肝硬化患者小肠细菌过度生长与内毒素血症

Small bowel bacterial overgrowth and endotoxemia in cirrhosis

目的 研究肝硬化患者小肠细菌过度生长与血浆内毒素、白细胞介素 (IL) 2、IL 6及肿瘤坏死因子 (TNF) α水平的关系。方法 71例肝硬化患者行葡萄糖 氢呼气试验 (GHBT)检测小肠细菌过度生长情况 ,鲎实验检测血浆内毒素水平及ELISA法检测血浆IL 2、IL 6及TNF α水平 ;分析血浆内毒素与血浆IL 2、IL 6及TNF α水平之间的关系。结果 71例肝硬化患者中 ,GHBT阳性者为 1 8例(2 5 3 % )。肝硬化伴与不伴小肠细菌过度生长者血浆内毒素分别为 (0 71 5± 0 2 2 9)Eu/L、(0 379±0 2 2 3)Eu/L(P <0 0 0 1 ) ;IL 2分别为 (1 9 1 5± 4 60 )ng/L、(9 41± 6 69)ng/L ;IL 6分别为 (93 2 9± 2 7 37)ng/L、(53 2 2± 2 8 31 )ng/L ;TNF α分别为 (42 1 8± 1 6 91 )ng/L、(2 7 72± 1 7 0 6)ng/L(P值均 <0 0 1 )。肝硬化患者血浆内毒素与IL 2、IL 6及TNF α存在直线正相关 ,相关系数分别为 0 894、0 857、0 845(P值均 <0 0 0 1 )。结论 肝硬化伴小肠细菌过度生长患者血浆内毒素、IL 2、IL 6、TNF α水平均增高 ,提示肝硬化小肠细菌过度生长是导致肝硬化患者出现内毒素血症的原因之一。肝硬化患者血浆内毒素水平升高与血浆IL 2、IL 6、TNF α水平升高相关 。

Objective To investigate the incidence of the small bowel bacterial overgrowth in cirrhotics and analyze the correlation among small bowel bacterial overgrowth (SBBO),plasma endotoxin level and plasma interleukin 2(IL 2), interleukin 6(IL 6), or tumor necrosis factor α(TNF α) level Methods Small bowel bacterial overgrowth in 71 cirrhotics was test by glucose hydrogen breath test (GHBT); plasma endotoxin in cirrhotics was measured with limilus lysate test; and plasma cytokine (IL 2?IL 6 and TNF α) was measured with a solid phase enzyme linked immunosorbent assay; the incidence of SBBO in those 71 cirrhotics was investigated and the correlation between plasma endotoxin level and plasma IL 2, IL 6, or TNF α level was analysed Results (1)Positive GHBT were observed in 18 of 71 icrrhotics(25 3%); (2) Plasma endotoxin, IL 2, IL 6 and TNF α levels were significantly higher in those cirrhotic patients with positive GHBT than in those with negative GHBT [(0 715±0 229) Eu/L versus (0 379±0 223) Eu/L, (19 15±4 60) ng/L versus (9 41±6 69) ng/L, (93 29±27 37) ng/L versus (53 22±28 31) ng/L, (42 18±16 91) ng/L versus (27 72±17 06) ng/L, respectively; P <0 01];(3) A significant correlation was observed between the level of plasma endotoxin and the level of plasma IL 2( r =0 894, P <0 001), IL 6( r =0 857, P <0 001) or TNF α( r =0 845, P <0 001)in cirrhotics; Conclusions (1)Plasma endotoxin, IL 2, IL 6,and TNF α levels are increased in cirrhotic patients with SBBO, which suggests SBBO in cirrhotics may exasperated endotoxeamia;(2)Plasma endotoxin level in cirrhotics may stimulate some kinds of immune activated cells to produce IL 2, IL 6 and TNF α,which may deteriorated cirrhosis or the complications.