促肠动力药对肝硬化肠源性内毒素血症的影响

The effect of prokinetic drug on intestinal origin endotoxemia in liver cirrhosis

目的 评价促肠动力药对肝硬化肠源性内毒素血症的治疗价值。方法 肝硬化大鼠分为促肠动力药治疗组和对照组 ,治疗前后分别采血测内毒素水平。另设正常对照组。 5 2例肝硬化病人分成促肠动力药组 (A组 )、乳果糖组(B组 )和对照组 (C组 ) ,疗程 2周 ,治疗前后分别抽血测内毒素。结果 治疗前两组肝硬化大鼠的血清内毒素水平无差别 (P >0 .0 5 ) ,高于正常大鼠 (P <0 .0 1) ,经促肠动力药物治疗后内毒素明显降低 (P <0 .0 1)。治疗后肝硬化病人内毒素水平在A、B组均有下降 (P <0 .0 1) ,两组间差异无统计学意义 ;对照组前后两次血内毒素水平无明显差异。结论 促肠动力药能降低肝硬化大鼠和病人的血清内毒素水平 ,提示其对肝硬化肠源性内毒素血症的治疗有益。

Objective To assess the effects of prokinetic drug in reducing intestinal origin endotoxemia in liver cirrhosis. Methods 20 cirrhotic rats induced by carbon tetrachloride were randomized to be treated with cisapride suspension (2mg·kg -1·d -1) or placebo for 10 days. Five healthy rats were used as a control group. Serum endotoxin level was tested before and after the experiment. Measurements of serum endotoxin level before and after treatment were also performed in 52 cirrhotic patients. They were randomly divided into three groups, one received the prokinetic drug therapy (Group A), one received lactulose (Group B) both for 2 weeks, and the an other group as control (Group C). Serum endotoxin level was tested before and after therapy. Results Serum endotoxin level was higher in cirrhotic rats [(0.73±0.41)Eu/ml and (0.70±0.35)Eu/ml] than that in normal rats [(0.06±0.02)Eu/ml,P<0.01]. It was much lower in the prokinetic treated group than placebo [(0.23±0.09)Eu/ml, P<0.01]. There was no significant changes of endotoxin level of cirrhotic rats treated with placebo (0.58± 0.21Eu/ml,P>0.05). The endotoxin level in portal vein was higher than that in peripheral vein in all cirrhotic rats. Serum endotoxin levels of cirrhotic patients were about the some among the three groups before therapy [( 0.63± 0.36)Eu/ml、( 0.66± 0.31)Eu/ml and ( 0.65± 0.20)Eu/ml, P>0.05]. It decreased significantly after therapy both in Group A (0.32± 0.21Eu/ml) and Group B (0.280±0.14Eu/ml, P<0.01), but not in Group C. The differnce between Group A and B was insignificant. Conclusion Administration of cisapride to cirrhotic rats and patients results in a reduction of serum level of endotoxin, suggesting that the prokinetic drug may be of help in reducing endotoxemia in liver cirrhosis.