肝硬化自发性细菌性腹膜炎外周血Th1/Th2平衡与肠道菌群的相关性  

Association between peripheral blood Th1/Th2 balance and intestinal flora of cirrhosis patients with spontaneous bacterial peritonitis

作　　者：朱明哲 冯喆 徐小妍 赫丹艳 徐婷婷[1] ZHU Ming-zhe;FENG Zhe;XU Xiao-yan;HE Dan-yan;XU Ting-ting(Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院肝胆脾外科,辽宁沈阳110004

出　　处：《中华医院感染学杂志》2022年第14期2127-2130,共4页Chinese Journal of Nosocomiology

基　　金：辽宁省自然科学基金资助项目(2018021131)。

摘　　要：目的分析肝硬化自发性细菌性腹膜炎(SBP)患者外周血T辅助细胞(Th)1/Th2平衡变化,并探讨其与肠道菌群改变的关系。方法收集2018年4月-2021年4月中国医科大学附属盛京医院78例肝硬化SBP患者为SBP组,同期42例肝硬化无菌性腹水(SA)患者为SA组;患者入院后第二天收集新鲜粪便标本,采用平板活菌计数法检测肠道菌群主要成分双歧杆菌、乳酸杆菌、大肠埃希菌及肠球菌数量,并计算双歧杆菌与大肠埃希菌数量对数值的比值(B/E);采集清晨空腹静脉血,测定外周血Th1、Th2比例以及血清肿瘤坏死因子α(TNF-α)、干扰素γ(IFN-γ)、白细胞介素(IL)-4、IL-10水平。结果SBP组双歧杆菌、乳酸杆菌数量及B/E值均少于SA组,大肠埃希菌和肠球菌数量多于SA组(P<0.05);SBP组患者外周血Th1细胞比例及Th1/Th2比值高于SA组(P<0.05),Th2细胞比例低于SA组(P<0.05);SBP组患者外周血IFN-γ、TNF-α水平均高于SA组(P<0.05),IL-4和IL-10水平均低于SA组(P<0.05)。结论肝硬化SBP患者存在明显的肠道菌群失调,肠道菌群紊乱可能通过影响机体Th1/Th2平衡促进肝硬化SBP发展。OBJECTIVE To explore the changes of peripheral blood helper T(Th) cell Th1/Th2 balance in cirrhosis patients with spontaneous bacterial peritonitis(SBP) and analyze their relationship with change of intestinal flora. METHODS A total of 78 cirrhosis patients with SBP who were treated in Shengjing Hospital Affiliated to China Medical University from Apr 2018 to Apr 2021 were assigned as the SBP group, meanwhile, 42 cirrhosis patients without sterile ascites(SA) were chosen as the SA group. The fresh stool specimens were collected from the patients on the second day after admission, the counts of major intestinal flora Bifidobacterium, Lactobacillus, Escherichia coli and Enterococcus were detected by plate viable bacteria counting method;the logarithm ratio of Bifidobacteria to E.coli count(B/E) was calculated. The early-morning fasting venous blood specimens were collected to detect the percentages of Th1, Th2 in peripheral blood as well as the levels of serum tumor-necrosis factorα(TNF-α), interferon γ(IFN-γ), interleukin-4(IL-4) and interleukin-10(IL-10). RESULTS The counts of Bifidobacteria and Lactobacillus as well as B/E were less in the SBP group than in the SA group, and the counts of E.coli and Enterococcus were more in the SBP group than in the SA group(P<0.05). The percentage of peripheral blood Th1 and the ratio of Th1 to Th2 were higher in the SBP group than in the SA group, while the percentage of Th2 cell of the SBP group was lower than that of the SA group(P<0.05). The levels of peripheral blood IFN-γ and TNF-α of the SBP group were significantly higher than those of the SA group(P<0.05), while the levels of IL-4 and IL-10 of the SBP group were significantly lower than those of the SA group(P<0.05). CONCLUSION The cirrhosis patients with SBP have significant imbalance of intestinal flora, and the imbalance of intestinal flora may promote the development of cirrhosis SBP by affecting the balance of Th1/Th2.

关 键 词：肝硬化 自发性细菌性腹膜炎 T辅助细胞1 T辅助细胞2 肠道菌群 

分 类 号：R657.31[医药卫生—外科学]