小肠细菌过度生长相关性轻微肝性脑病患者的血浆内毒素水平

The plasma endotoxic levels in small intestinal bacteria overgrowth correlating minimal hepatic encephalopathy in patients with cirrhosis

目的观察肝硬化患者小肠细菌过度生长相关性轻微肝性脑病患者的内毒素水平,探讨内毒素与轻微肝性脑病的关系。方法对90例肝硬化患者及20例健康志愿者进行内毒素水平、葡萄糖氢呼气试验(GHBT)、数字连接试验(NCT-A和NCT-BC)和数字符号试验(DST)检测,观察小肠细菌过度生长相关性轻微肝性脑病患者的内毒素水平变化。结果肝硬化组小肠细菌过度生长(36.7%,33/90)明显高于健康对照组(5%,1/20)。20名健康志愿者未检出轻微肝性脑病(MHE);90例肝硬化患者轻微肝性脑病37例(41.1%),其中伴小肠细菌过度生长肝硬化患者轻微肝性脑病发生率高于不伴小肠细菌过度生长患者。肝硬化组内毒素水平(69.6±21.3)pg/mL高于健康对照组(18.7±8.6)pg/mL;肝硬化小肠细菌过度生长组内毒素水平(89.5±17.6)pg/mL高于无小肠细菌过度生长组(57.3±15.8)pg/mL(P<0.05)。应用抗生素抑制小肠细菌过度生长及乳果糖治疗1周后GHBT、内毒素水平、NCT-A、NCT-BC及DST检查结果改善。结论内毒素与伴小肠细菌过度生长的轻微肝性脑病的发生及进展可能有一定的关系。

Objective To investigate the endotoxic levels in small intestinal bacteria overgrowth （SIBO） correlating minimal hepatic encephalopathy （MHE） in cirrhotic patients and to investigate the relationship between endotoxie levels and minimal hepatic encephalopathy. Methods Ninety patients with liver cirrhosis and 20 healthy volunteers were ineluded. In all participants, the endotoxic levels were detected. Glucose hydrogen breath test （GHBT） for small intestinal bacteria overgrowth （SIBO） was performed, and tests （NCT-A, NCT-BC and DST） for minimal hepatic encephalopathy （MHE） were performed. The change of endotoxic levels in small intestinal bacteria overgrowth （SIBO） correlating minimal hepatic encephalopathy （MHE） was observed. Results The rate of SIBO was higher in cirrhotic patients （36.7% , 33/90） than that in healthy controls（5% , 1/20）. None MHE was observed in healthy volunteers. Thirty-seven （41.1%） cirrhotic patients suffered from MHE. The rate of SIBO was significantly higher in cirrhotic patients with small intestinal bacteria overgrowth than that in cirrhotic patients without small intestinal bacteria overgrowth. The endotoxic levels in patients with cirrhosis [ （69.6 ± 21.3 ）pg/mL] were higher than that in healthy volunteers [ （18.7 ± 8.6） pg/mL, P 〈 0.05 ]. The endotoxic levels incirrhotic patients with SIBO [ （89.5 ± 17.6） pg/mL ] were higher than that in cirrhotic patients without SIBO [ （57.3 ± 15.8） pg/mL, P 〈 0.05 ]. The GHBT, endotoxic levels, number connection test and digit symbol test improved after inhibiting small intestinal bacteria overgrowth with one week antibiotics and laetulose administration. Conclusion Endotoxin may be related to pathogenesis and progression of MHE with SIBO.