肝源性腹泻62例诊治分析

Diagnosis and treatment of hepatogenous diarrhea: an analysis of 62 cases

目的探讨肝源性腹泻的发病机制、诊断要点及治疗体会。方法将本院2012年6月至2013年11月收治的62例肝源性腹泻患者依据治疗效果分为三级治疗,一级治疗给予酪酸梭菌二联活菌散调节肠道菌群;二级治疗给予蒙脱石散收敛、吸附、止泻和复方苯乙哌啶抑制肠蠕动;三级治疗给予生长抑素降低门静脉压力。观察治疗前的总胆红素、白蛋白、总胆汁酸、凝血酶原时间血小板计数、脾脏厚径、脾脏长径、脾静脉宽度、门静脉宽度、大便常规、大便培养和治疗前、治疗后腹泻的次数及腹泻的时间。计量资料采用Spearman秩相关进行统计分析。结果肝源性腹泻以肝硬化失代偿期最多见,腹泻次数,腹泻时间与Child-Pugh的相关系数rs分别为0.71、0.69,P值均<0.05,差异有统计学意义,即Child-Pugh分级越高,腹泻程度越重且越易出现,其临床表现无特异性,治疗上轻、中度腹泻以改善肝功能、调节肠道菌群、收敛、抑制肠蠕动为主,重度腹泻以降低门静脉压力为主。结论肝源性腹泻发病机制是多方面的,诊断上无特异性,治疗上以治疗原发性肝病、调节肠道菌群及降低门静脉压力为主,生长抑素对重度腹泻效果显著。

Objective To investigate the pathogenesis,diagnostic keys,and treatment of hepatogenous diarrhea.Methods Sixty-two patients with hepatogenous diarrhea were assigned to three levels of treatment.Patients given level-one treatment received live combined Clostridium butyricum and Bifidobacterium powder for regulating intestinal flora;patients given level-two treatment received montmorillonite powder for constriction,adsorption,and stopping diarrhea and compound diphenoxylate for inhibiting intestinal peristalsis;patients given level-three treatment received somatostatin for reducing portal pressure.Total bilirubin,albumin,total bile acid,prothrombin time,plate-let count,spleen thickness,spleen length,splenic vein width,and portal vein width,as well as routine stool test and stool culture,were measured before treatment,and the times of diarrhea and time of onset were determined before and after treatment.Measurement data were expressed as M（P25 -P75 ）,and statistical analysis was performed using the Spearman rank correlation coefficient.Results Hepatogenous di-arrhea was mostly seen in patients with decompensated liver cirrhosis.The higher the Child-Pugh score,the severer the diarrhea and the high-er the susceptibility to diarrhea.Hepatogenous diarrhea had no specific clinical manifestations.Mild or moderate diarrhea was treated mainly by improving liver function,regulating intestinal flora,and inhibiting intestinal peristalsis,while severe diarrhea mainly by reducing portal pres-sure.Conclusion The pathogenesis of hepatogenous diarrhea is complex,without specificity for the diagnosis.The key to therapy is to treat the primary liver disease,regulate intestinal flora,reduce portal pressure,and somatostatin shows good efficacy for severe diarrhea.