| Aims:To observe the efficacy of anti-endotoxin traditional Chinese medicine, compound oriental wormwood decoction, on the animal model of acute liver failure. To observe the therapeutic effect of treating chronic severe hepatitis B cases by the integration of anti-endotoxemia of traditional Chinese and western medicine.Methods:The experimental rats were divided into four groups (normal control group, the poisoning group, treatment group, prevention plus treatment group) prepared acute liver failure animal model by D-galactosamine. Thereafter, the treatment group and the prevention plus treatment group were treated with anti-endotoxin traditional Chinese medicine known as compound oriental wormwood decoction. Plasma endotoxin (ET), plasma lipid peroxide (LPO), plasma fibronectin (Fn) levels and liver pathology changes of four groups are constantly observed. The study selected 63 cases of chronic severe hepatitis B which were hospitalized in the wards of serious hepatitis in Tianjin infectious disease hospital from September 2009 to December 2009.They were randomly devided into 2 groups by the ratio of 2:1, with 21 cases in the control group following the basic western medicine and supportive therapy and the resting 42 cases in the treatment group receiving compound oriental wormwood decoction and retention-enema of Chinese medicine based on the basic western medicine and supportive therapy.Both groups of patients were observed for 8 weeks, during which Several key factors such as the total fatality rate,survival curve,,the improvement of clinical symptom after 2 weeks of both groups were closely observed. In addition,we study the level of blood INR,TBiL,ALB,CHE and MELD score before treatment and 2 weeks,4 weeks,6 weeks and 8 weeks after treatment.The level of ET, TNF-a and LPO before treatment and after 4 weeks treatment and the side effects of the treatment group were also be recorded.Results:Statistically significant difference (P<0.01) was noted after the injection of galactosamine within 24 hours, since the endotoxemia occurred when compared with the normal group. The plasma ET level of Poisoning rats gradually increased after 24,36 or 48 hours, reaching a peak after 60 hours and then dropping after 72 hours. The all time ET level in treatment group was lower than poisoning group. What's more, the LPO of treatment group was lower than that of the poisoning group and the LPO of prevention plus treatment group were also lower than the poisoning group and than that of the treatment group in the hour 24,36,60.24 hours after the poisoning, the Fn levels of all experimental groups were slightly decreased compared with the control group with statistically significant difference (P<0.01), statistically significant difference (P<0.01) was also found between poisoning prevention group and treatment group or untreated group after 72 hours. In terms of the liver pathological changes, the prevention of the treatment group is the minimum and the treatment group followed while the poisoning group is most serious.20 cases died during 8 weeks, of which 11 patients were in the treatment group and 9 in the control group,with the total morbidity 26.2% in the treatment group and 42.9% in the control group respectively. Therefore, the survival rate was higher in the treatment group than that of the control group during the period of treatment.After 2 weeks treatment, the symptoms like fatigue,abdominal distension,inappetency were much improved in both groups. Compared with the control groups,the index of the treatment group had significant difference in the improvement of fatigue, inappetency and yellowish and greasy tongue fur (all P<0.05).There was no significant difference in the level of INR,TBiL,MELD score,ET,TNF-αand LPO between two groups before treatment(all P>0.05). Gradual decline in the blood level of INR,TBiL and MELD score was noted while a upward trend in the blood level of ALB,CHEfor was detected during the successive 8 weeks.Compared with the control groups,the treatment group had significant difference in TBiL after 2 weeks treatment, in INR and MELD score since 4 weeks treatment and in ALB after 8 weeks treatment (all P<0.05).There was no significant difference in the level of CHE between two groups (all P>0.05).Both of the two groups suffered from ETM before treatment. The level of ET of the two groups was all above 160pg/ml. After 4 weeks, patients treated with ET, TNF-αand LPO were lower than those before treatment and even lower than those of the control group with statistically significant difference (all P<0.05). adverse effects were not detected in any group during treatment.Conclusions:The application of compound oriental wormwood decoction of anti-endotoxin traditional Chinese medicine can significantly reduce the acute liver failure of endotoxin in animal blood, plasma lipid peroxide levels, elevating plasma fibronectin level, reducing the extent of liver injury of experimental animals, which indicated that the compound oriental wormwood decoction has obvious effects on anti-endotoxin, anti-lipid peroxidation and protection of liver cells. As it showed, Before giving D-galactosamine to make the animal model, the application of compound oriental wormwood decoction of anti-endotoxin traditional Chinese medicine can make better effect as a prevention.The integration of anti-endotoxemia of traditional Chinese medicine and western medicine can better decrease the fatality rate,improving the clinical symptom and the level of ALB while decreasing the level of ET,TNF-a,,LPO,TBiL,INR and MELD score. It has the functions of anti-endotoxin, anti-lipoid oxidation,relief of the inflammation and necrosis of liver. It may better increase the synthesis and storage capability of the liver,improve the coagulation disorders than the western medicine and supportive therapy,, providing a better way to treat chronic severe hepatitis B. |
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