枯草杆菌肠球菌二联活菌胶囊对肝硬化失代偿期患者的临床疗效

目的 观察枯草杆菌肠球菌二联活菌胶囊对肝硬化失代偿期患者的临床疗效。方法 选择2013年6月至2016年6月在湖北医药学院附属人民医院住院治疗的85例肝硬化失代偿期患者为研究对象，随机分为观察组（43例）和对照组（42例）。对照组患者接受肝硬化常规治疗，观察组在对照组基础上加用枯草杆菌肠球菌二联活菌胶囊500 mg/次，3次/d，口服。两组患者疗程均为2个月。观察并比较两组患者治疗前后肝肾功能指标[丙氨酸转氨酶（ALT）、总胆红素（TBil）、前白蛋白（PA）、血肌酐（sCr）、胱抑素C（CysC）、β2微球蛋白（β2-MG）]、肠黏膜屏障功能指标[血氨、内毒素、肿瘤坏死因子（TNF-α）、血清二胺氧化酶（DAO）]、Child-Pugh评分及并发症发生率。结果 治疗后观察组患者ALT、TBil、CysC、β2-MG水平显著下降，PA水平显著升高（P<0.05或P<0.01），对照组患者治疗后ALT水平也明显下降（P<0.01），且观察组患者ALT、CysC、β2-MG下降幅度较对照组更大（P<0.05或P<0.01）。两组患者血氨、内毒素、TNF-α和DAO水平较治疗前明显下降（P<0.01），且观察组患者下降幅度较对照组更大（P<0.01）。观察组患者Child-Pugh评分显著降低（P<0.01），且其下降幅度较对照组更大（P<0.05）。观察组患者并发症的发生率明显低于对照组（P＜0.05）。结论 枯草杆菌肠球菌二联活菌胶囊能有效改善肝硬化失代偿期患者的肝肾功能，修复肠黏膜屏障功能，降低血氨、内毒素、TNF-α和DAO水平，减少并发症的发生。

Clinical effect of viable Bacillus subtilis-Enterococcus Capsulesin patients with decompensated cirrhosis

Objective To observe the efficacy of viable Bacillus subtilis-Enterococcus capsules in patients with decompensated cirrhosis. Methods 85 patients with decompensated cirrhosis in our hospital from June 2013 to June 2016 were randomly divided into observation group (43 cases) or control group (42 cases). Both groups received routine treatment for cirrhosis, while the observation group was additionally given enteric-coated Bacillus subtilis-Enterococcus capsules 500 mg tid orally. The course of therapy was two months. The hepatorenal function indexes [alanine aminotransferase (ALT), total bilirubin (TBil), prealbumin (PA), serum creatinine (sCr), Cystatin C (CysC), beta 2 microglobulin (β2-MG)], intestinal mucous membrane barrier function indexes [blood ammonia, endotoxin, tumor necrosis factor alpha (TNF-α), diamineoxidase (DAO)], Child-Pugh scores and incidence rates of complications in the two groups before and after treatment were observed. Results After treatment, the levels of ALT, TBil, Cys C, β2-MG decreased while PA increased significantly in observation group (P<0.05 or P<0.01). The level of ALT significantly decreased in control group (P<0.01). The decreases of ALT, CysC and β2-MG in observation group were more significant than in control group (P<0.05 or P<0.01). The levels of blood ammonia, endotoxin, TNF-α and DAO in the two groups　obviously decreased after treatment (P<0.01), with the decreases in observation group more significant than in control group (P<0.01). The Child-Pugh score of observation group was significantly lower after treatment (P<0.01), and the decrease was more obvious than that of control group (P<0.05). The incidence of SBP, HE and HRS in the observation group were lower than in the control group (P<0.05). Conclusion Enteric-coated viable Bacillus subtilis-Enterococcus capsules can effectively improve hepatorenal function, restore intestinal mucous membrane barrier function, decrease the levels of blood ammonia, endotoxin, TNF-α and DAO, and reduce the incidence of complications in patients with decompensated cirrhosis.