不同调整肠道菌群治疗方案对慢性乙型重型肝炎肠道菌群和血浆内毒素的影响  

Efficacy of Different Treatments on Intestinal Flora and Endotoxin in Patients With Chronic Severe Hepatitis B

作　　者：王蜀强[1] 林健梅[1] 黄仁刚[1] 杨兴祥[1] 江南[1] 

机构地区：[1]四川省医学科学院,四川省人民医院,成都610072

出　　处：《寄生虫病与感染性疾病》2014年第4期175-178,共4页Parasitoses and Infectious Diseases

基　　金：四川省卫生厅科研项目(100492)

摘　　要：目的研究不同调整肠道菌群治疗方案对慢性乙型重型肝炎患者肠道菌群和血浆内毒素的影响。方法纳入慢性乙型重型肝炎患者127例,分为A、B、C 3组,A组63例,B组32例,C组32例。A组患者口服金双歧,B组患者金双歧口服＋乳果糖口服,C组患者金双歧口服＋乳果糖灌肠。在治疗前和治疗第5、10、15以及20 d,分别检测3组患者大便肠球菌、酵母菌、双歧杆菌数量以及血浆内毒素水平。结果治疗10 d时A、B和C组患者双歧杆菌数量分别为8.58±1.84、8.21±1.82和8.43±1.94 l gn/g,均较治疗前升高,差异有统计学意义（P均〈0.01）;治疗20 d时3组患者双歧杆菌数量分别为8.80±1.67、7.82±1.70和7.58±1.85l gn/g,与治疗10 d时比较,A组患者双歧杆菌数量无明显变化,B组和C组均明显减少,差异有统计学意义（P均〈0.01）。治疗20 d时3组患者肠球菌数量分别为7.83±1.66、8.17±1.78和8.85±2.03lgn/g,酵母菌数量分别为4.77±1.38、5.38±1.29和5.89±1.45lgn/g,与治疗前比较,A、B组肠球菌无明显变化,C组患者肠球菌明显升高,差异有统计学意义（Pc〈0.01）;A组酵母菌无明显变化,B、C组患者酵母菌均升高,差异有统计学意义（PB〈0.05,PC〈0.01）。A组患者在第15天,B、C组患者在第10天血浆内毒素下降至最低值,分别为184.48±69.56、152.71±32.44和122.71±32.61 EU/L,较治疗前下降,差异有统计学意义（P均〈0.05）;3组最低值比较,C组明显低于A、B组。治疗20d时3组患者血浆内毒素分别为187.62±80.73、265.62±90.55和328.62±101.43 EU/L,与治疗最低值比较,A组无明显变化,B组和C组患者血浆内毒素均明显升高,差异有统计学意义（P均〈0.05）。结论单用金双歧口服可以调节肠道菌群、降低血浆内毒素,但作用轻微。金双歧口服联合乳果糖口服或灌肠可以显著降低血浆内毒素水平,但在治疗第5-15 d可能出现新的菌群失调,加重�Objective To research the effects of different treatments on intestinal flora and plasma endotoxin in patients with chronic severe hepatitis B. Methods Altogether 127 patients with chronic severe hepatitis B were randomly divided into groups A,B and C,namely 63 cases in group A,32 cases in group B and 32 cases in group C. Group A were given oral intestinal probiotics,group B given oral intestinal probiotics＋oral lactulose and group C given oral intestinal probiotics ＋lactulose enema. Before and 5,10,15 and 20 daysafter treatment,group A,B and C were detected the number of enterococcus, yeast, bifidobacteria and plasma endotoxin. Results At the 10 thday after treatment,the number of Bifidobacterium in groups A, B and C were respectively 8. 58 ± 1. 84,8. 21 ± 1. 82and 8. 43 ± 1. 94 lgn / g, all higher than that before treatment（ all P〈0. 01）. At the 20 thday the Bifidobacterium were respectively 8. 80 ± 1. 67,7. 82 ± 1. 70 and 7. 58 ± 1. 85 lgn / g; compared that at 10 th day,group A showed no statistical significant changes,while group B and C both decreased（ PB 0. 01,PC0. 01）. At the 20 thday of treatment the number of Enterococcus in groups A,B and C were respectively7. 83 ± 1. 66,8. 17 ± 1. 78 and 8. 85 ± 2. 03 lgn / g and the number of yeast were respectively 4. 77 ±1. 38,5. 38 ± 1. 29 and 5. 89 ± 1. 45 lgn / g. Compared with before treatment,Enterococcus in group A and B showed no statistical significant changes,while group C significantly increased（ P〈0. 01）. In terms of yeast,group A showed no significant changes,while groups B and C were both significantly increased（ PB0. 05,PC0. 01）. The plasma endotoxin reached the lowest value in group A at the 15 thday,and reached the lowest value in B and C at the 10thday; the value of yeast in A,B and C were respectively184. 48 ± 69. 56,152. 71 ± 32. 44 and 122. 71 ± 32. 61 EU / L,all decreased than that before treatment（ all P〈0. 05,respectively）. Group C was significantly lower than that both in group A and B（

关 键 词：慢性重型肝炎 乙肝 肠道菌群 内毒素血症 

分 类 号：R512.62[医药卫生—内科学]