The Experiment Study On The Treatment Of Severe Intra-abdominal Infection By Combining Antibiotics With Chinese Herbs

Background and ObjectiveFor the intra-abdominal infection, the translocation of the intestinal bacteria and endotoxin in blood produce endotoxemia, which can also cause Systemic Inflammatory Response Syndrome (SIRS) and even develop Multiple Organ Dysfunction Syndrome (MODS) in severe case with high mortality (5%~50%). It is a difficult problem in clinic.The major bacteria of intra-abdominal infection are Gran's negative germs, which can produce endotoxin and activate inflammation, thus the inflammatory mediators overflow into plasma, causing inflammatory response in distant part and cause an inflammatory waterfall at the same time. Tumor necrosis factor- α ( TNF- α ), the key part of cytokines network, appears early in circulation and induces a series of inflammatory changes of the mononuclear phagocyte system and micro-circulation. Interleukin-6 (IL-6) is induced by TNF- α, it is an important factor to enlarge inflammation and induce SIRS. It is used as an important index in evaluating the severity of SIRS. Interleukin-10 (IL-10) is a common anti- inflammatory factor which can repress mononuclear phagocyte system, so IL-6 / IL-10 can be used to judge the progress of SIRS.Many antibiotics used in intra-abdominal infection can not only kill the Gran's negative germs but also release endotoxin on the wall of germs, making SIRS more severe. Many Chinese herbal medicines, with the antipyretic and counteracting-poison function, obtain the certain curative effect in treating the SIRS. To investigate a new treatment program, this study aimed to determine the effect of treatment of intra-abdominal infection rat by combining the antibiotics (Imipenems ) with Chinese herbs(Xuebijing).Material and Method1. Experiment materials: 100 male healthy SD rats provided by Zhejiang Province Animal Center, Imipenems is the product of Hangzhou Merck Co. Inc;Xuebijing is the product of Hongri Medicine Co. Ltd.. TNF — a, IL — 6 and IL —10 test box is the product of Peking Esenboa Technology Development Co. Ltd. The endotoxin test box is the product of Shanghai Ehua Clinical Medical Technology Company.2. The animal model of intra-abdominal infection : rats are fased 8 hours before operation, under 2% barbital (50 mgseses/ kg) intraperitoneal anaesthesia ,a midline incision is made and the cecum is ligated and punctured, leaving a rubber in the hole to prevent the pinhole shut off.3.The division of experiment groups and methods: 100 male SD rats divided into 5 groups in random, 20 rats each : Sham group: only turns over the cecum and intravenous injection of 8ml/kg NS;controlled group: ligate and poke the cecum and intravenous injection of 8ml/kg NS;antibiotic group: ligate and poke the cecum and intravenous injection of 20mg/kg Imipenem;herbal group: ligate and poke the cecum and intravenous injection of 8ml/kg Xuebijing;Unite ligate and poke the cecum and intravenous injection of 20mg/kg Imipenem and 8ml/kg Xuebijing. Each group further divide into two sub-group, 2 hours or 6 hours after operation, half of the rats were sacrificed and 23ml of blood were taken from the femoral vein. Plasma endotoxin, TNF- a , IL-6 and EL-lOs were measured after centrifugation. 4. Statistics: the results were expressed with means ± standard deviation (*± s), and statistics were analyzed by means of one-way AN0V\ using the software of SPSS(10.0 versions),.Results1.Plasma endotoxin level: Plasma endotoxin in Controlled group is significantly higher than it in Sham group, and it is higher for 6-hours sub-group than 2-hours sub-group (P<0.01). It is significantly lower in Herbal group and Combine group than in controlled group and antibiotics group ( P<0.01). There is no significantly difference between antibiotics group and controlled group( P>0.05).2.Plasma TNF- a level: Plasma TNF- a in Controlled group got the peak 2 hours after operation and decreased in 6 hours decreased;in antibiotics group is lower than in controlledgroup( P<0.01) and have no difference in 6 hours after operation( P>0.Q5).In herbal group and combine group is significantly lower than in controlled group and antibiotics group( P<0.01). 3. Plasma IL-6 level: Plasma IL-6 in model group is significantly higher than in Sham group( P<0.01). Except antibiotics group 6 hours after operation, all the groups' plasma IL-6 level are lower than matched controlled group( P<0.01), but in combine group is lower than in antibiotics or herbal group( P<0.01).4.Plasma IL-10 level: Plasma IL-10 in model group is all higher than Sham group ( P<0.01), with endotoxin, TNF- a and IL-6 in direct ratio;in antibiotics group is higher than in other treatment group ( P<0.05).5JPlasma IL-6/ IL-10 ratio: ILr6/ IL-10 in Combine group is lower than in other groups( P<0.05). But there is no difference in other treatment groups and control group (P>0.05).Conclusion1. For intra-abdominal infection, the Chinese herbal can reduce blood endotoxin, TNF- a and IL-6 level, while the antibiotics can't.2. For intra-abdominal infection, Combine the Chinese herbal and antibiotics have antagonistic effect to endotoxin and inflammation mediators, decreasing the IL-6/ IL-10 ratio.