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背景:肝硬化患者易并发自发性腹膜炎、肝性脑病、感染性休克等并发症,与肠黏膜屏障功能受损、肠道菌群紊乱密切相关。目的:探讨谷氨酰胺(Gln)联合益生菌对肝硬化患者肠黏膜屏障和肝功能的影响。方法:选取2011年4~12月安徽省蚌埠医学院第一附属医院收治的肝硬化患者80例,随机分为Gln组、益生菌组、联合组、对照组,各组给予相同的常规保肝、利尿治疗,Gln组、益生菌组、联合组在常规治疗的基础上给予相应药物。Gln组:复方Gln肠溶胶囊400 mg tid,疗程14 d;益生菌组:酪酸梭菌二联活菌散1 500 mg tid,疗程14 d;联合组:复方Gln肠溶胶囊400 mg tid+酪酸梭菌二联活菌散1 500 mg tid,疗程14 d。试验第1、14 d采用Child-Pugh分级标准评估肝功能;以活性比色法定量检测血清二胺氧化酶(DAO)水平;以显色基质鲎试剂检测血清内毒素水平;以改良的酶学分光光度法检测血清D-乳酸水平;以全自动生化仪检测血清AST、ALT水平。结果:治疗14 d后,Gln组、益生菌组、联合组的血清DAO、内毒素、D-乳酸水平均较治疗前显著下降(P<0.05),Gln组、益生菌组、联合组的血清内毒素、D-乳酸水平均较对照组显著下降(P<0.05),且联合组又明显低于Gln组和益生菌组(P<0.05)。治疗14 d后,联合组的Child-Pugh评分较治疗前显著下降(P<0.01);联合组的Child-Pugh评分、血清AST、ALT水平均较其余三组显著下降(P<0.05)。结论:Gln与益生菌联合应用可有效改善肝硬化患者的肠黏膜屏障功能和肝功能。
BACKGROUND: Patients with cirrhosis are more likely to develop complications such as spontaneous peritonitis, hepatic encephalopathy and septic shock, which are closely related to impaired intestinal barrier function and intestinal flora disturbance. Objective: To investigate the effect of glutamine (Gln) combined probiotics on intestinal mucosal barrier and liver function in cirrhotic patients. Methods: From April to December 2011, 80 patients with cirrhosis who were admitted to the First Affiliated Hospital of Bengbu Medical College of Anhui Province were randomly divided into Gln group, probiotics group, combination group and control group. The same routine liver protection , Diuretic treatment, Gln group, probiotics group, the combination group on the basis of conventional treatment given the appropriate drug. Gln group: Compound Gln enteric-coated capsules 400 mg tid for 14 days; Probiotic group: Clostridium butyricum 2 500 mg tid for 14 days; Combination group: Compound Gln enteric-coated capsules 400 mg tid + Bacillus sanguinea diarrhea 1 500 mg tid, treatment 14 d. The liver function was evaluated by Child-Pugh grading on the 1 st and 14 th day of the experiment. Serum diamine oxidase (DAO) level was measured by the activity colorimetric method. Serum endotoxin level was detected by colorimetric substrate test. The level of serum D-lactate was detected by spectrophotometry. The serum AST and ALT levels were detected by automatic biochemical analyzer. Results: The levels of serum DAO, endotoxin and D-lactate in Gln group, probiotics group and combined group were significantly lower than those before treatment (P <0.05) after 14 days of treatment. The serum levels of Gln group, probiotics group and combined group Endotoxin and D-lactate levels were significantly lower than those of the control group (P <0.05), and the combined group was significantly lower than the Gln group and probiotics group (P <0.05). After 14 days of treatment, the Child-Pugh score in the combined group was significantly lower than that before treatment (P <0.01). The Child-Pugh score, serum AST and ALT levels in the combination group were significantly lower than those in the other three groups (P <0.05). Conclusion: Gln combined with probiotics can effectively improve intestinal mucosal barrier function and liver function in patients with liver cirrhosis.