微生态制剂联合莫沙必利在预防肝硬化食管胃静脉曲张出血应用价值的临床研究

Clinical Research of Application Value in Preventing Cirrhosis in Esophageal Varices Stomach Bleeding Using Probiotics Joint Mosapride

目的探讨微生态制剂联合莫沙必利在预防肝硬化食管胃静脉曲张出血中的临床应用价值。方法选择67例葡萄糖-氢呼气试验(GHBT)阳性的肝硬化(失代偿期)患者随机分为两组,对照组采用传统方法(包括利尿、护肝、输注白蛋白和新鲜血浆、降低门脉高压等)治疗;研究组在采用对照组治疗方法的基础上,口服双歧杆菌三联活菌、莫沙必利治疗12周,治疗前后检测患者内毒素(LPS)、肿瘤坏死因子α(TNF-α)和一氧化氮(NO)水平,同步观察患者血液动力学指标(包括心输出量CO、心脏字数CI、外周血管阻力R和门静脉血流量PVF)和食管曲张静脉直径(EVD)变化。结果治疗前GHBT阳性肝硬化患者血浆LPS、TNF-α和NO水平互相间呈正相关,血浆NO水平与CO、CI、PVE、EVD呈显著性正相关,与R呈显著性负相关;治疗后研究组LPS、TNF-α、NO、CO、CI、R、PVF、EVD与对照组比较有显著差异。结论肝硬化失代偿期患者血浆LPS、TNF-α和NO生成增多,NO在门脉高压形成及血流动力学紊乱中起重要作用;应用微生态制剂联合莫沙必利能有效地降低门脉高压和纠正高动力循环,为预防肝硬化食管胃静脉曲张出血提供一种新思路和有效辅助预防出血的方法。

Objective To discuss the application value in preventing cirrhosis in esophageal varices stomach bleeding using probiotics joint mosapride. Methods 67 patients with decompensated cirrhosis which GHBT positive, and then divided into two groups randomly. In control group the patients were treated with orthodox methods（including diuresis, protecting liver, infusing albumin and fresh plasma, reducing portal hypertension）. In study group, besides orthodx methods as metioned above, the patients took bifidobacterium trigeminy living bacterium and mosapride orally for 12 weeks. Before and after treatment, test blood LPS, TNF-α, NO, and monitoring index of hemodynamics（including CO, CI, R, PVF）. Results Before treatment, plasma LPS, TNF-α and NO level were positively correlated in patients with cirrhosis which GHBT positive, plasma NO and CO, CI, PVF, EVD shows significant positive correlation, and Ris significant negative correlation. After the treatment blood LPS, TNF-α, NO, CO, CI, R, PVF, EVD in study group compared with control group are signficantly different. Conclusion Patients with decompared cirrhosis serum LPS, TNF-α and NO increased formation, NO plays an important role in portal hypertension and hemodynamics; Application of probiotics joint mosapride can effectively reduce portal hypertension and correct high power cycle, provides a new thinking and effective method of auxiliary prevention bleeding in patients with cirrhosis esophageal varices.