慢性乙型肝炎重度患者肠道黏膜屏障功能的变化及其临床干预策略  

The change of intestinal mucosa barrier in chronic severe hepatitis B patients and clinical intervention

作　　者：宋怀宇[1] 姜春华[2] 杨建荣[1] 陈秋虹 黄钧[1] 黄云花[1] 梁列新[1] 

机构地区：[1]广西壮族自治区人民医院消化内科,南宁530021 [2]南宁市第四人民医院 [3]广西壮族自治区测试中心

出　　处：《中华肝脏病杂志》2009年第10期754-758,共5页Chinese Journal of Hepatology

基　　金：广西自然科学基金（桂科回0639013）

摘　　要：目的研究慢性乙型肝炎重度患者肠道黏膜屏障功能的变化情况，并探讨对其临床干预的方法。方法检测并比较30名正常人和60例慢性乙型肝炎重度患者尿乳果糖、甘露醇排泄率比值（L／M）和血清二胺氧化酶（DAO）的水平。将60例慢性乙型肝炎重度患者随机分为对照组和实验组，每组30例。对照组采用常规护肝、抗病毒治疗，而实验组在对照组治疗方案的基础上加用谷氨酰胺颗粒10g，3次／d，疗程为2周。于治疗前后分别测定两组患者的血清内毒素、DAO、L／M等水平。组间比较采用t检验与协方差分析。结果与正常人相比，慢性乙型肝炎重度患者血清DAO、尿乳果糖水平与L／M比值均升高（P值均〈0．01）。60例慢性乙型肝炎重度患者治疗两周后，与对照组相比，治疗组内毒素水平[（0．12±0．05）Eu／ml与（0．16±0．04）Eu／ml]、DAO水平[（7．03±1．91）μg／L与（8．68±1．76）μg／L]、L／M比值（0．020±0．011与0．034±0．119）均明显降低，P值均〈0．01。结论慢性乙型肝炎重度患者存在肠道黏膜屏障功能的早期损伤。在常规治疗的基础上加用谷氨酰胺颗粒能够更好地纠正肠道黏膜屏障功能异常，减轻肠源性内毒素血症。Objective To study the change of intestinal mucosa barrier in chronic severe hepatitis B patients and clinical intervention. Method （1） 30 normal healthy controls and 60 chronic severe hepatitis B patients were enrolled in this study. The change of intestinal permeability was determined by urine lactulos/mannitol ratio （L/M）, and the serum diamine oxidase （DAO） was measured. （2） 60 chronic severe hepatitis B patients were randomly divided into two groups： the control group and the treated group, each group has 30 cases. Patients in the control group received standard treatment for 2 weeks, however, in addition to standard treatment, patients in the treated group also recieved glutamine 10 g tid. Endotoxin （ET）, DAO and L/M were compared between the two group. Results （1） Compared to healthy controls, the level of L/M and DAO was significantly increased in chronic severe hepatitis B patients （t = 2.762, P 〈 0.01 or t = 6.326, P 〈 0.01）. （2） Compared to the control group, ET, DAO and L/M were significantly lower 2 weeks after treatment （F = 11.662, P 〈 0.01; F = 12.699, P 〈 0.01; F = 19.981, P 〈 0.01 ）. Conclusion （1） There is an early intestinal mucosa barrier damage in chronic severe hepatitis B patients. （2） Compared to standard treatment, adding glutamine can reverse intestinal mucosa barrier damage.

关 键 词：肝炎 乙型 慢性 谷氨酰胺 肠道黏膜屏障 

分 类 号：R512.62[医药卫生—内科学]