肝硬化患者肠黏膜屏障功能的变化  

Intestinal mucosal barrier function in patients with cirrhosis

作　　者：顾林[1] 燕善军[1] 王启之[1] 李大鹏[1] 汪建超[1] 汪强武[1] 

机构地区：[1]安徽省蚌埠医学院第一附属医院消化内科,233004

出　　处：《中华全科医学》2014年第11期1733-1735,共3页Chinese Journal of General Practice

摘　　要：目的探讨肝硬化患者肠黏膜屏障功能的变化特点以及肠黏膜屏障功能的评估指标,以对肠黏膜屏障功能进行评价。方法选择40例肝硬化患者以及20例健康志愿者作正常对照。应用活性比色法定量检测血浆二胺氧化酶(DAO)含量,应用显色基质鲎实验法来测定血浆内毒素含量,应用改良酶学分光光度法来测定血浆D-乳酸含量。通过比较三个指标在肝硬化患者与正常对照者之间的差异,判断其作为肠黏膜屏障功能检测指标的价值。结果 1肝硬化患者中血浆DAO、内毒素和D-乳酸水平较正常对照组增高(P<0.01),不同Child-Pugh分级间DAO、内毒素、D-乳酸水平比较差异均具有统计学意义(P<0.01),其中DAO水平A级<C级<B级,内毒素水平A级<B级<C级,D-乳酸水平A级<B级<C级。2肝硬化患者肝功能较正常对照组增高(P<0.01)。组间比较显示,不同Child-Pugh分级间肝功能水平比较差异均具有统计学意义(P<0.01),其中ALT水平A级<B级<C级,AST水平A级<B级<C级。3肝硬化组不同Child-Pugh分级的肝功能水平与血浆DAO、内毒素、D-乳酸水平比较均呈现正相关(P<0.05)。结论肝硬化患者病情发生发展过程中存在肠黏膜屏障功能障碍,对血浆DAO、内毒素、D-乳酸水平的检测可用于提示肠黏膜屏障功能的障碍。Objective To explore the changes and characteristics of intestinal mucosal barrier function in patients with cirrhosis,and study the evaluation indicators of intestinal mucosal barrier function. Methods 40 patients with liver cirrhosis and 20 healthy volunteers were enrolled in this study. The colorimetric assay was performed to determine the levels of serum diamine oxidase （DAO） activity, and quantitative chromogenic tachypleus amebocyte lysate （TAL） was performed to test the level of plasma endotoxin, and the modified enzyme-based spectrophotometric assay was performed to measure the level of plasma D-lactic acid. Their difference between the patients with liver cirrhosis and healthy volunteers were compared to judge their role in assessed intestinal mucosal barrier function. Results ①The levels of plasma DAO, endotoxin and D-lactate in the patients liver cirrhosis were higher than those in control group （P 〈 0.01 ） ;The difference in the levels of plasma DAO, endotoxin and D-lactate among the patients with different Child-Pugh score were statistically significant（P 〈0.01 ） ,in which DAO level in class A was less than class C,than class B;endotoxin level in class A was less than class B, than class C ; D-lactate level in class A was less than class B, than class C. ②The levels of ALT and AST increased in the patients with cirrhosis as compared with the normal control（P 〈0.01 ）. The difference in the levels of ALT and AST among the patients with different Child-Pugh score were statistically significant （P 〈 0.01 ）, the levels of both ALT and AST in class A was less than class B, than class C. ③The levels of ALT and AST in the cirrhosis patients with different Child-Pugh score were positively correlated with the levels of plasma DAO, endotoxin and D-lactate （P 〈 0.05 ）. Conclusion In the process of development of liver cirrhosis,intestinal mucosal barrier dysfunction is with disorders. The determination of the levels of plasma DAO, endotoxin and D-lactate will be helpfu

关 键 词：肝硬化 肠黏膜屏障 内毒素类 乳酸盐类 胺氧化酶 肝功能 

分 类 号：R575.2[医药卫生—消化系统] R575.5[医药卫生—内科学]