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目的 探讨病毒性肝炎后肝硬化与肠道通透性的关系。方法 参照Holt等的方法测定96例肝硬化患者血清中二胺氧化酶 (DAO)活性 ;并用气相色谱法测定服用乳果糖、甘露醇后在尿中的分泌率 ,用以评价患者肠黏膜的组织结构及其功能。结果 患者Child +Pugh分级各组中DAO的活性和乳果糖 /甘露醇 (L/M)比值与对照组间差异有显著性 (DAOA级 4 .6 8± 0 .97,B级 6 .0 5± 1.0 2 ,C级7.80± 1.34比 3.98± 0 .93,P <0 .0 5～ 0 .0 0 5 ;L/MA级 0 .0 39± 0 .0 0 7,B级 0 .0 6 8± 0 .0 12 ,C级 0 .119±0 .0 2 3比 0 .0 33± 0 .0 0 4 ,P <0 .0 5～ 0 .0 0 5 )。并发自发性细菌性腹膜炎 (SBP)组与非SBP组间差异有显著性 (DAO 7.6 7± 3.0 3比 4 .96± 0 .95 ,P <0 .0 0 5 ;L/M 0 .10 7± 0 .0 6 0比 0 .0 4 2± 0 .0 0 7,P <0 .0 0 5 ) ;非SBP组与对照组间差异亦具有显著性 (DAO 4 .96± 0 .95比 3.98± 0 .93,P <0 .0 5 ,L/M 0 .0 4 2± 0 .0 0 7比0 .0 33± 0 .0 0 4 ,P <0 .0 5 )。结论 病毒性肝炎后肝硬化患者肠道黏膜受损是导致SBP的主要原因之一 ,测定病毒性肝硬化患者血清中DAO活性及尿中L/M比值可以探知肠黏膜结构及其功能有无损害。
Objective To investigate the relationship between liver cirrhosis and intestinal permeability after viral hepatitis. Methods The serum level of DAO in 96 patients with cirrhosis was measured by the method of Holt et al. The secretion rate of urinary excretion of lactulose and mannitol was determined by gas chromatography to evaluate the intestinal mucosa Structure and function. Results The activity of DAO and lactulose / mannitol (L / M) ratio in each group of patients with Child + Pugh grading were significantly different from those in control group (DAA grade 4.68 ± 0.97, grade B 6.05 ± 1.0 2, C grade was 7.80 ± 1.34 vs 3.98 ± 0.93, P <0.05-0.050, L / MA grade was 0.039 ± 0.07, B grade was 0.06 8 ± 0. 0 12, C grade 0 .119 ± 0 .0 2 3 than 0 .0 33 ± 0. 0 0 4, P <0 0 0 0 0 0 0 5). There was a significant difference between spontaneous bacterial peritonitis (SBP) group and non-SBP group (DAO 7.6 7 ± 3.0 3 vs 4.96 ± 0.95, P <0.05; L / M 0 .10 7 ± 0. 0 6 0 than 0 0 4 2 ± 0 0 0 7, P <0 0 05). The difference between non-SBP group and control group was also significant (DAO 4.96 ± 0.95 ratio 3.98 ± 0.93, P <0.05, L / M0.042 ± 0.0700.033 ± 0.040, P <0.05). Conclusion The damage of intestinal mucosa in cirrhotic patients with viral hepatitis is one of the main causes of SBP. The determination of serum DAO activity and L / M ratio in patients with viral cirrhosis can detect the intestinal mucosa structure and its function without damage .