益生菌高活菌酸奶联合肠内营养对肝纤维化患者的辅助治疗效果观察

比较观察两种微生态制剂联合肠内营养(EN)对肝纤维化患者的营养效果及肝功能的改善情况。

选择104例通过瞬时弹性成像技术(TE)排除肝硬化的慢性肝病患者, 并且营养风险筛查2002评分(NRS2002)≥3分, 按入院顺序随机数字表法分成观察组(益生菌高活菌数酸奶+EN)54例和对照组(金双歧+EN)50例。两组患者入院后24 h内开始启动肠内营养治疗, 观察组每日补充高活菌益生菌酸奶, 对照组给予肠内营养液加金双歧口服。对比3周后两组患者胃肠道情况、炎性指标、肝功能各项指标、肝纤维化改善程度及营养状况。

观察组与对照组患者在使用益生菌制剂3周后, 胃肠道症状均有改善, 其中观察组恶心、呕吐、腹胀的改善较对照组恢复程度更好(P < 0.05), 腹泻、便秘的缓解两组差异不大(P > 0.05)。通过血浆炎性指标分析, 观察组IL-1β、TNF-α下降较对照组明显(P < 0.05), 血清ALT、AST、GGT、ALP较治疗前降低明显, 与对照组相比血清ALT、GGT、ALP的改善较好, 差异均具有统计学意义(P < 0.05)。在治疗3周后, 肝纤维化指标结果显示, 观察组与对照组血清LN、Ⅳ-C水平均有下降, 观察组下降更为显著(P < 0.05), 但两组患者HA、PC-Ⅲ水平治疗前后均改变不明显, 与入院前相比差异无统计学意义(P > 0.05)。随着肝功能的纠正和肠内营养治疗, 肝脏合成蛋白的能力增强, 两组患者营养不良均有改善, 治疗3周后, 其中观察组血清ALB的提高较对照组显著, 差异有统计学意义(P < 0.05)。

长期服用益生菌酸奶有助于改善慢性肝病患者肠道微生态环境, 对早期肝脏纤维化有一定改善, 但是否有逆转肝纤维化的作用仍需大样本研究。

Effect of probiotics yogurt combined with enteral nutrition as adjuvant treatment in patients with liver fibrosis

ObjectiveTo observe the effects of two kinds of probiotics combined with enteral nutrition(EN) for nutrition and improvement of liver function in patients with liver fibrosis.MethodsOne hundred and four patients with chronic liver disease and a nutritional risk score(NRS2002) of ≥3 were randomly divided into observation group(high viable probiotics yogurt+EN) or control group(Golden Bifid+EN) according to the order of admission, excluded those with liver cirrhosis by transient elastography(TE). The patients started enteral nutrition treatment within 24 hours after admission. The observation group was supplemented with high viable probiotics yogurt in addition to enteral nutrition solution, while the control group was given enteral nutrition solution and Golden Bifid. After 3 weeks, the gastrointestinal tract, inflammatory indexes, liver function, liver fibrosis and nutritional status were observed.ResultsAfter using probiotics for 3 weeks, the gastrointestinal symptoms of patients in both groups were improved, with the improvement of nausea, vomiting and abdominal distension in the observation group superior to the control group(P < 0.05); the remission of diarrhea and constipation had no significant differences between the two groups(P > 0.05). Analysis of plasma inflammatory indexes showed that the levels of IL-1β and TNF-α in the observation group were significantly lower than those in the control group(P < 0.05); the serum ALT, AST, GGT and ALP in the observation group were better than those before treatment compared with the control group, and serum ALT, GGT and ALP improved better, with statistically significant differences(P < 0.05). After 3 weeks of treatment, the liver fibrosis index results showed that the serum levels of LN and Ⅳ-C in the observation group and the control group decreased, with the observation group significantly superior to control group(P < 0.05), but the levels of HA and PC-Ⅲ in the two groups did not change significantly after treatment(P > 0.05); with the correction of liver function, the protein synthesis ability of liver was enhanced, and the malnutrition in both groups was improved. After 3 weeks of treatment, the improvement of serum ALB in the observation group was significantly higher than that in the control group(P < 0.05).ConclusionLong-term administration of probiotics yogurt will help to improve the intestinal microflora environment of patients with chronic liver disease. It has a positive effect on early serological indicators of liver fibrosis to some extent, but whether it can reverse liver fibrosis still needs further study with a large sample size.