| Obstructive jaundice (OJ) is caused by the mechanical blocking of bile duct system which results in malfunction of bile drainage, the bile can not pass into duodenum through the bile duct and the bilirubin in the bile reflux into blood.Clinically when the bile duct obstruction has been happened for a period of time, it leads to hepatatrophia, reduction of hepatocyte, fribinotophy of hepatic tissue, and finally results in destruction of liver function. To cure obstructive jaundice is mainly adopt operation to treat the obstruction but the case fatality rate still up to 16%-30%after the operation.Objective: To evaluate the protective effect and mechanism on liver function, we choose 'damp-heat removing and liver comforting' herbs for this study after referring to the literature. To study the effect of this kind of herbs on the treatment during the perioperational period, to find out if it can play an important role to reduce destruction effect on liver function and lower the rate of hepatic failure and the fate of death in the postoperational period. In the animal experiment by using molecular biology, from the point of hepatocyte-apoptosis, screening the relative genes BCL-2, TNF-R1, PKC, interferencing the expression of the relative genes by using the damp-heat removing and liver comforting' herbs, to discuss wheter the herbs cam inhibit thehepatocyte-apoptosis to protect the liver function.Methods:Partâ… : Clinical study1. Randomly chose 60 causes according to the criteria for obstructive jaundice, 30 cases by using the' damp-heat removing and liver comforting' method (the experimental group) and the other 30 cases by using the regular treatment (the control group).2. Estimate the effective index by rvaluating the cardinal symptoms after 5 days of preoperational treatment, to compare the effective index before and after the treatment respectively for inter-group comparison, to compare the total effective rate between two groups.3. Collect the biochemistry index of ALT, AST, TBIL 5 days before operation, and at the day of operation (pre-operational), abd 7 days after operation.Partâ…¡: Animal experiment1. Select 100 Wister Rats and divided into 10 groups randomly. One group for false operation (killed after 3 days), one group for operation without adding any factor(killed after 3 days), 4 herbal groups which were killed at the 3rd, Tth, 14th, 21st days after the treatment respectively, 4 saline groups which were killed at the 3rd, Tth, 14th, 21st days after the treatment respectively.2. Examine the bilirubin level of the false operation group and the operation group after the death of the rats, confirming the success model making by comparing the bilirubin level between two group.3. Gatriclysis the rats with the damp-heat removing and liver comforting' herbs (Shu-dan tang) in the herbal group. Gastriclysis the rats with 0.9% saline in the saline group and the rats were killed at the 3rd, Tth, 14th, 21st days after the treatment respectively, bilirubin level were examined in two groups and to observe the change.4. Colour and fix the hepatic tissue to make the specimen, make the original place test of the hepatocyte apoptosis by using Tunnel method. Examine the expression of PKC, BCL-2, TNF-R1, with immunohistochemical SABC method.Result:Partâ… : Clinical study result1. There is obvious improvement in the symptoms after treatment in experimental group before the operation to compare with the control group, it has shown obvious statistic significance.2. The inter group comparison of symptoms before and after the treatment shown obvious statistic difference, the total effective rate is 86.7 %inexperimental group and the total effective rate is 53.33 % in the control group.3. Biochemical index of AST, ALT level were lowered obviously in the herbal group during the preoperational period, the inter group comparison and comparison with control group both shown the statistic significance.4. The AST, ALT, TBIL levels had been reduced dramatically in the comparison between 5 days before operation and 7 days after operation groups. There was statistic significance in the comparison between experimental group and control group 7 days after operation.Partâ…¡: Animal experiment1. The expression of PKC, BCL-2, TNF-R1 had been raisen as time went by in both herbal group and saline group. There was obvious statistic significance in the comparison between the herbal and control groups in day 14th.. It shown significant suppression on the TNF-R1, PKC expression and significant facilitation on BCL-2 expression.2. The hepatocyte apoptosis index had been raisen as time went by and reached the peak in both herbal and saline groups. The hepatocyte apoptosis index was always lower in herbal groups which comparing to the saline groups in different period, it shown obivous statistic significance.Conclusion:Clinical application of damp-heat removing and liver comforting' herbs on the obstructicve jaundice patients in the perioperational period can obviously improve their liver function to give protective effect on the liver; results in the animal experiment had proved the herbs can suppress PKC, TNF-R1 expression and facilitate BCL-2 expression; reduce hepatocyte apoptosis at the same time. By using the molecular biology, it also proved the herbs has superior function in reducing liver function damage.
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