内毒素血症对肝硬化腹水形成机制的研究  

Effect of endotoxin in ascites formation of liver cirrhosis

作　　者：何峰[1] 李小安[1] 赵微[1] 陆德云[1] 方丽[1] 

机构地区：[1]成都医学院第一附属医院消化内科,四川成都610500

出　　处：《海南医学》2013年第15期2256-2259,共4页Hainan Medical Journal

基　　金：成都医学院独立资助项目(编号:CYFY11DL-006)

摘　　要：目的检测肝硬化腹水患者的血清和腹水中内毒素(Endotoxin,ETX)水平,探讨其与腹水形成的内在联系。方法按照一定标准选取2011年1月至2012年6月本院收治的肝炎肝硬化代偿期患者(对照组)10例、肝炎性和酒精性肝硬化腹水患者80例,包含无明显感染症状的腹水(SA组)50例和有自发性腹膜炎腹水患者(SBP组)30例。按照不同时间段抽取各组患者的清晨空腹外周静脉血和腹水标本进行内毒素含量检测和腹水细菌培养。采用SPSS17.0统计软件处理各组间内毒素含量的差异。结果治疗前50例SA组患者血清、腹水内毒素值分别为(0.108±0.034)U/L、(26.1±3.2)U/L,30例SBP组患者血清、腹水内毒素值为(0.418±0.044)U/L、(1286.1±98.3)U/L。统计结果显示腹水患者的血清内毒素值明显高于对照组患者的(0.025±0.004)U/L(F=201.04,P<0.001);SBP组患者的腹水内毒素值较SA组患者高(t=12.78,P<0.001),不同时间段内毒素水平与腹水病情的严重程度有关(r=7.12,P<0.05)。腹水细菌培养结果阳性率30%,隐匿性感染确实存在于肝硬化腹水患者。结论肝硬化腹水患者血清内毒素升高可能与疾病的严重程度有关,隐匿性感染确实存在于无感染症状的腹水患者中。Objective To detect endotoxin （ETX） level in the serum and ascites of patients with liver cirrho- sis, and to explore the intrinsic links with the formation of ascites. Methods The study recruited ten patients of com- pensatory liver cirrhosis patients （the control group） and 80 patietns of hepatitis or alcoholic cirrhosis with ascites in our hospital from January 2011 to June 2012, including 50 patients of aseites with no obvious infectious symptoms （SA group） and 30 patients of ascites with spontaneous bacterial peritonitis （SBP group）. The fasting peripheral venous blood and ascites specimens were extracted from patients of each group at different time points to detect endotoxin levels and made bacteria culture of ascites. SPSS17.0 statistical software was applied to deal with the differences of endotoxin among each group. It was considered statistically significant when P was less than 0.05. Results Before treatment, en- dotoxin values of serum and ascites were （0.108±0.034） U/L and （26.1 ±3.2） U/L in SA group, （0.418±0.044） U/L and （1286.1 ±98.3） U/L in SBP group, respectively. Statistical results showed that endotoxin levels in SA group and SBP group were significantly higher than those in the control group [（0.025±0.004） U/L], F=201.04, P〈0.001）, and the level in SBP group was significantly higher than that in SA group （t=12.78, P〈0.001）. Toxin level of aseite were corre- lated with the severity of liver cirrhosis （r=7.12, P〈0.05）. Bacteria culture results of ascites were positive （30%）, which revealed the occult infection did exist in patients of liver cirrhosis with ascites. Conclusion The elevated endo- toxin level in serum or ascites of patients of liver cirrhosis may be related to the severity of the disease. The occult in- fection does exist in patients with ascites but with no infectious symptoms.

关 键 词：内毒素 肝硬化 腹水形成 

分 类 号：R575.2[医药卫生—消化系统]