柔肝健脾活血利湿方对肝硬化患者肠道菌群及内毒素血症的影响

Effect of Rougan Jianpi Huoxue Lishi Recipe on Intestinal Flora and Endotoxemia for Patients with Cirrhosis

目的:观察柔肝健脾活血利湿方对肝硬化患者肠道菌群及内毒素血症的影响。方法:收集2013年5月~2015年11月我院收治的78例肝硬化患者为研究对象,依据治疗方法不同分为西医组(38例)及中医组(40例),2组分别实施常规西药及柔肝健脾活血利湿汤治疗,观察治疗前后2组肠道菌群[大便肠球菌、酵母菌、双歧杆菌]数量、肠黏膜屏障功能[二胺氧化酶(DAO)、血清内毒素(ET)、降钙素(PCT)]、肝功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)]、药物安全性及1年随访复发率。结果:治疗前2组大便肠球菌、酵母菌、双歧杆菌菌群数量、DAO、ET、PCT、ALT、AST、TBIL相较无明显差异(P>0.05),治疗后2组大便肠球菌、双歧杆菌菌群数量较治疗前明显增加,酵母菌明显减少,DAO、ET、PCT、ALT、AST、TBIL明显降低,且中医组增加、减少、降低幅度较西医组明显,中医组1年后随访复发率5.00%较西医组明23.68%显低,有统计学意义(P<0.05)。结论:柔肝健脾活血利湿方可有效改善肝硬化患者肠道菌群、内毒素血症、肠粘膜屏障功能及肝功能,且复发率低、安全性高,有临床应用价值。

Objective： To investigate the effect of Rougan Jianpi Huoxue Lishi Decoction on cirrhosis patients with intestinal flora and endotoxemia. Methods ： 78 cases of liver cirrhosis patients were collected from May 2013 to November 2015 in our hos- pital as the research object, according to the different treatment methods were divided into western medicine group （38 cases） and Chinese medicine group （40 cases） , 2 groups were given routine western medicine and Rougan Jianpi Huoxue Lishi Decoction, observing 2 groups before and after treatment of intestinal bacteria, enterococcus [ stool the number of bifidobacterium, yeast, in- testinal mucosal barrier function ] amine oxidase （ DAO ）, serum endotoxin （ ET）, ealcitonin （ PCT）, liver function [ alanine aminotransferase （ALT） and aspartate aminotransferase （AST）, total bilirubin （TBIL）], drug safety and 1 year follow-up the recurrence rate. Results ： Before treatment, 2 groups of entero coccus, yeast, bifidobacteria in quantity, DAO, ET, PCT, ALT, AST, TBIL compared with no significant difference （ P 〉 0. 05 ）, the 2 groups after treatment of enterococcus, bifidobacterium fe- cal microflora increased significantly than that before treatment, yeast was significantly reduced, DAO, ET, PCT ALT, AST and TBIL decreased significantly, and the Chinese medicine group increased, decreased significantly, compared with western medi- cine group, the Chinese medicine group after 1 years of follow-up, the recurrence rate was 5% compared with western medicine group was lower whch was 23. 68% , with statistical significance （P 〈 0. 05 ）. Conclusion： Rougan Jianpi Huoxue Lishi Decoc- tion can effectively improve the intestinal flora in patients with liver cirrhosis, endotoxemia, intestinal mucosal barrier function and liver function, and low recurrence rate, high safety, is worthy of clinical application.