微生态制剂治疗乙型肝炎肝硬化并发自发性细菌性腹膜炎患者临床疗效分析*

doi:10.3969/j.issn.1672-5069.2020.06.022

摘要/Abstract

摘要： 目的应用微生态制剂治疗肝硬化并发自发性细菌性腹膜炎(SBP)患者,观察疗效及其尿乳果糖/甘露醇(L/M)比值、血清细胞因子和内毒素水平的变化。方法 2014年12月～2018年6月我院收治的乙型肝炎肝硬化并发SBP患者68例,被机分为对照组34例和观察组34例,给予对照组喹诺酮类联合第三代头孢菌素类药物抗感染治疗4周,观察组在对照组治疗方案的基础上再联合应用微生态制剂(培菲康胶囊)治疗4周。使用高效液相色谱仪和示差折光检测器按标准操作检测尿L和M,并计算L/M比值,常规检测血清降钙素原(PCT),采用ELISA法测定血清IL-10、TNF-α和内毒素。结果在治疗结束时,观察组腹围、24 h尿量、腹水白细胞和血清PCT水平分别为(67.4±10.2)cm、(1685.4±305.6)ml、(156.2±92.0)×10⁶/L和(0.45±0.15)ng/ml,与对照组比【分别为(75.6±11.3)cm、(1450.3±326.8)ml、(360.8±110.5)×10⁶/L和(1.24±0.60)ng/ml,P<0.05】,差异显著;观察组血清ALT、AST和TBIL水平分别为(40.6±18.0)U/L、(45.8±20.4)U/L和(45.2±10.8)μmol/L,显著低于对照组【分别为(62.5±15.4)U/L、(59.8±21.5)U/L和(54.0±11.5)μmol/L,P<0.05】;观察组尿L/M比值、血清IL-10、TNF-α和内毒素水平分别为(0.07±0.01)、(32.6±5.4)ng/L、(29.8±7.0)ng/L和(0.33±0.10)EU/ml,与对照组比,差异显著【分别为(0.09±0.01)、(27.1±5.0)ng/L、(38.9±8.5)ng/L和(0.46±0.13)EU/ml,P<0.05】。结论应用微生态制剂协助治疗乙型肝炎肝硬化并发SBP患者能够有效改善腹水情况、降低血清炎性细胞因子水平、减少肠源性内毒素血症,保护肝功能,临床应用价值肯定。

关键词: 肝硬化, 自发性细菌性腹膜炎, 微生态制剂, 尿乳果糖/甘露醇比值, 内毒素

Abstract: Objective Microecological preparation is always applied to treat patients with liver cirrhosis complicated by spontaneous bacterial peritonitis (SBP), and we conduct a clinical trial to administer the microecological agent for the treatment of patients with SBP, and observe the changes of ascites, biochemical indexes, urinary lactulose / mannitol (L/M) ratio, serum cytokines and endotoxin. Methods 68 patients with liver cirrhosis complicated by SBP were recruited in this study between December 2014 and June 2018,and were randomly divided into control (n=34) and observation groups (n=34). The patients in the control were treated with quinolones and third generation of cephalosporins for four weeks, and the patients in the observation group were treated with microecological preparations (Peifeikang capsule) at the basis of the treatment regimen in the control group for four weeks. Urine lactulose / mannitol were detected by high performance liquid chromatography, serumprocalcitonin (PCT), IL-10, TNF-α and endotoxin levels were also determined. Results At the end of four week treatment, the abdominal circumference, 24-hour urine volume, leukocyte counts in ascites and serum PCT levels in the observation group were(67.4±10.2)cm,(1685.4±305.6)ml, (156.2±92.0)×10⁶/L and (0.45±0.15)ng/ml, all significantly different compared to 【(75.6±11.3)cm, (1450.3±326.8)ml, (360.8±110.5)×10⁶/L and (1.24±0.60)ng/ml, respectively, P<0.05】 in the control; serum ALT, AST and bilirubin levels in the observation group were (40.6±18.0)U/L,(45.8±20.4)U/L and (45.2±10.8)μmol/L, all significantly lower than 【(62.5±15.4)U/L,(59.8±21.5)U/L and (54.0±11.5)μmol/L, respectively, P<0.05】 in the control; the urine L/M ratio, serum IL-10, TNF-α and endotoxin levels were (0.07±0.01), (32.6±5.4)ng/L, (29.8±7.0)ng/L and (0.33±0.10)EU/ml, all significantly different compared to 【(0.09±0.01), (27.1±5.0)ng/L,(38.9±8.5)ng/L and (0.46±0.13)EU/ml, respectively, P<0.05】 in the control. Conclusion The application of microecological agents in assisting treatment of patients with liver cirrhosis complicated by SBP could effectively improve ascites subsidizes, protect liver functions, inhibit the expression of inflammatory cytokines, reduce intestinal endotoxin and regulate intestinal flora.

Key words: Liver cirrhosis, Spontaneous bacterial peritonitis, Microecological agents, Urinary lactulose / mannitol ratio, Endotoxin

李翠茹, 武丽, 平采艳, 周红霞, 蔡志刚. 微生态制剂治疗乙型肝炎肝硬化并发自发性细菌性腹膜炎患者临床疗效分析^*[J]. 实用肝脏病杂志, 2020, 23(6): 845-848.

Li Cuiru, Wu Li, Ping Caiyan, et al. Clinical efficacy of microecological agents in the treatment of patients with hepatitis B liver cirrhosis complicated by spontaneous bacterial peritonitis[J]. Journal of Practical Hepatology, 2020, 23(6): 845-848.

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微生态制剂治疗乙型肝炎肝硬化并发自发性细菌性腹膜炎患者临床疗效分析^*

Clinical efficacy of microecological agents in the treatment of patients with hepatitis B liver cirrhosis complicated by spontaneous bacterial peritonitis

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