| Background: Acute cholangitis of severe type (ACST) is the most severe diseaseof biliary tract infection, which is characterized by sudden occurrence, rapid changewith many complications and high mortality. Sepsis and subsequent multiple organdysfunction syndrome (MODS) induced by ACST is the direct cause of death. By overreleasing of cytokine and mediators of inflammation, the sepsis caused by bacteria andlipopolysaccharide (LPS) become the key point of pathophysiological change of ACST,and the mechanism and its management are hot spots of current researches. In theprogression of MODS caused by ACST, the damage of liver is believed to be theprominent process, and may be an important site of intervention. Objectives: To study the optimal methods of setting up rat ACST model and thebest way of biliary tract drainage for treatment; to observe the changes of white bloodcell (WBC), platelet (PLT), alanine aminotransferase (ALT), bilirubin (BIL), LPS,tumor necrosis factor α (TNF-α) and nitric oxide (NO) in ACST rats; to study thesignificance of LPS, TNF-α, NO, nuclear factor κB (NF-κB) in the pathogenesis ofACST and their effects to liver damage; to observe the pathological change of liver, thelevel of caspase-3 expression and the rate of hepatocyte apoptosis, so as to find out themechanism and form of liver damage during ACST; to investigate the effects andmechanism of integrated traditional and western medicine approach to ACST rats, andto provide the experimental basis in its possible application to clinical therapy. Methods: 104 healthy SD rats (half male) were divided into eight groups: (1) shamoperation (SO) group: the common bile duct was separated only; (2) ACST group: themodel of ACST was made; (3) simple drainage (SD) group: drainage was applied inACST model; (4) simple herb (SH) group: Qingdan Decoction was applied in ACSTmodel; (5) simple antibiotics (SA) group: antibiotics was applied in ACST model; (6)drainage + herb (DH) group: drainage and Qingdan Decoction were applied in ACSTmodel; (7) drainage + antibiotics (DA) group: drainage and antibiotics were applied inACST model; (8) drainage + herb + antibiotics (DHA) group: drainage, QingdanDecoction and antibiotics were applied in ACST model. The samples were taken at the48th hour after operation, and the mortality was calculated; routine blood test wasdetected by automated hematology analyzer; serum LPS concentrations were measuredby quantitative chromogenic LAL test; serum TNF-α concentrations were determinedby radioimmunoassay method; serum NO concentrations were analyzed by nitratereductase method; serum ALT, D-bil, I-bil were measured by automatic biochemistryanalyzer; histology of liver was examined with light microscope; the expressions ofNF-κB and caspase-3 in hepatocyte were detected by immunohistochemical method;apoptosis of heaptocyte was detected by TUNEL method. Rusults: 1. No death in SO group was observed. The mortality in ACST group was thehighest(50%), and the second was SH group(43.8%), there was no significant differencebetween these two groups (P>0.05). Compared with ACST group, the mortality of SD,SA, DH, DA and DHA group decreased significantly (P<0.01), the mortality in DHAgroup was the lowest (8.3%). 2. The WBC in ACST, SH and SA group was significant high compared with SOgroup (P<0.01,P<0.01,P<0.05 respectively); the WBC in SD, DH, DA and DHA, thedrainage groups decreased significantly compared with ACST group's, and there was nosignificant difference compared with SO group's. 3. The PLT in all biliary tract infection groups decreased significantly comparedwith that in SO group; the PLT in all drainage groups increased significantly than thosein no drainage groups (P<0.05). The PLT in antibiotics therapy groups was higher thanthat in herb therapy groups (P<0.05). 4. The serum ALT in ACST, SD, SH and SA groups was higher than in SO group(P<0.01). The serum ALT in other groups was lower than in ACST group except for SHgroup (P<0.05). The ALT in drainage groups decreased significantly compared withthose in no drainage... |
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