枯草杆菌二联活菌肠溶胶囊对NASH患者血清内毒素和肠道菌群的影响

Influence of lived combined B. subtilis and E. faecium enteric-coated capsules on serum endotoxin and intestinal microflora of patients with NASH

目的探讨枯草杆菌二联活菌肠溶胶囊对非酒精性脂肪性肝炎(NASH)患者血清内毒素和肠道菌群的影响。方法选取消化科门诊就诊的NASH患者78例,采用随机数字表分为观察组(n=39例)和对照组(n=39例)。两组患者均予以甘草酸二胺肠溶胶囊450 mg/次,3次/d保肝治疗。观察组患者加用枯草杆菌二联活菌肠溶胶囊500mg,3次/d,连用6周。观察并记录两组患者治疗前后肝功能指标(ALT和γ-GT)、血脂指标(LDL-C、HDL-C、TC和TG)、血清内毒素及肠道菌群的变化情况。结果治疗6周后,两组患者的ALT、γ-GT和血清内毒素水平较前均有明显下降(P<0.05或P<0.01),且观察组下降值明显大于对照组(P<0.05);两组患者的LDL-C、TC、TG均较前明显下降,HDL-C水平较前明显上升(P<0.05),且观察组下降或上升值明显大于对照组(P<0.05);同时观察组患者双歧杆菌、乳酸杆菌、拟杆菌和肠球菌数量较前明显上升,肠杆菌较前明显减少(P<0.05),而对照组治疗前后肠道菌群数量均无明显变化(P>0.05)。结论枯草杆菌二联活菌肠溶胶囊治疗NASH能纠正肠道菌群紊乱,恢复肠道微生态平衡,从而减轻肠源性内毒素血症,改善肝功能指标,降低血脂水平,对NASH有显著的辅助治疗效果。

Objective To discuss influence of lived combined B. subtilis and E. faecium enteric-coated capsules on serum endotoxin and intestinal microflora of patients with non-alcoholic steatohepatitis（ NASH）. Methods 78 cases of patients with NASH were selected,who were given the out-patient treatment in Department of Gastroenterology,and were divided into observation group（ n = 39 cases） and control group（ n = 39 cases） by table of random number. The patients in two groups were given 450 mg Diammonium Glycyrrhizinate Enteric-coated Capsules per time,three times a day as the liver protection treatment. The patients in observation group were additionally given500 mg lived combined B. subtilis and E. faecium enteric-coated capsules,three times a day for 6 weeks. The changes of liver function indexes（ ALT and γ-GT）,blood fat indexes（ LDL-C,HDL-C,TC and TG）,serum endotoxin and intestinal microflora of patients in two groups were observed and recorded. Results After 6 weeks＇ medical treatment,the ALT,γ-GT and serum endotoxin levels of patients in two groups obviously declined than before（ P〈0. 05 or P〈0. 01）,and the declining rate of patients in observation group was much higher than that in control group（ P〈0. 05）. The LDL-C,TC and TG of patients in two groups obviously declined than before,while the HDL-C obviously rose than before（ P〈0. 05 or P〈0. 01）,and the declining or rising rate of patients in observation group was much higher than that in control group（ P〈0. 05）. Meanwhile,the amount of Bifidobacterium,Lacticacid bacteria,Bacteroidaceae and Enterococcus of patients in observation group obviously rose than before,and the amount of Enterobacteria obviously declined than before（ P〈0. 05）,while the amount of intestinal microflora of patients in control group appeared no obvious changes before and after medical treatment（ P〉0. 05）.Conclusion The treatment of lived combined B. subtilis and E. faecium enteric-coated capsules on NASH can adjust the disorder of intestinal microflora and resume the balance of intestinal microecology to alleviate the intestinal endotoxemia（ IETM） and improve the liver function index,effect significant adjuvant therapy and reduce the blood fat.