肝硬化患者应用质子泵抑制剂前后细菌DNA和内毒素的变化及意义  

Changes and significance of bacterial DNA and endotoxin in patients with liver cirrhosis before and after proton pump inhibitor therapy

作　　者：郭晓会[1] 王建华[1] 冯志杰 任海霞[1] 刘晓东[1] 郭永泽[1] GUO Xiaohui;WANG Jianhua;FENG Zhijie(Department of Digestive System Diseases,Affiliated Hospital of Hebei Engineering University,Hebei,Handan 056000,China)

机构地区：[1]河北工程大学附属医院消化内科,河北省邯郸市056000

出　　处：《河北医药》2020年第21期3253-3256,3260,共5页Hebei Medical Journal

基　　金：邯郸市科学技术研究与发展计划项目(编号:20043783)。

摘　　要：目的探讨肝硬化患者短期使用质子泵抑制剂治疗前后细菌数量和细胞因子的变化及临床意义。方法回顾性分析2018年1月至2019年3月消化内科收治的107例肝硬化患者的一般资料,同时选取60例健康体检者为对照组,测定治疗前后细菌DNA、内毒素水平及其与预后的关系。结果107例肝硬化患者,其中Child-Pugh A级28例、B级57例、C级22例,血浆中内毒素表达水平分别为(47.91±10.12)pg/ml、(55.08±11.45)pg/ml、(61.04±9.51)pg/ml,明显高于对照组的(40.81±8.97)pg/ml,差异均有统计学意义(P<0.05);根据有无腹水将107例肝硬化患者分为腹水组(69例)和无腹水组(38例),腹水组患者血浆中内毒素表达水平(57.12±9.34)pg/ml显著高于无腹水组的(48.95±11.28)pg/ml,差异有统计学意义(P<0.05);对肝硬化腹水患者进行细菌培养,均为阴性,其中35例(50.72%)患者腹水中检测到细菌DNA,质子泵抑制剂治疗前后,细菌DNA表达水平差异无统计学意义(P>0.05);血浆中内毒素表达水平治疗前(52.56±8.91)pg/ml与治疗后(53.46±9.71)pg/ml比较,差异无统计学意义(P>0.05)。结论内毒素表达水平与肝硬化患者疾病严重程度有关,并对预后有一定的指导价值,质子泵抑制剂治疗前后肝硬化患者细菌DNA和内毒素表达水平无明显变化,短期内使用质子泵抑制剂对肝硬化腹水细菌移位无影响。Objective To investigate the changes and significance of bacterial DNA and endotoxin in patients with cirrhosis before and after proton pump inhibitor therapy.Methods The clinical data about 107 patients with liver cirrhosis who were treated in our hospital from January 2018 to March 2019 were retrospectively analyzed,at the same time,the other 60 healthy subjects who underwent health examination were enrolled as control group.The expression levels of bacterial DNA and endotoxin before and after treatment were observed and compared between the two groups.Moreover the correlation between the expression levels and prognosis of patients was analyzed.Results Of the 107 patients with liver cirrhosis,there were 28 patients with Child-Pugh level A,57 patients with Child-Pugh level B,22 patients with Child-Pugh level C,and the expression levels of endotoxin were(47.91±10.12)pg/ml,(55.08±11.45)pg/ml,(61.04±9.51)pg/ml,respectively in the three groups,which were significantly higher than those[(40.81±8.97)pg/ml]in control group(P<0.05).According to the presence or absence of ascites,the 107 patients were divided into ascites group(n=69)and no ascites group(n=38),the expression levels of endotoxin in ascites group were significantly higher than those[(57.12±9.34)pg/ml vs(48.95±11.28)pg/ml]in no ascites group(P<0.05).The bacterial culture was negative in all the patients,in which,bacterial DNA was detected in ascites of 35 patients(50.72%).There were no significant differences in bacterial DNA expression levels before and after proton pump inhibitor treatment(P>0.05).In addition there were no significant differences in the expression levels of endotoxin before and after treatment(P>0.05).Conclusion The expression levels of endotoxin are related to the severity of disease in patients with cirrhosis,which has a certain guiding value in evaluating the prognosis of patients.There are no significant changes in bacterial DNA and endotoxin expression levels before and after proton pump inhibitor treatment,and the short-term us

关 键 词：细菌转位 内毒素 感染 肝硬化 质子泵抑制剂 

分 类 号：R657.31[医药卫生—外科学]