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目的探讨双歧杆菌乳杆菌三联活菌片对非酒精性脂肪性肝病(NAFLD)患者肠道菌群、肝功能、胰岛素抵抗及血清炎症因子的影响,为NAFLD患者的治疗提供参考。方法选择2013年6月至2016年1月于鹤壁市传染病医院肝病科门诊或住院诊治的110例NAFLD患者作为研究对象,随机分为观察组和治疗组,治疗组给予双歧杆菌乳杆菌三联活菌片2.0 g口服,3次/d,观察组不给予药物治疗,共治疗6个月。同时,选择健康查体者30例作为对照组。比较治疗前后的肠道菌群、肝功能指标、胰岛素抵抗指数和血清炎症因子的变化情况。用SPSS 17.0软件包进行单因素方差分析、配对样本t检验。结果治疗前,NAFLD患者双歧杆菌、乳杆菌及双歧杆菌与肠杆菌之比(B/E)明显低于对照组,肠杆菌明显高于对照组,差异均有统计学意义(P<0.05),但观察组与治疗组间差异无统计学意义(P>0.05)。治疗后,治疗组双歧杆菌、乳杆菌数量明显增加,肠杆菌数量明显减少,B/E值升高,差异均有统计学意义(P<0.05)。治疗前,NAFLD患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转移酶(GGT)、稳态模型下的胰岛素抵抗指数(HOMA-IR)、内毒素、肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)均明显高于对照组,差异均有统计学意义(P<0.05),但观察组与治疗组间无明显差异。治疗后,治疗组ALT、AST、GGT、HOMA-IR、内毒素、TNF-α和IL-6水平均较本组治疗前明显下降,差异均有统计学意义(P<0.05),但治疗组治疗后各指标仍明显高于对照组,差异均有统计学意义(P<0.05)。结论双歧杆菌乳杆菌三联活菌片有助于恢复NAFLD患者肠道菌群平衡,降低转氨酶,改善胰岛素抵抗,缓解炎症反应。
Objective To investigate the effect of Lactobacillus bifidum triple active viable tablet on intestinal microflora, liver function, insulin resistance and serum inflammatory factors in patients with non-alcoholic fatty liver disease (NAFLD), and provide a reference for the treatment of NAFLD. Methods A total of 110 patients with NAFLD diagnosed and treated in Hepatology Department of Hebi City Infectious Disease Hospital from June 2013 to January 2016 were randomly divided into observation group and treatment group. The treatment group was given Lactobacillus bifidum triple Live bacilli 2.0 g orally, 3 times / d, the observation group was not given drug treatment, a total of 6 months. At the same time, 30 healthy people were selected as the control group. The changes of intestinal microflora, liver function index, insulin resistance index and serum inflammatory factors before and after treatment were compared. One-way analysis of variance (ANOVA) was performed with the SPSS 17.0 software package and paired-samples t test. Results Before treatment, the ratio of Bifidobacterium, Lactobacillus and Bifidobacterium to Enterobacter was significantly lower in NAFLD patients than in control group, and the Enterobacteriaceae were significantly higher than those in control group (P <0.05 ), But there was no significant difference between observation group and treatment group (P> 0.05). After treatment, the number of Bifidobacterium and Lactobacillus in the treatment group increased significantly, the number of Enterobacteriaceae decreased significantly, and the B / E value increased. The differences were statistically significant (P <0.05). Before treatment, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), insulin resistance index (HOMA-IR) The levels of tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) were significantly higher than those of the control group (P <0.05), but there was no significant difference between the observation group and the treatment group. After treatment, the levels of ALT, AST, GGT, HOMA-IR, endotoxin, TNF-α and IL-6 in the treatment group were significantly decreased compared with those before treatment in the treatment group, with statistical significance (P <0.05) After treatment, each index was still significantly higher than the control group, the difference was statistically significant (P <0.05). Conclusion Lactobacillus bifidum triple active live attenuated tablets can help restore the balance of intestinal microflora in patients with NAFLD, reduce transaminases, improve insulin resistance and relieve the inflammatory reaction.