)/vasoactive intestinal polypeptide (VIP)/nitrergic nerves (NO) were significantly decreased (P<0.01), the never network was significantly disrupted.After treatment with DCQT, the nerve network was significantly recovered. Compared with MODS group, the quantity and the IOD of cholinergic nerves(ach)/substance P(SP) /vasoactive intestinal polypeptide (VIP)/nitrergic nerves (NO) of intestine in DCQT group were significantly increased (P<0.01). Compared the MODS group with the control group, the ENS-ICC-SMC network was significantly destructed. After treatment with DCQT, the ENS-ICC-SMC network was significantly recovered, and the network struction was basicly maintained.Conclusions The gastrointestinal tracts of the rats with MODS induced by bacterial peritonitis were significantly distention, and the syndrome of intestinal obstruction was remarkable. DCQT could alleviate the distention and syndrome of enteroparalysis significantly.ICC-DMP network was severely damaged in rats with MODS. DCQT could protect ICC-DMP and basically maintain the ICC-DMP network. The number cholinergic/substance P/vasoactive intestinal polypeptide/nitrergic nerves were reduced in MODS, the enteric nerve-ICC network was damaged significantly. DCQT could prevent the decreasing of the enteric nerve, and the struction of network in ENS-ICC-SMC was significantly damaged in rats with MODS. DCQT could basically maintain the network of ENS- ICC-SMC. |
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