慢性肝病患者肠道通透性和炎症因子变化的研究  

Changes of the intestinal permeability and inflammatory factors in chronic liver disease

作　　者：周应生 刘树人[2] 陈汉先[2] 欧阳石[2] 

机构地区：[1]广东省深圳市光明新区公明医院消化内科,518106 [2]广州解放军第458医院全军肝病中心,510600

出　　处：《现代消化及介入诊疗》2011年第4期217-220,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：总后勤部卫生部专项科研项目(08BJZ07)

摘　　要：目的探讨慢性肝病患者肠黏膜屏障及炎症细胞因子的变化。方法收集各种慢性肝病患者和正常人的血清,统一采用酶联免疫吸附法和改良分光光度法检测血清D-乳酸(D-Lac)、二胺氧化酶(DAO)、内毒素(ET)、降钙素原(PCT)和肿瘤坏死因子(TNF)水平。结果各组患者人口学特征无明显差别(P>0.05),从肝炎病毒携带者到慢性重型肝炎,患者血清中D-Lac(从1.52±0.29μg/ml至4.07±0.43μg/ml),DAO(从1.22±0.34u/ml至4.07±0.42u/ml),ET(从1.39±0.27pg/ml至25.51±4.42pg/ml),PCT(从1.22±0.34μg/ml至23.17±5.28μg/ml)的水平逐渐升高(P<0.05);同样肝硬化失代偿期血清D-Lac,DAO,ET,PCT和TNF-α的水平(4.28±0.70μg/ml,3.64±0.53u/ml,18.14±3.98pg/ml,18.75±3.84μg/ml和27.12±4.64ng/ml)也较代偿期高(1.93±0.40μg/ml,1.82±0.58u/ml,13.03±2.44pg/ml,2.44±0.52μg/ml和14.73±2.60ng/ml)(P<0.05);酒精性肝病患者血清D-Lac,DAO,ET,PCT和TNF-α的水平(3.35±0.55μg/ml,3.03±0.42u/ml,14.30±4.06pg/ml,17.99±3.75μg/ml和32.46±6.84ng/ml)也高于正常对照(1.68±0.41μg/ml,1.08±0.32u/ml,1.40±0.28pg/ml,1.29±0.25μg/ml和11.14±1.74ng/ml)(P<0.05),但较慢性重型肝炎和肝硬化失代偿期低(P<0.05)。结论随着肝损伤程度的加重,慢性肝病患者肠黏膜屏障的通透性,炎症反应和细胞因子同时升高,与肝损伤之间形成恶性循环。Objective To investigate the alterations of intestinal permeability and serum inflammatory cytokines in patients with chronic liver disease. Method Various chronic liver disease patients were enrolled in this study. The serum samples were taken and cryopreserved at - 30 ℃. Serum levels of D-lactate（D-Lac）, diamine oxidase（DAO）, endotoxin（ET）, procalcitonin（PCT） and tumor necrosis factor α（TNF-α） were determined by enzyme linked immunosorbent assay（ELISA） and improved spectrophotometry. Results There were no differences in demography characteristics among these groups（P〉0.05）. From hepatitis virus carriers to patients with chronic severe hepatitis, the levels of D-Lac（from 1.52 ± 0.29 μg/ml to 4.07 ± 0.43 μg/ml）, DAO（from 1.22 ± 0.34 u/ml to 4.07 ± 0.42 u/ml）, ET（from 1.39 ± 0.27 pg/ml to 25.51 ± 4.42 pg/ml）, PCT （from 1.22 ± 0.34 μg/ml to 23.17 ± 5.28 μg/ml） were gradually elevated. On the other hand, levels of D-Lac, DAO, ET, PCT and TNFα in patients with decompensated liver cirrhosis（4.28 ± 0.70 μg/ml,3.64 ± 0.53 u/ml,18.14 ± 3.98 pg/ml, 18.75 ± 3.84 μg/ml and 27.12 ± 4.64 ng/ml, respectively）were higher than patients with compensated liver cirrhosis （1.93 ± 0.40 μg/ml, 1.82 ± 0.58 u/ml, 13.03 ± 2.44 pg/ml, 2.44 ± 0.52 μg/ml and 14.73 ± 2.60 ng/ml. respectively）（P〈0.05）. The levels of D-Lac, DAO, ET, PCT and TNF-α in patients with alcoholic liver disease （3.35 ± 0.55 μg/ml, 3.03 ± 0.42 u/ml, 14.30 ± 4.06 pg/ml, 17.99 ± 3.75 μg/ml and 32.46 ± 6.84 ng/ml, respectively） were also higher than in control group（1.68 ± 0.41 μg/ml, 1.08 ± 0.32 u/ml, 1.40 ± 0.28 pg/ml, 1.29 ± 0.25 μg/ml and 11.14 ± 1.74 ng/ml, respectively）（P〈0.05）, but lower than in chronic severe hepatitis group and decompensated liver cirrhosis group（P〈0.05）. Conclusion In the chronic liver diseases, with the aggravation of the liver damage, the patient′intestinal permeability and inflammatory cytokines were elevated which c

关 键 词：慢性肝病 肠黏膜 通透性 炎症因子 

分 类 号：R512.6[医药卫生—内科学]