关于肠黏膜屏障功能衰竭临床分期标准的初步探讨

A preliminary study on the clinical staging criteria for intestinal barrier failure

目的:初步建立肠黏膜屏障功能衰竭(IBF)的临床分期标准。方法:选取消化系统恶性肿瘤、肝硬化、炎性肠病等患者共50例作为病例组,选取25例健康志愿者作为对照组,均口服双糖探针后检测样本尿液中乳果糖/甘露醇(L/M)含量以评价肠道通透性,同时采集其新鲜粪便行菌群分析,记录其临床指标及实验室指标,分析病例组与对照组的临床表现、肠道通透性、肠菌群及免疫指标间的关系。结果:与对照组(0.02938±0.00725)相比,病例组尿L/M比值(0.06694±0.02343)显著增高,差异有统计学意义(t=9.874,P<0.01)。不同程度菌群失调患者肠道通透性差异无显著性(F=2.285,P=0.113)。随着患者腹胀及腹泻程度的增高,肠道通透性增高及中重度菌群失调的比例也增加。病例组C反应蛋白[(47.8±33.5)mg/Lvs(3.2±2.6)mg/L]、血浆内毒素[(5.806±4.219)EU/mLvs(0.018±0.056)EU/mL]及血清白细胞介素-6(22.19±8.45)pg/mLvs(6.24±0.13)pg/mL]水平较之对照组均有显著升高(均P<0.01)。结论:根据患者的临床症状、肠黏膜通透性、肠菌群状态及免疫指标间的关系,可初步建立IBF的临床分期标准。

Objective To tentatively develop the clinical staging criteria for intestinal barrier failure （IBF）. Methods Fifty patients with gasteroenterological cancer, hepatic cirrhosis, or IBD and twenty-fve healthy volunteers as control were included in this study. Intestinal permeability was assessed with urinary laetulose/mannitol （L/M） ratio detected by gas chromatography after oral administration of double-sugar probe. Faecal flora were analyzed. Clinical demonstrations and laboratory test results were recorded. The relationship among the clinical demonstrations, intestinal permeahility, gut flora, and immune indices was analyzed. Result The L/M ratio was signifieae, tly higher in the patients than that in the controls （0.066 94 ± 0.023 43 vs 0.029 38 ± 0.007 25; t = 9.874, P 〈 0.01 ）. The intestinal permeability did not differ significantly among patients with different degrees of flora imbalance （F = 2.285, P = 0.113）, but the permeability and the rate of moderate-to-severe flora imbalance were increased with the worsening of abdominal distension and diarrhea. The levels of C-reaction protein, LPS, and IL-6 were markedly higher in the patients than in the control subjects （P 〈 0.01 for all comparisons）. Conclusions The clinical staging criteria for IBF can be established based on the relationship among the clinical demonstrations, intestinal permeability, state of gut flora, and immune indices.