双歧杆菌四联活菌片联合乳果糖对乙肝肝硬化患者肠道菌群 和肠黏膜屏障功能及肝功能水平的影响

目的研究双歧杆菌四联活菌片联合乳果糖对乙肝肝硬化患者肠道菌群、肠黏膜屏障功能及肝功能水平的影响。方法选择2017年12月至2018年12月于我院感染科住院治疗的乙肝肝硬化患者80例,按照随机数字表法分为试验组和对照组各40例。两组患者常规予以抗病毒及保肝治疗。试验组患者加用双歧杆菌四联活菌片和乳果糖口服液。对照组患者仅给予乳果糖口服液。检测患者肠道肠杆菌、肠球菌、双歧杆菌、乳杆菌和白假丝酵母数量。测定患者血清内毒素和血清二胺氧化酶水平及尿乳果糖/甘露醇(L/M)比值。记录两组患者丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)和总胆红素(TBIL)水平。观察治疗过程中的药物不良反应发生情况。结果治疗4周后,试验组患者肠道肠球菌数量高于治疗1周后(18.41±2.92 vs 18.32±3.06),同时试验组患者肠道双歧杆菌数量与治疗前、治疗1周后以及对照组同时期相比差异也有统计学意义(均P0.05)。试验组患者治疗后肠道乳杆菌和白假丝酵母水平与治疗前相比差异均有统计学意义(均P0.05)。治疗4周后,对照组患者肠道肠杆菌水平高于治疗1周后(F=10.192,P=0.019);而白假丝酵母水平高于治疗前(F=8.567,P=0.024)。治疗前两组患者血清内毒素、血清二胺氧化酶和尿L/M以及AST、ALT、TBIL水平差异无统计学意义(均P0.05)。治疗1个月后,两组患者血清内毒素、血清二胺氧化酶和尿L/M以及AST、ALT、TBIL均较治疗前明显下降(均P0.05),且试验组的下降幅度较对照组更大(均P0.05)。两组患者均未发生不良反应。结论双歧杆菌四联活菌片联合乳果糖可以改善乙肝肝硬化患者肝功能状态,调节失衡的肠道菌群,降低肠黏膜通透性,值得临床推广。

Effects of Quadruple Viable Bifidobacterium tablets combined with lactulose on intestinal flora, intestinal mucosal barrier function and liver function in patients with hepatitis B cirrhosis

Abstract: Objective To study the effects of Quadruple Viable Bifidobacterium combined with lactulose on intestinal flora, intestinal mucosal barrier function and liver function in patients with hepatitis B cirrhosis. Methods Eighty patients with hepatitis B cirrhosis who were hospitalized in our hospital from December 2017 to December 2018 were enrolled and randomly divided into Observation group or Control group, 40 cases in each group. Both groups were given conventional treatment; The observation group was additionally given Quadruple Viable Bifidobacterium tablets and lactulose, while the control group received lactulose alone. The contents of Enterobacters, Enterococci, Bifidobacteria, Lactobacilli and Candida albicans were observed. The levels of serum endotoxin, serum diamine oxidase, urine lactulose/mannitol (L/M) ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) were detected. The occurrence of adverse drug reactions during the treatment were recorded. Results After 4 weeks of treatment, the number of Enterococci in Observation group was higher than that after 1 week of treatment (18.41±2.92 vs 18.32±3.06), and that of Bifidobacteria was statistically different from that before treatment, 1 week after and 4 weeks after treatment and that in the control group, respectively. Compared with those before treatment, the numbers of Lactobacilli and Candida albicans after treatment were statistically different. After 4 weeks of treatment, the number of Enterobacteria in the control group was higher than that after 1 week of treatment (F=10.192, P=0.019); the number of Candida albicans was higher than that before treatment (F=8.567, P=0.024). There were no significant differences in serum endotoxin, serum diamine oxidase, urine L/M, AST, ALT and TBIL between the two groups before treatment (all P>0.05). After 1 month of treatment, serum endotoxin, serum diamine oxidase and urine L/M, as well as AST, ALT and TBIL were significantly lower than those before treatment (all P<0.05), with the observation group superior to the control group ( all P<0.05). No adverse reactions occurred in either group. Conclusion Viable Quadruple Bifidobacterium combined with lactulose can improve the liver function of patients with hepatitis B cirrhosis, regulate the imbalance of intestinal flora and reduce intestinal mucosal permeability.