肝硬化患者肠道菌群失调与Child-Pugh分级的关系  

Relationship between intestinal dysbacteriosis and Child-Pugh classification in patients with cirrhosis

作　　者：黄晓宇[1] 李刚平[2] 寇继光[1] 李蕾[1] 夏秀梅[1] 杨玲[2] 侯晓华[2] 

机构地区：[1]湖北省孝感市中心医院消化内科,湖北孝感432000 [2]华中科技大学同济医学院附属协和医院消化内科,武汉430022

出　　处：《临床肝胆病杂志》2015年第3期392-395,共4页Journal of Clinical Hepatology

摘　　要：目的评估肝硬化患者与健康人相比肠道菌群分布状态;肠道菌群分布与肝功能Child-Pugh分级的关系;益生菌治疗对于肝硬化患者肠道菌群的改善情况及对患者肝脏生化指标的影响。方法随机选择2014年2月至2014年7月健康成人21例及孝感市中心医院就诊的肝硬化不伴腹水患者26例及肝硬化伴腹水患者22例,其中肝硬化组在常规治疗基础上给予益生菌(贝飞达),共治疗14 d进行比较研究。测定研究对象的肠道菌群、血氨及ALT,血清白蛋白水平及TBil值,计量资料组间比较采用t检验,多组间比较采用方差分析,计数资料采用非参数检验。结果肝硬化患者均存在程度不同的肠道菌群失调,主要表现为肠球菌、肠杆菌显著增多(P<0.01),双歧杆菌减少(P<0.01);菌群失调的严重程度与患者肝功能严重程度有关,肝功能Child-Pugh C级患者菌群失调较A级严重(P<0.01);益生菌可改善肝硬化患者生化指标、降低血氨、提高肠道双歧杆菌数量(P<0.01);益生菌亦可改善肝硬化患者肝功能Child-Pugh分级,其中肝硬化合并腹水患者效果更明显(P<0.01)。结论肝硬化组患者存在不同程度肠道菌群失调,益生菌能有效改善肝硬化患者肠道菌群失调并可改善生化指标及降低血氨。Objective To evaluate the distribution of intestinal flora in patients with cirrhosis compared with healthy people and investigate the relationship between the distribution of intestinal flora and Child- Pugh classification of liver function,and to analyze the effect of probiotic treatment on the improvement of intestinal flora and liver biochemical indices in patients with cirrhosis. Methods Twenty- six patients with compensated cirrhosis（ without ascites） and 22 with decompensated cirrhosis（ with ascites） who were admitted to our hospital from February2014 to July 2014,as well as 21 healthy adult subjects,were randomly selected. Patients with cirrhosis were given probiotic（ Bei Feida） treatment in addition to conventional therapy for 14 days. All patients signed informed consent forms. The distribution of intestinal flora,blood ammonia,serum alanine aminotransferase,serum albumin,and serum bilirubin levels were determined. Comparison of continuous data between the two and multiple groups was made by t test and analysis of variance,respectively,and comparison of categorical data was made by non-parametric test. Results All patients with cirrhosis had varying degrees of intestinal dysbacteriosis,predominantly due to significantly increased enterococci and enteric bacilli（ P 〈 0. 01） and significantly reduced bifidobacteria（ P 〈 0. 01）. Dysbacteriosis was associated with liver function. Patients with Child- Pugh C cirrhosis had significantly more severe dysbacteriosis than patients with Child- Pugh A cirrhosis（ P 〈0. 01）. Probiotic treatment significantly improved liver biochemical indices,reduced blood ammonia,and increased intestinal bifidobacteria（ P 〈0. 01）. Probiotic treatment improved the Child- Pugh classification in patients with cirrhosis and had a more significant effect on cirrhotic patients with ascites（ P 〈 0. 01）. Conclusion Patients with cirrhosis have varying degrees of intestinal dysbacteriosis. Probiotic treatment can effectively relieve dysbacteriosis,im

关 键 词：肝硬化 肠道菌群 益生菌 

分 类 号：R575.2[医药卫生—消化系统]