The Prevention And Therapeutic Effect Of Lidan Mixture On Neonatal Intrahepatic Cholestasis Disease

Part 1 Clinical features and TCM treatment of neonatal intrahepatic cholestasis disease caused by Citrin defects(NICCD)Objective :Retrospective summarized 20 cases of neonatal intrahepatic cholestasis disease caused by Citrin defects(NICCD)of the clinical features and TCM syndrome classification,and analyzed the therapeutic effectiveness of Chinese medicine Lidan Mixture,to provide experience in the early diagnosis and treatment of NICCD.Method:Retrospective analysis of the clinical features and traditional Chinese medicine(TCM)syndrome classification of 20 cases of NICCD,confirmed by common genetic loci detection were selected from June 2012 to June 2015 in Department of Integrated Traditional and Western Medicine in Wuhan Children Hospital.The clinical efficacy of Chinese medicine Lidan mixture for treatment of NICCD,before and after treatment,the index changes of liver function and coagulation function were observed and Color Doppler ultrasound was used to detect the situation of hepatosplenomegaly.Results:20 cases all began with pathological jaundice in 3 months,15 cases were clinical recovery after treatment,and the other 5 cases got better.The average hospitalization days were(14.67±1.56)days.After the treatment,serm total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT),total bile acid(TBA)were markedly lower,albumin(ALB)and gross albumin(GLB)were significantly higher[TBil(μmol/L):64.0±39.5 vs.173.5±54.1,DBil(μmol/L):37.7±24.8 vs.80.9±46.4,ALT(U/L):42.1±25.8 vs.55.0±32.2,TBA(μmol/L):67.5±20.3 vs.195.0±61.3,Alb(U/L):37.9±4.7 vs.33.1±4.7,GLB(g/L):17.3±4.0 vs.14.6±2.8,],activated partial thromboplastin time(APTT)of coagulation function was significantly reduced(s: 38.2±8.3 vs.63.1±24.0,P < 0.05).Color Doppler showed that hepatosplenomegaly was shrinkage after treatment hepato--megaly(cm):2.12±0.70 vs.3.04±0.25,splenomegaly(cm):0.25±0.03 vs.0.58±0.32,all P < 0.05].After 1 month of follow up,the infants were almost in normal,and the average of body weight increase was(1.01±0.32)kg,the color and frequency of stool were distinctly better,golden in 15 cases,pale yellow in 5 cases and no white.The frequency of 18 cases were keeping 5 times or less,and fatty diarrhea was better.Conclusion:NICCD in children began with pathological jaundice and other clinical manifestations,and with a series of clinical test abnormalities.TCM syndromes in most cases were qi and blood deficiency type,and the utilization of combined disease with syndrome pattern combined with the use of traditional Chinese medicine could obtain significant clinical effects.Part II The Prevention Effect of Lidan Mixture pretreatment in young rats with intrahepatic cholestasis Objective:To investigate the protective effect of Lidan Mixture in young rats with intrahepatic cholestasis.Methods:A total of 40 young Sprague-Dawley rats were randomly divide into normal,model,Dexamethasone(DXM)group,Ursodeoxycholic acid(UDCA)group and Lidan Mixture(LM)group,with 8 rats in each group(♀4,♂4).The rats in the normal and model groups were given 0.9%Normal saline(NS)by gavage,while the other groups were given different doses of DXM、UDCA、LM.On the 5th day of experiment,alpha-naphthylisothiocyanate(ANIT,50 mg/kg)was applied by gavage to establish the model of intrahepatic cholestasis in all groups except the normal group.All rats were sacrificed 48 hours after gavage.Colorimetry was used to measure the serum levels of total bilirubin(TBIL),direct bilirubin(DBIL),total bile acid(TBA),alkaline phosphatase(ALP),gamma glutamyl transpeptidase(GGT),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)in each group,and ematoxylin-eosin staining was applied to observe the morphological changes of the liver under a light microscope.Results:Compared with the normal group,the model group had significantly increased serum levels of TBIL,DBIL,TBA,ALP,GGT,ALT,and AST(P<0.01).Compared with the model group,the serum levels of TBIL,DBIL,TBA,ALT,and AST of the DXM、UDCA and LM groups showed varying degrees of decreasing(P<0.01).Compared with the DXM、UDCA groups,The LM group’s TBIL、DBIL、TBA、ALP、GGT、ALT、AST had statistically reductions(P<0.05).The model group had the most severe pathological changes.Compared with the model group,the DXM、UDCA and LM groups showed certain improvement in pathological changes of the liver and the LM group had better improvement compared with the DMX and UDCA.Conclusions:Compared with the DMX and UDCA,LM had a better melioration in ANIT-induced intrahepatic cholestasis in young rats.