非酒精性脂肪性肝炎患者肠道菌群失调与肠道通透性及血清内毒素的相关性研究

Relationship of disturbance of intestinal flora,intestinal permeability and serum endotoxin in patients with NASH

目的探讨非酒精性脂肪性肝炎患者肠道菌群失调与肠道通透性及血清内毒素的相关性。方法选择肠道菌群中具有代表性的细菌共8种进行培养。研究对象为健康成人(A组)和非酒精性脂肪性肝炎(B组)各30例,计数两组肠道菌群中8种细菌的数量,检测所有被研究者的血清内毒素、二胺氧化酶(DAO)、D-乳酸及TNF-α的浓度,比较两组细菌数量和血清指标的变化,并进行相关分析。结果与A组比较,B组双歧杆菌、乳杆菌和拟杆菌的菌落数显著减少(P<0.01或P<0.05),而肠球菌、肠杆菌的菌落数则有显著增加(P<0.01或P<0.05);酵母真菌、葡萄球菌、梭菌菌落数没有发生显著改变(P>0.05);血清内毒素、DAO、D-乳酸、TNF-α水平显著增高(P<0.01);相关分析显示肠杆菌与内毒素、DAO、D-乳酸相关(r=0.644,P<0.001;r=0.415,P=0.023;r=0.383,P=0.037);血清内毒素和DAO、D-乳酸、TNF-α显著相关(r=0.485,P=0.007;r=0.477,P=0.008;r=0.490,P=0.006);TNF-α则与DAO、D-乳酸相关(r=0.426,P=0.019;r=0.440,P=0.015)。结论非酒精性脂肪性肝炎患者存在肠道菌群失调、肠道通透性增高及肠源性内毒素血症,肠杆菌的过度生长与肠源性内毒素血症及肠道通透性密切相关。

Objective To investigate the relationship of disturbance of intestinal flora,intestinal permeability and plasma endotoxin in patients with nonalcoholic steatohepatitis（NASH）.Methods Representative bacteria in intestinal flora were cultivated and counted routinely.The subjects were divided into 2 groups： healthy control group（group A,n=30） and NASH group（group B,n=30）.Their intestinal flora,serum endotoxin,diamine oxidase,D-lactate and TNF alpha levels were detected respectively.Results Compared with group A,bacillus bifidus,bacillus lactis and bacteroides decreased（P〈0.01 or P〈0.05）,enterobacteria and enterococcus increased（P〈0.01 or P〈0.05）,and serum endotoxin,diamine oxidase,D-lactate and TNF alpha levels increased remarkably（P〈0.01） in group B.The enterobacteria correlated with serum endotoxin,dia-mine oxidase and D-lactate（r=0.644,P〈0.001;r=0.415,P=0.023;r=0.383,P=0.037）;serum endotoxin correlated with diamine oxidase,D-lactate and TNF alpha（r=0.485,P=0.007;r=0.477,P=0.008;r=0.490,P=0.006）;TNF alpha correlated with diamine oxidase and D-lactate（r=0.426,P=0.019;r=0.440,P=0.015）.Conclusion Alteration of intestinal flora,increasing of intestinal permeability and intestinal endotoxemia existed in patients with NASH and the overgrowth of enterobacteria correlated with intestinal permeability and serum endotoxin positively.