益生菌制剂对肝硬化并发自发性细菌性腹膜炎患者肠道屏障功能的影响*

doi:10.3969/j.issn.1672-5069.2021.06.025

摘要/Abstract

摘要： 目的研究益生菌制剂对肝硬化并发自发性细菌性腹膜炎(SBP)患者肠道屏障功能的影响。方法 2018年1月～2020年1月我院收治的肝硬化并发SBP患者120例,采用随机数字表法将患者分为对照组60例和观察组60例,分别给予常规对症治疗和在此基础上加用双歧杆菌三联活菌肠溶胶囊治疗14 d。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)、可溶性髓系细胞触发受体-1(sTREM-1)和单核细胞趋化蛋白-1(MCP-1)水平,采用免疫比浊法检测血清C-反应蛋白(CRP)水平,采用化学发光法检测血清降钙素原(PCT)水平,采用分光光度法检测血清D-乳酸(D-Lac)水平,采用改良偶氯基质显色法鲎试验检测血清二胺氧化酶(DAO)、脂多糖(LPS)水平,采用蛋白印迹法检测结肠组织人结肠腺癌细胞紧密连接蛋白闭合蛋白(occludin)和闭锁小带蛋白-1(ZO-1)水平。结果在治疗14 d末,观察组腹水消退等总有效率为90.0%,显著高于对照组的73.3%(P＜0.05);观察组血清TNF-α、CRP、PCT、sTREM-1和MCP-1水平分别为(28.1±5.0)ng/L、(14.0±2.6)mg/L、(1.1±0.2)μg/L、(74.1±10.2)ng/L和(150.5±20.5)ng/L,显著低于对照组【分别为(39.1±6.2)ng/L、(19.6±2.9)mg/L、(1.9±0.2)μg/L、(114.2±12.9)ng/L和(204.1±26.5)ng/L,P＜0.05】;观察组血清D-Lac、DAO、LPS、occludin和ZO-1水平分别为(4.6±0.6)mg/L、(2.7±0.4)κU/L、(0.5±0.1)κEU/L、(0.5±0.1)和(0.4±0.1),显著低于对照组【分别为(8.6±0.9)mg/L、(3.9±0.5)κU/L、(0.7±0.1)κEU/L、(0.8±0.1)和(0.8±0.2),P＜0.05】。结论应用益生菌制剂治疗肝硬化并发SBP患者可能能改善肠道屏障功能,从而有效抑制细菌移位,降低炎性因子分泌,提高治疗疗效。

关键词: 肝硬化, 自发性细菌性腹膜炎, 益生菌制剂, 肠道屏障功能, 治疗

Abstract: Objective The purpose of this study was to investigate the effect of probiotics on intestinal barrier function of patients with liver cirrhosis (LC) complicated with spontaneous bacterial peritonitis (SBP). Methods 120 LC patients with SBP were admitted to our hospital between January 2018 and January 2020,and were randomly divided into control (n=60) and observation group (n=60). The patients in the control were given conventional supporting treatment and antimicrobial therapy, and those in thecombination were treated with enteric solution of triple viable bifidobacterium capsule for 14 days. Serum tumor necrosis factor-α (TNF-α), C - reactive protein (CRP), procalcitonin (PCT), soluble myeloid cells trigger receptor 1 (sTREM - 1), monocyte chemotactic protein 1 (MCP 1), D - lactic acid (D-Lac), diamine oxidase (DAO), lipopolysaccharide (LPS), closed tight junction protein (occludin) and small atresia with protein 1 (ZO - 1) were detected. Results At the end of 14 day treatment, the total effective rate in the observation group was 90.0%, significantly higher than 73.3% in the control group (P＜0.05); serum TNF-α, CRP, PCT, STREm-1 and McP-1 levels in the observation group were (28.1±5.0) ng/L, (14.0±2.6) mg/L, (1.1±0.2) g/L, (74.1±10.2) ng/L and (150.5±20.5) ng/L, all significantly lower than [(39.1±6.2) ng/L, (19.6±2.9) mg/L, (1.9±0.2) g/L, (114.2±12.9) ng/L and (204.1±26.5) ng/L, respectively,P<0.05] in the control; serum D-Lac, DAO, LPS, occludin and ZO-1 levels in the observation group were (4.6±0.6) mg/L, (2.7±0.4)κU/L, (0.5±0.1)κEU/ L,(0.5±0.1) and (0.4±0.1), all significantly lower than [(8.6±0.9) mg/L, (3.9±0.5) κU/L, (0.7±0.1))ΚEU/L, (0.8±0.1) and (0.8±0.2), respectively, P＜0.05] in the control. Conclusion The application of probiotic preparations has a definite clinical efficacy in the treatment of LC patients with SBP, which could effectively inhibit the secretion of inflammatory factors and improve the intestinal barrier functions.

Key words: Liver cirrhosis, Spontaneous bacterial peritonitis, Probiotics, Intestinal barrier functions, Therapy

刘玉玲, 甄增国, 王慧娟, 万秀敏, 郭振凯. 益生菌制剂对肝硬化并发自发性细菌性腹膜炎患者肠道屏障功能的影响^*[J]. 实用肝脏病杂志, 2021, 24(6): 867-870.

Liu Yuling, Zhen Zengguo, Wang Huijuan, et al. Effects of probiotics on intestinal barrier function of patients with liver cirrhosis complicated by spontaneous bacterial peritonitis[J]. Journal of Practical Hepatology, 2021, 24(6): 867-870.

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益生菌制剂对肝硬化并发自发性细菌性腹膜炎患者肠道屏障功能的影响^*

Effects of probiotics on intestinal barrier function of patients with liver cirrhosis complicated by spontaneous bacterial peritonitis

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