乳果糖联合微生态制剂对肝硬化合并自发性腹膜炎患者肠道菌群、肠黏膜屏障功能和肝功能的影响分析

Effects of Lactulose combined with micro-ecological preparations on intestinal flora,mucosal barrier and liver function in patients with liver cirrhosis complicated with spontaneous peritonitis

目的分析乳果糖联合微生态制剂对肝硬化合并自发性腹膜炎患者肠道菌群、肠黏膜屏障功能和肝功能的影响。方法选取哈尔滨医科大学附属第二医院2017年3月至2019年3月收治的134例肝硬化合并自发性腹膜炎患者为研究对象,采用随机数表法将入选患者分别纳入观察组和对照组,每组各67例。两组患者均给予保肝、营养支持、抗感染等综合治疗,观察组患者加用乳果糖和微生态制剂治疗,两组患者治疗均持续21 d。检测两组患者治疗前后肠道菌群、肠黏膜屏障功能和肝功能,对比两种治疗方案的临床疗效和安全性。结果观察组患者治疗21 d后双歧杆菌属、乳酸杆菌属含量均显著高于本组治疗前和同期对照组(均P<0.05),白念珠菌属含量均显著低于本组治疗前和同期对照组(均P<0.05);对照组患者治疗前后肠道菌群含量未见显著变化(P<0.05)。两组患者停药后3 d乳果糖排泄率、乳果糖/甘露醇排泄率比值均显著低于本组治疗前(均P<0.05),观察组患者停药后3 d上述指标均显著低于对照组(均P<0.05)。治疗21 d后,两组患者谷草转氨酶(aspartate transaminase,AST)、谷丙转氨酶(alanine aminotransferase,ALT)水平均显著低于本组治疗前(均P<0.05),白蛋白(albumin,ALB)水平均显著高于本组治疗前(均P<0.05);且观察组患者AST、ALT水平均显著低于对照组(均P<0.05),ALB水平显著高于对照组(P<0.05)。观察组患者治疗总有效率显著高于对照组(P<0.05)。两组患者治疗期间均未发生药物相关不良反应。结论乳果糖联合微生态制剂能够有效调节肝硬化合并自发性腹膜炎患者肠道菌群,改善肠黏膜屏障功能和肝功能,提高临床疗效,且安全性良好。

Objective To analyze the effects of Lactulose(LAC)combined with micro-ecological preparations on intestinal flora,mucosal barrier and liver function in patients with liver cirrhosis complicated with spontaneous peritonitis.Method A total of 134 patients with liver cirrhosis complicated with spontaneous peritonitis who were treated in the Second Affiliated Hospital of Harbin Medical University from March 2017 to March 2019 were included in observation group and control group,67 patients in each group,all patients were given comprehensive treatment such as liver protection,nutritional support,and anti-infection.Observation group patients were supplemented with LAC and micro-ecological preparations,and the treatment course of both groups lasted for 21 days.Changes in intestinal flora,intestinal mucosal barrier,and liver function before and after treatment were detected in the two groups of patients,and the effects and safety of the two treatment regimens were compared.Result The contents of Bifidobacterium and Lactobacillus in observation group were significantly higher than those before treatment and control group at the same time(all P<0.05),while the contents of Candida albicans were significantly lower than those before treatment and control group at the same time(all P<0.05).There was no significant change in content of intestinal flora before and after treatment in control group(P<0.05).The LAC excretion rate and Lactulose/Mannitol excretion rate ratio in the two groups 3 days after withdrawal were significantly lower than before treatment(all P<0.05),and the above indexes in observation group were significantly lower than those in control group 3 days after withdrawal(all P<0.05).The levels of aspartate transaminase(AST)and alanine aminotransferase(ALT)in the two groups were significantly lower than before treatment(all P<0.05),and the levels of albumin(ALB)were significantly higher than before treatment(all P<0.05).The levels of AST and ALT in observation group were significantly lower than those in control group 21 days after treatment(all P<0.05),and the level of ALB was significantly higher than that in control group(P<0.05).The total effective rate of observation group was significantly higher than that of control group(P<0.05).No drug-related adverse reactions occurred in the two groups during treatment.Conclusion LAC combined with micro-ecological preparation can effectively regulate the intestinal flora of patients with liver cirrhosis complicated with spontaneous peritonitis,improve the intestinal mucosal barrier function,liver function and clinical efficacy,and have a good safety.