The Role Of Intestinal Endotoxemia In The Development Of Traumatic Shock And Obstructive Jaundice

Both traumatic shock and obstructive jaundice (OJ) companied with intestinal endotoxemia (IETM). It could activate the mononuclear phagocytes to release lots of inflammatory mediators, cytokines and nitric oxide to insult the liver. Furthermore, the secondary hepatic injury may deteriorate traumatic shock or accelerate obstructive jaundice to develop into hepatic fibrosis. However, the mechanism of IETM keeps unclear and needs to be further studied.The paper includes three parts. (1) The role of IETM in both traumatic shock and obstructive jaundice. (2) The effects of lipopolysaccharide-binding protein(LBP), cluster differentiation 14(CD14), scavenger receptor(SR) and nuclear transcriptive factor kappa B(NF-kB) on the secondary .hepatic injury derived from both traumatic shock and obstructive jaundice. (3) The effects and mechanism of glycine(Gly) on IETM.There are three experiments in the first part.Experiment one: The objective is to investigate the role of IETM in traumatic shock. A model of traumatic shock was employed. The rats were randomly divided into sham and shock group. The rats were harvested after resuscitation from shock by Oh, 6h, 12h and 24h respectively. Plasma ALT, endotoxin(ET), TNF-a , mortality, the phagocytic index and the permeability of terminal ileum were observed. Plasma ET and ALT of the patients with both the hemorrhagic shock and traumatic shock were clinically tested simultaneously. The mortality of each shock group after the resuscitation from traumatic shock significantly increased. Plasma ET, TNF-a and ALT were all increased and showed positive correlation among them. The phagocytic index of KC was markedly decreased at the same time. The permeabilityof terminal ileum was much higher and the Lanthanum (La) particles were observed among the intestinal cells. Plasma ET and ALT of the shock patients were also increased and positively correlative. Taken together, it is concluded that traumatic shock companied with either IETM or the secondary hepatic injury. The formation of IETM may be the increased intestinal permeability and the weak phagocytic function of KC.Experiment two: The objective is to study the effects of IETM on obstructive jaundice and the secondary hepatic injury as well as the effects of Salvia Miltiorrhiza(SM) on IETM. With the model of obstructive jaundice in rats and mice respectively, the rats were randomly divided into sham, ligation 7 day (L7), ligation 14 day (L14), SM7 day and SM14 day groups. The mice were randomly divided into sham L7, L14, L28, L36 groups.Plasma ALT, AST, ET and hepatic TNF-a were tested. The permeability of terminal ileum was observed. With the prolongation of obstructive jaundice, plasma ET, TNF- a , ALT and AST were all increased and were positively correlative. The permeability of ileum was significantly increased and La particles were also observed among the intestinal cells. SM markedly improved the intestinal permeability and the secondary hepatic injury. The results suggested that obstructive jaundice company with either IETM or the secondary hepatic injury. The mechanism of IETM is correlated with the increased intestinal permeability. SM may ameliorate IETM and the secondary hepatic injury.Experiment three: The objective is to further investigate the role of IETM in the development of hepatic fibrosis after obstructive jaundice. The model of hepatic fibrosis with obstructive jaundice was employed in mice. The relation between IETM and hepatic fibrosis was studied. If the exogenous ET could facilitate the development of hepatic fibrosis was also evaluated. The results suggested that with the prolongation of obstructive jaundice, the hepatic fibrosis got much serious. Plasma ET and hepatic TNF-a got increased and were positively correlative. The exogenous ET could accelerate the hepatic inflammatory reaction and fibrosis.Part two: Based the first part, we pay more attention to how IETM works in traumatic shock, obstructive jaundice and hepatic fibrosis. There are two experiments in this part.Experiment four: The obj...