双歧三联活菌对酒精性肝病的治疗作用

The therapeutic role of live combined bifidobacterinm, lactobacillus and disease

目的研究酒精性肝病（ALD）患者肠道菌群的变化以及双歧三联活菌对酒精性肝病的治疗作用。方法66例住院ALD患者完全随机分为标准治疗组（34例）和试验治疗组（32例），分别接受7d的标准治疗和试验治疗（双歧三联活菌＋标准治疗）。治疗前后做大便细菌培养和肝酶学测定。以24名健康不饮酒者为对照组。结果与对照组相比，ALD患者肠道菌群数量显著（10gCFU／g）减少[双歧杆菌（6．30±0．17）比（7．50±0．32）；乳酸杆菌（3．15±0．19）比（4．59±0．34）；肠球菌（4．43±0．20）比（5．50±0．30），P〈0．05]；并有显著的肝酶学增高[AST：（104．1±0．9s）U／L比（29．15±2．（13）u／L；ALT：（50．49±5．90）U／L比（22．964-2．40）U／L；谷氨酸转肽酶（GGT）：（161．50±13．50）U／L比（51．90±6．20）U／L；TBil（22．56±1．17）比（16．78±0．79），P〈0．05]。在7d治疗后，试验治疗组患者肠道菌群数量（10gCFU／g）明显高于标准治疗组[双歧杆菌（7．90±0．39）比（6．81±0．27）；乳酸菌（4．20±0．27）比（3．20±0．27）；肠球菌（5．3±0．31）比（4．30±0．30），P〈0．05]。尽管治疗前2组患者的肝酶学改变与对照组相比差异都有统计学意义，但是治疗后试验治疗组AST、ALT下降更明显，与标准治疗组相比差异有统计学意义[ASTI（54．67±7．71）U／L比（76．43±5．06）U／L；ALT（36．69±4．67）U／L比（51．26±2．25）U／L，P〈0．05]。在26例酒精性肝炎的亚组中，试验治疗后只有AST下降明显，与标准治疗组相比差异有统计学意义[（56．38±9．47）U／L比（88．54±15．16）U／L，P〈0．05]。结论ALD患者与健康对照组相比肠道菌群显著减少，短期经口补充双歧三联活菌不但有利于肠道菌群的恢复，而且有利于肝功能的恢复。

Objective To investigate the character of bowel flora and the therapeutic role of live combined bifidobacterium, lactob-acillus and enterrococcus （LCBLE） in alcoholic liver disease（ALD）. Methods Sixty-six adult males admitted with a diagnosis of ALD were enrolled in this randomized, clinical study in 32 weeks. Patients were randomized to 7 days of LCBLE plus standard therapy and standard therapy （ abstinence, high caloric, protein low fat diet, vitamins, etc） only. Stool cultures and liver enzymes were performed before the trail and were repeated after the therapy. Results Compared to healthy controls, ALD patients had significantly reduced numbers of bifidobacteria, lactobacilli, and enterococci. Liver enzymes were significantly elevated in the alcoholic group com- pared to the healthy control group, indicating that these patients did have alcohol-induced liver injury. After 7 days of therapy of LCBLE, ALD patients had significantly increased quantity of bifidobacteria, lactobacilli and enterococci compared to the standard therapy arm. Despite similar values at study initiation, patients treated with LCBLE had significantly lower AST and ALT activity at the end of treatment than those treated with standard therapy alone. In a subgroup of 26 subjects with diagnosis alcoholic hepatitis, therapy of LCBLE was associated with a significant reduc- tion in liver enzymes and TB. In this subgroup, there was a mean AST reduction in the LCBLE therapy compared with the standard therapy arm. Conlusions ALD patients have significantly altered bowel flora compared to healthy controls. Short-term oral supplementation with LCBLE is associated with restoration of the bowel flora and improvemerit in alcohol-induced liver injury than standard therapy alone.