| Objectives: Endotoxin, named lipopolysaccharide (LPS), is a necessarycomponent of outer membrane from gram-negative bacteria and consists ofthe steam trap of lipid A and hydrophilic polysaccharide. The former is thebiological activity part of LPS, which is discharged after the bacterial lysesd.Acting on the macrophage, endothelial cells and neutrophils of host cell, LPSwill induce and produce the cytokine,such as tumor necrosis factor (TNF-a),interleukin IL-6and IL-1, which affect the temperature regulation center ofhypothalamus. Another way, the endotoxin directs on white blood cells, whichreleased endogenous pyrogen and increased body temperature. Patients withliver cirrhosis and portal hypertension suffer from the intestinal bacterialovergrowth, dysfunction of the intestinal mucosal barrier and the decline ofthe body immunity, so they are prone to bacterial translocation. The mostcommon bacteria is the gram-negative bacteria to oxygen, which comes fromsmall intestine and closely related with the endotoxin in the blood.The blood plasma procalcitonin (PCT) is the precursor of calcitonin, aspecific protease cleaves PCT to calcitonin, catacalcin, and an N-terminalresidue. PCT is normally produced in the C-cells of the thyroid gland,it iscleaved but none is released into the blood stream. PCT levels are thereforeundetectable (<0.1ng/ml) in healthy humans. During bacterial infections, PCTis probably produced by extra-thyroid tissues, Such as the mononuclear cellsand macrophages of liver, lung, endocrine cells and the lymphocytes ofintestinal tissue. The level of PCT changed following with the degree ofinfection. The production of PTC is soon and its half-life is25-30hours.Bacterial endotoxin is the main factor that induces the production of the PCT,and the whole process will be regulated by bacterial endotoxin and severalkinds of inflammatory factors. As a sensitive and specific indicator, the PCT can distinguish bacteria infection from virus infection, and guide theapplication of antibiotics.Portal hypertension can lead to the different parts of varicose veins in theportal venous system. The most common varicose veins are esophageal andgastric varices, which are the most serious and the multiple complications incirrhosis patients with portal hypertension when bleeding. At the present, theendoscopic treatment has become a main measure for treating the esophagealand gastric varices hemorrhage. There are several methods of endoscopictreatment, which includes endoscopic variceal ligation,sclerotherapy andgastric varices injection with human body tissue rubber. The commonmechanism is making vascular occlusive through mechanical or obstruction,so that varicose veins become shrinking or disappearing,and the purpose toprevent rebleeding or stop bleeding will become true. Whether infection willbe happen is a clinical common problem that we should considered afterendoscopic treatment. With the strict disinfection and standardized operationfor endoscope, the operation itself causes the incidence of infection isextremely low. It is not easy to distinguish whether the fever is a kind ofemergency response or bacterial infection after endoscopic treatment.Thesestudy is little at home and abroad. Studies suggest that the plasma endotoxinand procalcitonin were the sensitive indexes for the infections. This study willexplore whether the existence of infection is reflected through the changes ofendotoxin and procalcitonin after esophageal and gastric varces withendoscopic treatment, and provide theoretical basis for the application ofantibiotics.Methods: Patients with liver cirrhosis were randomly divided into thetreatment group and control group. The former based on conventional careadded two days antibiotic treatment. The first day of preoperative and the firstday and the7th day of postoperative, the blood samples were got from fastingin the morning. The endotoxin was detected by gram-negative bacteriumlipopolysaccharide detection kit (photometric method) and the procalcitoninwas detected by double antibody sandwich ABC-ELISA. Results:â‘ The plasma procalciton and endotoxin in liver function withChild-Pugh B+C were much higher than the Child-Pugh A before endoscopictreatment, P=0.000, P=0.000, respectively.â‘¡Thedifferent endoscopictreatment methods, which include endoscopic variceal ligation, sclerotherapy,gastric varices injection with human body tissue rubber and combine witheach other were indiscrimination in both treatment group and control group,the difference were no statistically significant.â‘¢Patients in liver functionwith Child-Pugh A, the plasma endotoxin level in the treatment group was nostatistical significance compared with preoperative,(P=0.085); the plasmaendotoxin level in the control group was significantly increased comparedwith preoperative,(P=0.001), especially on the7th day,(P=0.004). Patients inChild-Pugh B+C, the plasma endotoxin level in the treatment group wassignificantly decreased compared with preoperative,(P=0.000), the first and7th day were more significantly decreased than preoperative, P=0.000,P=0.010, respectively; the plasma endotoxin level in the control group wassignificantly increased compared with preoperative (P=0.000), especially onthe7th day,(P=0.000).â‘£For patients in Child-Pugh A, the plasmaprocalcitonin level in the treatment group was significantly increasedcompared with preoperative,(P=0.030), but the first day and the7th day wereno statistically significant compared with preoperative, P=0.092, P=0.337,respectively; the plasma procalcitonin level in the control group was nostatistically significant compared with preoperative,(P=0.852); For patient inliver function with Child-Pugh B+C, the plasma procalcitonin level in thetreatment group was no statistical significance comparing with preoperative,(P=0.852); the plasma procalcitonin level in the control group wassignificantly increased comparing with preoperative,(P=0.000), the7th daywas more significantly increase than preoperative,(P=0.003).Conclusions:Patients appeared transient fever after endoscopic treatment, most ofthem were low fever, the rates of fever in Child-Pugh B+C were much higherthan that in the Child-Pugh A. Patients in Child-Pugh A should be prudent when planning to use the antibiotics after endoscopic treatment, but patients inChild-Pugh B+C should consider to use antibiotics for prophylaxis as early aspossible, because the procalcitonin and endotoxin level were moresignificantly increased than preoperative after endoscopic treatment. |
PDF Full Text Request