乳果糖联合培菲康对肝硬化自发性细菌性腹膜炎患者肠黏膜屏障功能及炎性细胞因子的影响

摘要

目的 探讨乳果糖联合培菲康对肝硬化自发性细菌性腹膜炎患者肠黏膜屏障功能、血清及腹水TNF-α、IL-6水平的影响.方法 选择肝硬化自发性细菌性腹膜炎患者120例,随机分为常规治疗组(n=60)和联合治疗组(n=60),另外选择健康体检者30例为健康对照组.所有患者均于治疗前、治疗后口服糖分子探针乳果糖、甘露醇,采用高压液相色谱示差法测定尿乳果糖/甘露醇排泄率,测定治疗前后血清及腹水TNF-α、IL-6水平,并统计患者的病死率.结果 治疗前常规治疗组和联合治疗组患者尿乳果糖/甘露醇排泄率,血清及腹水TNF-α、IL-6水平显著高于健康对照组(P<0.05,P<0.01);治疗后联合治疗组尿乳果糖/甘露醇排泄率、血清及腹水TNF-α、IL-6水平较常规治疗组明显下降(P<0.05或P<0.01);联合治疗组的病死率明显低于常规治疗组(8.33% vs 18.33%,P<0.05).结论 乳果糖联合培菲康可以降低肝硬化自发性细菌性腹膜炎患者血清及腹水TNF-α、IL-6水平,提高肠黏膜屏障功能,改善患者预后.%Objective To evaluate the effects of lactulose and bifid lriple viable on intestinal barrier function, serum and ascites TNF-α, interleukin-6 levels in hepatitis cirrhotic patients with spontaneous bacterial peritonitis ( SBP ).Methods One hundred and twenty- SBP patients with hepatitis cirrhosis were randomly allocated into two groups, treatment group( n =60 ) and control group( n = 60 ).Health volunteers were selected as healthy control group( n = 30 ).All subjects were observed for 7days.To evaluate intestinal perneability, the concentration of lactulose( LAC )and mannitol( MAN ) in urine was measured using high pressure liquid chromatograph with refractive index detector ( HPLC RID ), the concentration of serum and ascites TNF-α and interleukin-6 were measured before and after seven day-s of treatment with lactulose and bifid lriple viable, and mortality rate of patients was counted.Results The levels of urinary- excretion of LAC/MAN ratios, serum and ascires TNF-α and interleukin-6 levels in treatment group and control group were significantly higher than of healthy control group ( P ＜ 0.05 or P ＜ 0.01 ); the levels of urinary excretion of LAC/MAN ratios, serum and ascites TNF-α and interleukin-6 levels after treatment in treatment group were significantly lowered than that of control group( P ＜ 0.05 or P ＜ 0.01 ); the mortality rate of treatment group was significantly lowered than that of control group( 8.33 ％ vs 18.33 ％, P ＜ 0.05 ).Conclusion The treatment combined with lactulose and bifid lriple viable can effectively reduce serum and ascites TNF-α and interleukin-6 levels, improve intestinal barrier function and prognosis.