肝硬化患者肠道粘膜通透性及其与Child-Pugh分级相关性的研究  

Study on the alteration of intestinal permeability in patients with liver cirrhosis and its relationship with the ChildPugh classification

作　　者：马维娟[1] 许建明[1] 胡静[1] 刘晓昌[1] 梅俏[1] 

机构地区：[1]安徽医科大学第一附属医院消化内科,安徽合肥230022

出　　处：《中华疾病控制杂志》2015年第4期411-414,共4页Chinese Journal of Disease Control & Prevention

摘　　要：目的了解肝硬化患者肠道粘膜通透性的改变并探讨其与Child-Pugh分级之间的相关性。方法纳入66例肝硬化患者,并选择40例健康体检者作为对照,采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测血二胺氧化酶(diamine oxidase,DAO)、D-乳酸水平,采用高效液相色谱法测定尿乳果糖/甘露醇(lactulose/mannitol,L/M)排泄率比来评价肠道粘膜通透性。结果肝硬化患者Child-Pugh分级各组的血DAO、D-乳酸水平及尿L/M排泄率比均明显高于对照组,差异有统计学意义(均有P<0.05)。血DAO水平与尿L/M排泄率比、血D-乳酸水平与尿L/M排泄率比均呈线性相关(r=0.518、r=0.527,均有P<0.05)。血DAO水平、血D-乳酸水平及尿L/M排泄率比与Child-Pugh评分均呈正相关(rs=0.705、rs=0.791、rs=0.851,均有P<0.05)。结论血DAO、D-乳酸水平及尿L/M排泄率比三种检测指标能准确反映肠粘膜通透性的变化。肝硬化患者的肠粘膜通透性较对照组明显增高,且与Child-Pugh评分呈正相关,肠粘膜通透性的检测对肝硬化患者的治疗有一定的临床价值。Objective To explore the alteration of intestinal permeability in patients with liver cirrhosis and it＇s relationship with Child-Pugh classification. Methods 66 patients with liver cirrhosis were enrolled and 40 healthy volunteers served as controls. To evaluate the intestinal permeability,the serum levels of diamine oxidase（ DAO）,D-lactate were measured by enzyme-linked immunosorbent assay（ ELISA） and the ratio of urine lactulose to mannitol（ L / M） was measured by high performance liquid chromatograph. Results The serum levels of DAO,D-lactate and the ratio of urine L / M of Child-Pugh Classes A,B,C were significantly higher than those in the control group,respectively（ P〈0. 05）.The linear correlation analysis showed that the plasma level of DAO was correlated with the ratio of urine L / M（ r = 0. 518,P〈0. 05）. The linear correlationship was also found between the level of D-lactate and the ratio of urine L / M（ r = 0. 527,P〈0. 05）. The levels of DAO,D-lactate and the ratio of urine L / M was positively correlated with Child-Pugh classification（ rs= 0. 705,rs= 0. 791,rs= 0. 851,all P〈0. 05）. Conclusions The serum levels of DAO,D-lactate and the ratio of urine L / M can exactly reflect the alteration of intestinal permeability. The intestinal permeability in patients with liver cirrhosis was significantly higher than that in the control group and positively correlated with Child-Pugh classification. It is clinically valuable to detect the intestinal permeability in patients with liver cirrhosis.

关 键 词：肝硬化 研究 通透性 

分 类 号：R181[医药卫生—流行病学]