重建肠道菌群对酒精性肝炎伴慢性腹泻病人治疗作用的研究

Therapeutic Role of Probiotics for Restoration of Bowel Flora in Alcoholic Hepatitis with Chronic Diarrhea

目的:研究酒精性肝炎(alcoholic hepatitis,AH)伴慢性腹泻病人肠道菌群的变化,观察应用益生菌制剂重建肠道菌群后对AH的治疗作用。方法:68名病人随机分组并分别接受了7天的标准治疗和实验治疗(益生菌制剂+标准治疗)。治疗前后分别做大便细菌培养和肝酶学测定,以24名不饮酒的健康志愿者作为匹配对照组。结果:AH伴慢性腹泻病人与健康对照组相比肠道菌群数量显著减少(P(0.05);且有显著的肝酶学增高(P(0.05)。在7天治疗后,实验组病人较标准组病人的腹泻症状改善明显(P<0.05),同时肠道菌群数量也有显著升高(P(0.05)。两治疗组的肝酶学在治疗后都有显著下降,但实验治疗组的AST下降更明显(P(0.05)。结论:AH伴慢性腹泻病人与健康对照组相比肠道菌群显著减少,短期经口补充益生菌制剂后不但有利于控制腹泻症状,重建肠道菌群,而且更有利于肝功恢复。

Objective：To investigate the character of bowel flora and the theropeutic role of probiotics in patients of alcoholic hepatitis（AH）with chronic diarrhea.Methods：66 adult males admitted with a diagnosis of AH with chronic diarrhea were enrolled in this clinical study in 1 year.Patients were randomized to receive 7 days of standard therapy（abstinence,high caloric,protein low fat diet,vitamins,etc）versus probiotics plus standard thropy.Stool cultures and liver enzymes were performed before the trail and were repeated after the therapy.Results were compared between groups and with 24 healthy,matched controls who did not consume alcohol.Results：Compared to the healthy controls,patients of AH with chronic diarrhea had significantly reduced numbers of bowel flora（P﹤0.05）.Liver enzymes were significantly elevated in the alcoholic group compared to the healthy control group（P﹤0.05）,indicating that these patients did have alcohol-induced liver injury.After 7 days of therapy,diarrhea of the patients in the experimental therapy group had significantly alleviated（P〈0.05）,and the quantity of bowel flora had been greatly increased,compared to the standard therapy arm（P﹤0.05）.Despite similar values at study initiation,patients treated with probiotics had significantly lower AST activity at the end of treatment than those treated with standard therapy alone（P﹤0.05）.Conclusion：Patients of AH with chronic diarrhea have significantly altered bowel flora compared to the healthy controls.Short-term oral supplementation with probiotics was associated with restoration of the bowel flora and greater improvement in alcohol-induced liver injury than standard therapy alone.