The Role Of Gut Barrier In The Course Of Compensated To Decompensated Cirrhosis In Rats

Aims: Cirrhosis is an irreversible alteration of the liver architecture, consisting of hepatic fibrosis and areas of nodular regeneration. According to the symptom and complications the cirrhosis are divided into compensated and decompensated stages. Referred to Child-Pugh classification, which was used frequently nowadays in clinical, Child A match to compensated cirrhosis, Child C to decompensated cirrhosis and Child B was intergrade. Although there were great many effective remedies in dealing with cirrhosis and its complications, we were always baffled with what's the main course in aggravating outcome of the liver disease,especially how compensated cirrhosis run down to decompensated cirrhosis. Intestinal endotoxemia (IETM) hypothesis, proposed by professor Han De-wu through 20years exploring, gives us highlights to the core mechanism of liver disease. In order to enrich the IETM theory, we designed a series experiments trying to make out the role of gut barrier in the course of compensated to decompensated cirrhosis. And we hope the study would give a new idea to clinician in dealing with cirrhotic patients.Methods and results: The study was carried out in three parts.The first part was to explore the relationship between intestinal permeability and IETM in cirrhotic rats induced by composed factors. There were four experiments in this part, in which we studied the relationship between the Child-Pugh classification and portal endotoxin, the relationship between different probes and portal endotoxin, the role of kupffer cell in systemic endotoxemia and the relation between gut flora and portal endotoxin respectively. The cirrhotic model we used was induced by complex pathogens. At 0,6 and 10 weeks Child-Pugh degree was evaluated and the level of portal plasma endotoxin, FITC-D and HRP-II was detected. The phagocytosis of Kupffer cells was evaluated by injection of Indian ink via tail vain and the ileum flora was studied by direct smear and Gram stain.The liver tissues were examined by H-E stain and electronic microscope.The result showed: (1)Portal endotoxin had positive correlation with Child-Pugh classification during the course of cirrhosis(r=0.680,P<0.01). Which means higher level of portal endotoxemia had effect on different stages of cirrhosis. (2) Portal FITC-D and HRP-II was correlated with portal endotoxin and Child stages. (3)The difference was obvious at different stages of cirrhosis in phagocytosis of Kupffer cells, as assessed by histological examination of the liver tissues after Indian ink injection via the tail vein. The particle of carbon phagocyted by kupffer cells was larger and distributed badly at 6 and 10 weeks of cirrhosis. And the phagocytotic index was correlation significantly with portal endotoxin. (4)The flora of terminal ileum, estimated by index of coccus/bacillus, and G+/G—, was...