谷氨酰胺联合双歧杆菌四联活菌对酒精性肝病并发慢性腹泻患者肠道菌群重建的疗效观察

摘要

Objective To observe the effect of glutamine plus viable bifidobacterium quadruple on intestinal flora reconstruction in patients with alcoholic liver disease complicated by chronic diarrhea.Methods A total of 90 patients with alcoholic liver disease complicated by chronic diarrhea from March to August 2015 in Wuhan No.1 Hospital were randomly divided into observation group (50 cases) and control group (40 cases).The control group orally took montmorillonite powder;the observation group took montmorillonite powder,glutamine and viable bifidobacterium quadruple.The therapeutic effect on diarrhea was evaluated after 2 weeks of treatment.Liver function indexes [alanine aminotransferase (ALT),aspartate aminotransferase (AST),albumin,total bilirubin (TBIL)],serum tumor necrosis factor-α(TNF-α),serum immunoglobulin(IgA,[gG,IgM),immune function indicators(CD3+,CD4+,CD8+,CD4+/CD8+) and intestinal mucosal barrier function indexes [serum diamine oxidase(DAO),endotoxin,D-lactate,intestinal secretory immunoglobulin A(sIgA)] were tested before and after medication.Results The total effective rate in observation group was significantly higher than that in control group[84.0％ (42/50) vs 62.5％ (25/40)] (P ＜ 0.05).There were significant differences of ALT,AST,albumin,TBIL,TNF-α,IgA,IgM,CD3+ ratio,CD4+ ratio,CD4+/CD8+,DAO,endotoxin,D-lactate and intestinal sIgA before and after treatment in observation group [(51 ± 18) U/L vs (82 ± 28) U/L,(48 ± 17) U/L vs (83 ± 29) U/L,(36 ± 6) g/L vs (24 ± 6) g/L,(35 ± 13) μmol/L vs (49 ± 14) μmol/L,(6.1 ± 2.1) ng/L vs (9.9 ±3.8)ng/L,(4.8 ± 1.6)g/L vs (3.6 ± 1.3)g/L,(2.1 ±0.9)g/L vs (1.5 ± 1.0)g/L,(72 ± 19)％ vs (57±13)％,(48 ±7)％ vs (39 ±5)％,(1.51 ±0.29) vs (1.23 ±0.35),(2.7 ±1.2)kU/L vs (5.4± 2.2) kU/L,(0.042 ± 0.006) μg/L vs (0.067 ± 0.027) μg/L,(7.5 ± 2.8) mg/L vs (13.7 ± 4.7) mg/L,(623 ± 164) μg/g vs (494 ± 123) μg/g] (P ＜ 0.05).There were significant differences of ALT,AST,TNF-α,IgM,CD3+ ratio,CD4+/CD8+,DAO,endotoxin,D-lactate and intestinal sIgA between observation group and control group after treatment [(66 ± 16) U/L,(64 ± 21) U/L,(8.3 ±4 2.8) ng/L,(1.5 ± O.8) g/L,(63 ± 17) ％,(1.27 ± 0.28),(3.9 ± 1.8)kU/L,(0.059 ±0.012) μg/L,(10.7 ±3.6) mg/L,(745 ± 159) μg/g] (P ＜0.05).Conclusion Glutamine plus viable bifidobacterium quadruple is effective for treating intestinal flora reconstruction in patients with alcoholic liver disease complicated with chronic diarrhea.%目的 观察谷氨酰胺联合双歧杆菌四联活菌对酒精性肝病并发慢性腹泻患者肠道菌群重建的疗效.方法 选取2015年3-8月于武汉市第一医院接受治疗的90例酒精性肝病并发慢性腹泻患者作为研究对象.采用分段随机方法分为观察组(50例)和对照组(40例).对照组口服蒙脱石散1.0g/次、3次/d;观察组在对照组的基础上加服谷氨酰胺1.0g/次、3次/d和双歧杆菌四联活菌1 500 mg/次、3次/d;均连续治疗2周.观察2组患者腹泻的治疗效果.检测2组患者治疗前后的肝功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、白蛋白、总胆红素]、血清肿瘤坏死因子α(TNF-α)、血清免疫球蛋白(Ig)A、IgG、IgM、免疫功能(CD3、CD4、CD8+、CD4+/CD8+)及肠黏膜屏障功能[血清二胺氧化酶(DAO)、内毒素、D-乳酸及肠道分泌型IgA (sIgA)].结果 观察组的总有效率高于对照组[84.0％(42/50)比62.5％ (25/40)],差异有统计学意义(P＜0.05).观察组患者治疗后血清ALT、AST、白蛋白、总胆红素、TNF-α、IgA、IgM、CD3比例、CD4+比例、CD4+/CD8+、DAO、内毒素、D-乳酸及肠道sIgA水平与治疗前比较差异均有统计学意义[(51±18)U/L比(82±28) U/L,(48±17) U/L比(83±29) U/L,(36±6)g/L比(24±6) g/L,(35±13) μmol/L比(49±14) μmol/L,(6.1±2.1)ng/L比(9.9±3.8) ng/L,(4.8±1.6)g/L比(3.6±1.3)g/L,(2.1±0.9)g/L比(1.5±1.0) g/L,(72±19)％比(57±13)％,(48±7)％比(39±5)％,(1.51±0.29)比(1.23±0.35),(2.7±1.2) kU/L比(5.4±2.2)kU/L,(0.042±0.006) μg/L比(0.067±0.027) μg/L,(7.5±2.8) mg/L比(13.7±4.7) mg/L,(623±164) μg/g比(494±123) μg/g];且血清ALT、AST、TNF-α、IgM、CD3+比例、CD4+/CD8+、DAO、内毒素、D-乳酸及肠道sIgA水平与对照组治疗后[(66±16) U/L、(64±21)U/L、(8.3±2.8) ng/L、(1.5±0.8) g/L、(63±17)％、(1.27±0.28)、(3.9±1.8)kU/L、(0.059±0.012) μg/L、(10.7±3.6) mg/L、(745±159)μg/g]比较差异均有统计学意义(均P＜0.05).结论 谷氨酰胺联合双歧杆菌四联活菌对酒精性肝病并发慢性腹泻患者肠道菌群重建具有良好的疗效.