| Background: Acute abdomen is a clinical symptom complex in surgery, which is characterized by sudden occurrence, rapid change, many complications and high mortality. Sepsis following acute abdomen is rather ominous and septic shock mainly contributes to its mortality. There were about 750,000 patients with sepsis each year and over 225,000 patients were dead according to the latest statistics from American Center of Disease Control. Generally speaking, it was not the continuous presence of bacteria and toxin but the response of organism which played a key role in the development and severity of sepsis. Bacteria and toxin merely initiate the process, while the excessive response exerted dominant effects.Objectives: This research would investigate the significance of endotoxin, TNF- a, sCD14 and activation of monocytes in the pathogenesis of sepsis, and delineate the effects of Fufang Qingxia Decoction by examining the kinetics of serum or plasma concentrations of endotoxin, TNF- a ,sCD14 and the expression of TNF- a mRNA, CD14 mRNA in peripheral blood monocytes in patient with acute abdomen accompanying sepsis.Methods: 38 patients with acute abdomen accompanying sepsis were enlisted in this study. All the patients were randomly divided into two groups. One receiving routine treatment served as group A, and the other additionally treated with Fufang Qingxia Decoction served as group B. 10 healthy individuals were selected as normal control(groups C). All the patients had APACHE II scores assessed. Peripheral blood was obtained within 24h, on 3rd and 7th days. Serum concentration of sCD14 was determined by sandwich ELISA; TNF- a was examined by radioimmunoassay method.Plasma endotoxin was measured using a quantitative chromogenic LAL test. The total RNA was extracted from isolated peripheral blood monocytes, and the gene expression of TNF- a and CD 14 was evaluated by semiquantitive RT-PCR. Results:1. Compared with group C, significantly increased plasma or serum endotoxin, TNF-a and sCD14 concentrations were observed in both group A and group B on the entry day (P<0.01). Endotoxin decreased significantly in these two study groups on 7th day (P<0.05), and endotoxin in group B was obviously lower than that in group A (P<0.05). sCD14 in group B decreased significantly on 3rd and 7th days (P<0.01) too, and was obviously lower than that in group A in the same period (P<0.05), so was TNF- a on 7th day (P<0.05).2. The expression of TNF- a mRNA in the monocytes was significantly higher in group A and group B than in group C within 24h of admission (P<0.05). After treatment, TNF- a mRNA decreased significantly in both of the group A and B on 7th day (P<0.01), and the mRNA level was significantly lower in group B (P<0.05). On the entry and 7th days patients in group A and B had an abundant expression of CD 14 mRNA in the monocytes whose level was the same as that in group C . There was no significant difference before and after treatment.3. The serum sCD14 and endotoxin levels were P<0sitively correlated in patients on 1st (r=0.414,P<0.05) and 3th (r=0.48,P<0.01)days; TNF-a protein levels were closely related to endotoxin on lst(r=0.43,P<0.01) ,3rd (r=0.34,P<0.05) and 7th (r=0.592, P<0.05) days. The expression of TNF- a mRNA correlated well with TNF- a on 1 st (r=0.575,P<0.05), 3rd (r=0.787,P<0.01) days and with endotoxin on 1st (r=0.473, P<0.05), 7th (r=0.782,P<0.01) days.Conclusions:1. Endotoxin, TNF-a and sCD14 might play imP<0rtant roles in the pathogenesis of sepsis.2. Peripheral blood monocytes were activated in sepsis accompanying with enhanced expression of TNF- a mRNA and increased release of TNF- a .3. Increased serum concentrations of sCD14 might be associated with P<0or outcome.4. Fufang Qingxia Decoction could effectively decrease the concentrations of endotoxin, TNF-a and sCD14 in serum or plasma and inhibit TNF-a production by monocytes through transcriptional mechanism. Combining traditional and westernmedicine therapy may be one of the effective ways to trea...
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