Effect Of Huanglian-Jie-Du-Tang In The Management Of Mediators Of Imflammation And Multiple Organ Dysfunction Syndrome

BackgroundThere are more than 30 years that multiple organ dysfunction syndrome (MODS) were united and named after "sequential systems failure" put forward firstly by Tilney. MODS have being become one of the main death reasons of current ICU, the mortality of MODS is 40-100%. The trend of the morbidity of MODS is being increased year by year, and the valid prevention and cure measure of MODS is lack currently. It is urgent and puzzled problem of MODS to solve at home and abroad. It is believed mostly that the gastrointestinal tract is one of the start factors and the key organs of MODS, the microcirculation disturbance and histiocyte lesion caused by the dysinflammatory cascade response and the free radicals injury was possibly key mechanism in the developing of MODS.MODS was indicated to be "organs failure syndrome" of traditional Chinese medicine(TCM) among modern research of TCM on MODS. The factors of the infecttivity and no-infectivity are the beginning reasons of MODS as well as lesion of the "toxin pathogen" , "heat pathogen" on Qi and blood and splanchnic organs through the developing of MODS. The heat-clearing and detoxicating method is believed to be one of main preventing and curing methods of MODS. The result of clinical case of MODS analyzed by APACHE II shall be applied for the clinical practice. Meanwhile the effect and applied value of Huanglian-Jie-Du-Tang in the developing of MODS shall be comprehended through the experiment of Huanglian-Jie-Du-Tang in the management of mediators of imflammation and Multiple Organ Dysfunction Syndrome induced by zymosan in rats.Objectivel.To investigate the influence factors of death of MODS through clinical case, to evaluate objectively the cause of death and the occurrence rate of organs failure of MODS, meanwhile to understand the relation between MODS and the syndrome-classification of TCM. The goal provides science evidence for the prevention and cure of MODS.2.To dicuss the effect and protection of organs function of Huanglian-Jie-Du-Tang in the management of mediators of imflammation and Multiple Organ Dysfunction Syndrome induced by zymosan in rats, meanwhile to comprehend the physiopathogenic mechanism of MODS.Methodsl.On using APACHE IImethod, the death factors of MODS and the occurrence rate and number of organs failure shall be investigated between survival groups and death groups through the review research of 45 cases of MODS, meanwhile to analyze the relation between MODS and the syndrome-classification of TCM.2. The big rat model of MODS was induced by injecting the belly cavity with the mixed liquid of zymosan-paraffin. Sixty rats were randomized to control, model, low-dosage and high-dosage groups. The multiple sorts of effect of Huanglian-Jie-Du-Tang in the management of MODS induced by zymosan in rats shall be investigated by the methods of physics, bio-chemical, nuclear medicine and pathology applied. The investigated items include the behavior, appearance, body temperature, breath, the heart rate, GPT, Cr, and number of PMN of rats of different groups of MODS etc. The content of MPO is examined among the blood plasma, intestine, lung and liver etc. IL-8 of the blood plasma and pathology of intestine, lung and liver etc is examined too.3. The results of all data were shown in the form of Ix +SD and were dealed with using SPSS 11. 5 programs of statistics. The relation of data between two groups were compared using standard t-test. Meanwhile the relation of data among several groups were compared using least significant differential method test. The numeration data were ananlyzed using X2 test. p<0. 05 was considered statistically significant.Results1.Clinical case retrospective analysis1.1.APACHE II, age, PMNs and generating rate of organs are significant difference between survival groups and death groups (). Organs increasing, APACHEIIand mortality of MODS is too high, nevertheless it is no relation between APACHEIIand mortality of MODS.1.2.The mortality of 45 MODS patients showed 42.2% in the first hospital of Guangzhou university of TCM. The rate of organ-system failure among 45 MODS patients showed respiration failure 86. 7%, gastrointestines dysfunction 57. 8%, heart failure 51.1%, brain dysfunction 51.1%, circulation failure 48.9%, kidney dysfunction 44. 4%, coagulation dysfunction 42.2%, liver dysfunction 20%. The mortality of two organs failure showed simultaneously respiration and kidney failure 63%, respiration and gastrointestines tract dysfunction 47%, heart and brain dysfunction 47%, especially respiration, gastrointestines tract, kidney and heart failured simultaneously were approximate to 100%.1.3. The syndrome-classification of TCM of 45 MODS patients showed toxin-heat-pathogen collected and tied syndrome 73%, Qi-deficiency syndrome54% in the survival groups, but showed toxin-heat-pathogen collected and tied syndrome 68%, Qi-deficiency syndrome68% in the death groups. The incidence rate of its two syndrome of MODS were higher than their syndrome-clssification.2. Experimental study on effect of Huanglian-Jie-Du-Tang in the management of mediators of imflammation and MODS induced by zymosan in rats.2. l.The big rat model of MODS induced by injecting the belly cavity with the mixed liquid of zymosan-paraffin were successful, and showed systemic inflammatory response syndrome(SIRS), multiple organs failure such as respiration, heart, liver, kidney and so on. The rat model of MODS showed too that effect of toxin-heat-pathogen collected and tied in the splanchnic organs is the physiopathogenic mechanism of TCM about MODS.2.2.Effect of groups treatmented by Huanglian-Jie-Du-Tang were more relief than no-treated groups in the management of MODS induced by zymosan in rats, such as behavior, appearance and pathology etc.2. 3. On coming different time stages, the effect of groups treatmented by Huanglian-Jie-Du-Tang were more relief than no-treated groups in the management of MODS induced by zymosan in rats such as number of PMN, valueof liver and kidney function test etc, them were compared to be considered significant difference().But the effect of groups treatmented by Huanglian-Jie-Du-Tang were more slightly exacerbation than which of the blank groups' .2. 4. On coming different time stages, the effect of groups treatmented by Huanglian-Jie-Du-Tang were compared to be considered more significant difference than no-treated groups in the management of MODS induced by zymosan in rats such as blood plasma IL-8, blood plasma MPO, small intestines MPO, lung MPO and liver MPO etc, which of roups treatmented by Huanglian-Jie-Du-Tang ascends slightly or slowly. But the effect of groups treatmented by Huanglian-Jie-Du-Tang were more slightly exacerbation than which of the blank groups' .Conclusion1. 1. It is important effect that the death factors of MODS showed APACHE II,age, PMNs , rate of per organ and multiple organs failure etc. The more PMNs were low, the more patients of MODS were possibly died.1.2. APACHE II were good to interpret critical condition of MODS, but it were poor calibration overall mortality prediction. The rate of per organ failure showed respiration, gastrointestinal tract, kidney, brain and heart from high to low, especially the mortality of two or more organs failure together were higher.1. 3. The toxin-heat-pathogen syndrome and Qi-def iciency syndrome were main important syndrome of syndrome-classification of TCM according to MODS investigated by us. It is indicated that the heat-clearing and detoxicating method was main method and Qi-benifiting method shall be given consideration to two or more things.2. 1. The big rat medol of MODS induced showed that gastrointestinal tract was the starting factor of the developing of MODS as well as the function of more distant organ beyond gastrointestinal tract was injuried from circulation by SIRS, PMNs activated, free radical ions and so on.2. 2. PMNs activated were distributed differently in the middle of the blood, gastrointestinal tract, liver and lung, which were connected mutually. MODS was made by infernal circle of gastrointestinal^liver-blood-lung, which manifested that PMNs of blood circulation were activated by the inflammationof gastrointestinal tract or the movement of bacteria and endotoxin.2. 3. The physiopathogenic mechanism of MODS was similar as well as multiple organs failure were caused by the lesion of toxin-heat-pathogen collected and tied in Qi-blood and the splanchnic organs according to the physiopathogenic mechanism of TCM about MODS.2.4.The quantity and infiltrated density in the different organs of PMNs were managed by different-dosage Huanglian-Jie-Du-Tang, which effect showed controlling the strength of inflammatory response, anti-oxygen free radicals, regulating cytokines, protecting organs function and so on. But it might be poisonous to organs function in correspondence to high-dosage Huanglian-Jie-Du-Tang.2.5.It exists the relativity of time-dosage-effect according to the experimental resut of different-dosage Huanglian-Jie-Du-Tang in the management of mediators of imflammation and Multiple Organ Dysfunction Syndrome induced by zymosan in rats.