肝硬化失代偿期患者肠黏膜通透性的变化

Alteration of intestinal permeability in patients with decompensated cirrhosis

目的探讨肝硬化失代偿期患者肠黏膜通透性的变化。方法将64例肝硬化失代偿期患者分为Child-pugh B组(28例)和Child-pugh C组(36例)。测定治疗前、治疗后7d的尿乳果糖/甘露醇(L/M)比值、血浆内毒素(ET)水平和血浆二胺氧化酶(DAO)活性。结果治疗前Child-pugh C组尿L/M比值、血浆ET水平明显高于Child-pugh B组(P<0.01),但血浆DAO水平低于Child-pugh B组(P<0.01)。治疗后7d,两组尿L/M比值、血浆ET水平相比较差异无统计学意义(P>0.05);Child-pugh C组DAO水平出现上升趋势而Child-pugh B组则出现下降趋势,两组相比较差异有统计学意义(P<0.05)。结论尿L/M比值、血浆ET水平和DAO活性作为肠黏膜通透性的检测指标,能够准确反映肠黏膜通透性的变化。肠黏膜通透性升高可能是肝硬化患者病情恶化的关键因素之一。

Objective To explore the alteration of intestinal permeability in the patients with decompensated cirrhosis. Methods 64 cases of decompensated cirrhosis were divided into the Child-Pugh B group（n= 28） and the Child-Pugh C group（n= 36）. The ratio of urine lactulose to mannitol（L/M） ,level of endotoxin（ET） and plasma ac- tivity of diamine oxidase（DAO） were detected before treatment and on 7 d after treatment. Results Before the treat- ment, the ratio of L/M and the ET level in the Child-Pugh C group was higher than those in the Child-Pugh B group, but the activity of DAO in the Child Pugh C group was lower than that in the Child-Pugh B group（P〈0.01）. On 7 d after treatment,the ratio of L/M and the ET level were not statistically different between the two groups（P〈0.05）. The activity of DAO showed the increasing trend in the Child Pugh C group and the decreasing trend in the Child- Pugh B group,with statistical difference between the two groups（P〈0.05）. Conclusion The ratio of urine L/M, plasma ET level and the DAO activity are the detection markers for the intestinal permeability,which can exactly re- flect the changes of intestinal permeability. The increase of intestinal permeability may be one of key factors for liver cirrhosis deterioration.