熊去氧胆酸联合微生态制剂治疗原发性胆汁性胆管炎患者对肠道菌群的影响*

doi:10.3969/j.issn.1672-5069.2020.04.018

摘要/Abstract

摘要： 目的研究熊去氧胆酸(UDCA)联合微生态制剂治疗原发性胆汁性胆管炎(PBC)患者对粪肠道菌群的影响。方法 2017年6月～2019年6月我院收治的128例PBC患者被随机分为两组,每组64例,分别给予UDCA和UDCA联合双歧杆菌三联活菌肠溶胶囊治疗24周。采用实时荧光定量PCR法检测粪肠道菌群,采用放射免疫分析法测定血清肿瘤坏死因子-α(TNF-α),采用ELISA法测定血清白介素2(IL-2)、IL-6、IL-17和IL-22水平。结果治疗后,观察组粪双歧杆菌和拟杆菌菌落数分别为(8.7±0.9)lg CFU/g和(8.9±0.9 lg CFU/g,显著高于对照组【分别为(8.0±0.6)lg CFU/g和(8.1±0.6)lg CFU/g,P＜0.05】,而酵母样真菌和大肠埃希菌菌落数分别为(4.3±0.7)lg CFU/g和(8.7±0.6)lg CFU/g,显著低于对照组【分别为(5.1±0.7)lg CFU/g和(9.2±0.7)lg CFU/g,P＜0.05】;治疗后,观察组血清TNF-α、IL-2、IL-6、IL-17和IL-22水平分别为(5.9±1.6)pg/ml、(65.5±12.6)pg/ml、(5.6±1.1)pg/ml、(7.6±2.3)pg/ml和(17.5±2.7)pg/ml,显著低于对照组【分别为(7.0±2.1)pg/ml、(85.7±20.1)pg/ml、(6.7±1.5)pg/ml、(9.2±3.2)pg/ml和(23.3±4.4)pg/ml,P＜0.05】;治疗后,观察组血清HA、Ⅳ-C和PⅢP水平分别为(113.2±24.1)μg/L、(145.5±19.8)μg/L和(134.6±21.5)μg/L,显著低于对照组【分别为(168.4±47.2)μg/L、(178.4±51.7)μg/L和(170.5±48.2)μg/L,P＜0.05】。结论应用UDCA联合微生态制剂能有效纠正PBC患者肠道菌群失调,调节血清细胞因子水平,缓解肝纤维化程度。

关键词: 原发性胆汁性胆管炎, 熊去氧胆酸, 微生态制剂, 肠道菌群, 治疗

Abstract: Objective The aim of this study was to observe the effects of ursodeoxycholic acid (UDCA) and microecological agents on intestinal flora in patients with primary biliary cholangitis (PBC). Methods 128 patients with PBC were admitted to our hospital from June 2017 through June 2019, and were randomly divided into two groups, with 64 cases in each group. The patients in the control group were treated with UDCA, and those in the observation group were treated with UDCA and microecological agent combination for 24 weeks. The fecal flora were detected by PCR, and serum tumor necrosis factor-α(TNF-α), interleukin-2 (IL-2), IL-6, IL-17 and IL-22 as well as serum hyaluronic acid (HA), laminin (LN), collagen type Ⅳ (Ⅳ-C) and procollagen-Ⅲ-peptide (PⅢP) were assayed respectively. Results At the end of the treatment, the fecal colonies of bifidobacteria and bacteroides in the observation group were (8.7±0.9) lg CFU/g and (8.9±0.9 lg CFU/g, respectively, significantly higher than [(8.0±0.6) lg CFU/g and (8.1±0.6) lg CFU/g, respectively, P<0.05], while the colonies of yeast-like fungi and escherichia coli were (4.3±0.7) lg CFU/g and (8.7±0.6) lg CFU/g, significantly lower than [(5.1±0.7) lg CFU/g and (9.2±0.7) lg CFU/g, respectively, P<0.05]in the control; serum TNF-α, IL-2, IL-6, IL-17 and IL-22 in the observation group were (5.9±1.6) pg/ml, (65.5±12.6) pg/ml, (5.6±1.1) pg/ml, (7.6±2.3) pg/ml and (17.5±2.7) pg/ml, significantly lower than [(7.0±2.1) pg/ml, (85.7±20.1) pg/ml, (6.7±1.5) pg/ml, (9.2±3.2) pg/ml and (23.3±4.4) pg/ml, P<0.05]in the control group; serum HA, Ⅳ - C and P Ⅲ P were (113.2±24.1) μg/L, (145.5±19.8) μg/L and (134.6±21.5), significantly lower than [(168.4±47.2) μg/L, (178.4 ±51.7) μg/L and (170.5±48.2) μg/L, respectively, P<0.05]in the control. Conclusion Ursodeoxycholic acid and microecological agents combination regimen might effectively correct intestinal flora imbalance, regulate serum cytokines and alleviate the degree of liver fibrosis in patients with PBC.

Key words: Primary biliary cholangitis, Ursodeoxycholic acid, Microecological agents, Intestinal flora, Therapy

齐敬聪, 邢文静, 杜洋, 高辰玮. 熊去氧胆酸联合微生态制剂治疗原发性胆汁性胆管炎患者对肠道菌群的影响^*[J]. 实用肝脏病杂志, 2020, 23(4): 524-527.

Qi Jingcong, Xing Wenjing, Du Yang, et al. Effect of ursodeoxycholic acid and microecological agents on intestinal flora in patients with primary biliary cholangitis[J]. Journal of Practical Hepatology, 2020, 23(4): 524-527.

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熊去氧胆酸联合微生态制剂治疗原发性胆汁性胆管炎患者对肠道菌群的影响^*

Effect of ursodeoxycholic acid and microecological agents on intestinal flora in patients with primary biliary cholangitis

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