病毒性肝炎后肝硬化患者肠道的通透性

Research on intestine permeability in patients with post-hepatitis cirrhosis

目的 探讨病毒性肝炎后肝硬化与肠道通透性的关系。方法 参照Holt等的方法测定96例肝硬化患者血清中二胺氧化酶 (DAO)活性 ;并用气相色谱法测定服用乳果糖、甘露醇后在尿中的分泌率 ,用以评价患者肠黏膜的组织结构及其功能。结果 患者Child +Pugh分级各组中DAO的活性和乳果糖 /甘露醇 (L/M)比值与对照组间差异有显著性 (DAOA级 4 .6 8± 0 .97,B级 6 .0 5± 1.0 2 ,C级7.80± 1.34比 3.98± 0 .93,P <0 .0 5～ 0 .0 0 5 ;L/MA级 0 .0 39± 0 .0 0 7,B级 0 .0 6 8± 0 .0 12 ,C级 0 .119±0 .0 2 3比 0 .0 33± 0 .0 0 4 ,P <0 .0 5～ 0 .0 0 5 )。并发自发性细菌性腹膜炎 (SBP)组与非SBP组间差异有显著性 (DAO 7.6 7± 3.0 3比 4 .96± 0 .95 ,P <0 .0 0 5 ;L/M 0 .10 7± 0 .0 6 0比 0 .0 4 2± 0 .0 0 7,P <0 .0 0 5 ) ;非SBP组与对照组间差异亦具有显著性 (DAO 4 .96± 0 .95比 3.98± 0 .93,P <0 .0 5 ,L/M 0 .0 4 2± 0 .0 0 7比0 .0 33± 0 .0 0 4 ,P <0 .0 5 )。结论 病毒性肝炎后肝硬化患者肠道黏膜受损是导致SBP的主要原因之一 ,测定病毒性肝硬化患者血清中DAO活性及尿中L/M比值可以探知肠黏膜结构及其功能有无损害。

Objective To study the relationship of intestine permeability with post hepatitis cirrhosis. Methods Serum DAO levels were measured by Holt method and lactulose/mannitol absorption tests were performed in 96 patients (Child A, n =11; Child B, n =37; Child C n =48) with post hepatitis cirrhosis and 49 healthy control subjects to evaluate the intestine structure and function of the patients. Lactulose and mannitol levels in 5 hours urine were determined by gaschromatographic assay. Results DAO activity and lactulose/mannitol ratio were higher in each patient group than those in normal control group (DAO Child A 4.68±0.97, Child B 6.05±1.02, Child C 7.80±1.34 vs 3.98±0.93, P <0.05～0.005; L/M Clind A 0.039±0.007, Child B 0.068±0.012, Child C 0.119±0.023 vs 0.033±0.004, P <0.05～0.005), these abnormalities were more prominent in Child C patients. The levels in group with spontaneous bacterial peritonitis(SBP) was higher than those in non SBP group (DAO 7.67±3.03 vs 4.96±0.95, P <0.05; L/M 0.107±0.060 vs 0.042±0.007 P <0.05), and non SBP group higher than normal control (DAO 4.96±0.95 vs 3.98±0.93, P <0.05; L/M 0.042±0.007 vs 0.033±0.004, P <0.05). Conclusions The impairment of intestinal function barrier is one of the primary causes of spontaneous bacterial peritonitis in patients with post hepatitis cirrhosis.