| Objective To study of thioacetamide (TAA) induced liver injury in the formation mechanism of intestinal endotoxemia to explore the chronic hepatic failure, intestinal endotoxemia in patients with the presence and the protection of the gastrointestinal function of treatment strategies to improve the prognosis.Methods(1)Determination of the successful modeling of serum endotoxin and serum D-lactic acid and tumor necrosis factor-a levels, A portion of the ileum, lymph nodes, liver and spleen tissues placed in saline to carry out the above-mentioned organizations, the contents of bacterial culture.A portion of the liver and ileum by 10% neutral formalin-fixed, paraffin-embedded after dehydration to carry out the liver andileum pathology testing. Study of intestinal endotoxemia in thioacetamide-induced acute liver injury in the formation mechanism.(2) 30 patients with chronic hepatitis B patients as the control group, analyzing 48 cases of patients with chronic hepatic failure, check bowel sounds and abdominal plain film,the proportion of detected spherobacterium and bacillus in stool,fecal secretory IgA, serum endotoxin, serum D-lactate and TNF-a levels.For patients with intestinal cleansing:every other day a decoction of rhubarb retention enema; a daily probiotic supplement intestine; for individual patients with mixed enteral and parenteral nutrition therapy, develop individualized nutrition programs:①the total energy by 30kcal/(kg·d) calculation;②rationalize the ratio of the various-nutrients;③to enteral nutrition-based, parenteral nutrition supplemented by the establishment of individualized nutritional support program. Through the above implementation of the program to protect the gastrointestinal tract function, reducing chronic liver failure in patients with injury of intestinal barrier function, promote gastrointestinal peristalsis, reduce intestinal absorption of toxin produced and reduce the fatality rate. To this study of 49 cases previously hospitalized patients with chronic hepatic failure as the control to observe its effect on mortality, and to observe changes in gastrointestinal function..Results(1)TAA-induced acute liver injury, serum endotoxin level significantly increased serum TNF-a levels increased significantly, and with elevated levels of endotoxin were positively correlated.Simultaneous increase in intestinal permeability, intestinal flora imbalance, intestinal bacterial translocation. Ileal pathology significantly shorter as shown in intestinal villi,destruction, inflammatory cell infiltration increased.(2) Before treatment, patients with chronic hepatic failure there is 60.42% reduction in bowel sounds, there are 64.58% the existence of abdominal flatulence, fecal secretory IgA (sIgA) (378.12±101.23 mg/L), serum endotoxin(592.75±189.63 EU/ml),serum D-lactic acid(13.56±2.89μg/ml),and serum TNF-a(71.23±45.13 pg/ml)'levels are all elevated. The results showed that: the more serious gastrointestinal dysfunction in case-fatality rate is higher; measures to protect the gastrointestinal function through treatment for 4 weeks case fatality rate of 37.50%,lower than the control group(16.94%),ability to improve gastric peristalsis, fecal sIgA, serum D-lactate levels, serum endotoxin, serum TNF-a levels.Conclusions(1)Structural changes in intestinal mucosa, intestinal permeability increased,intestinal flora and intestinal bacterial translocation is the formation of gut-derived endotoxemia important factor. Endotoxemia by promoting the expression of TNF-a increased liver damage. (2)Patients with chronic hepatic failure there is reduced ability of gastrointestinal motility, gastrointestinal barrier function impairment, there are different degrees of dysfunction, to complement the intestinal bacteria, clean intestines of accumulated toxins and individual nutritional support treatment can be adjusted flora and reduce re-absorption of toxins and improving nutrition, reducing gastrointestinal dysfunction and reducing mortality.
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