Effects Of Jiedu Huayu Tongfu Decoction On Endotoxin And TLR4/NF-κB Pathway In Patients With Subacute And Chronic Acute Liver Failure

Objective: Through the comparison of the SALF&ACLF patients before and after treatment,clinical symptoms,liver function(ALT,AST,ALP,GGT,ALB,TBIL,CHE),coagulation(PTA),to observe the clinical effect of Jiedu Huayu Tongfu Decoction on SALF&ACLF patients.A comparison of the experimental group and the control group of patients before and after treatment(endotoxin,inflammatory factor TNF-a,IL-6,TLR4 m RNA,NF-κBm RNA,to further analyze the Jiedu Huayu Tongfu Decoction on SALF&ACLF of TNF-α and IL-6,endotoxin,TLR4 m RNA,NF-κBm RNA,to explore the mechanism of the treatment of SALF&ACLF.Methods: Taking 68 cases of SALF or ACLF patients as the research object in the Digestive Department of the First Affiliated Hospital of Henan University of traditional Chinese medicine and the Department of infectious diseases of Henan Province People’s Hospital.They were randomly divided into two groups,the experimental group and the control group,each with 34 cases.The control group was treated with western medicine,while the experimental group was treated with Jiedu Huayu Tongfu Decoction on the basis of the control group.The course of treatment was 30 days.The serum liver function,coagulation function and clinical symptoms were observed before and after treatment,and detecting serum endotoxin,TNF-a,IL-6 and TLR4 m RNA,NF-κBm RNA to observe the changes of the level.Results: 1.Patients in the two groups after treatment were compared with before treatment,TCM syndrome score decreased significantly,and the experimental group compared with the control group decreased more significantly,there was statistical significance(P<0.05).2.Two groups of patients after treatment,serum TBIL,DBIL levels before treatment were significantly decreased,and the experimental group after treatment,TBIL,DBIL level decreased significantly better than the control group,there weresignificantly different(P<0.05).After treatment,serum CHE levels were increased compared with before treatment,experimental group after treatment CHE level was slightly higher than that of control group,but no statistical significance in two groups after treatment(P>0.05).After treatment,serum ALT,AST,ALP,GGT,WBC levels than before treatment were decreased,and P<0.05,the difference was statistically significant;The difference of the two groups after treatment was no statistically significant difference(P>0.05).The serum ALB levels of patients in the two groups after treatment were higher than those before treatment,and P<0.05,the difference was statistically significant,the difference of serum ALB level after treatment between the two groups was not statistically significant(P>0.05)3.Comparison the serum PTA levels With before treatment,that was significantly increased by after treatment in two groups,and the test group patients increased the level of PTA was significantly better than the control group,there was statistical significance in two groups(P<0.05).4.The serum endotoxin level before and after the treatment in two groups were higher than those in healthy control group,the difference was statistically significant(P<0.05).The serum endotoxin,TNF-α and 1L-6 levels were significantly decreased after treatment in two groups,and the experimental group decreased more significantly,there was statistical significant differences(P<0.05).5.In the test and control groups,the expression of TLR4 m RNA,NF-κBm RNA levels were higher than the healthy group before and after,the difference was statistically significant(P<0.05).TLR4 m RNA,NF-κBm RNA expression levels were decreased compared with before treatment in the test and control groups,and the experimental group decreased more significantly,there were statistically significant(P<0.05).Conclusion:1.Jiedu Huayu Tongfu decoction can improve the clinical symptoms of SALF&ACLF patients,improve the metabolism and synthesis function of liver.2.Jiedu Huayu Tongfu prescription may promote excretion or inhibit the absorption of SALF&ACLF of endotoxin,reduce the liver toxicity from endotoxin,improve liver injury.3.Jiedu Huayu Tongfu may impact the TLR4/NF-κB signaling pathway by lowering the serum endotoxin level of the patients,to reduce the release of inflammatory cytokines such as TNF-a,IL-6 and cut down the damage of liver cells,and to treat SALF&ACLF.