小檗碱改善肠黏膜屏障功能对肝硬化合并自发性腹膜炎的治疗价值

Effects of berberine on intestinal mucosal barrier function in patients with liver cirrhosis complicated with spontaneous bacterial peritonitis

目的研究小檗碱(BBR)改善肠黏膜屏障功能对肝硬化合并自发性腹膜炎(SBP)患者的治疗价值。方法选取2015年2月至2019年6月于该院消化内科住院治疗的120例肝硬化合并SBP患者作为SBP组,将其进一步分为SBP对照组、BBR治疗组、谷氨酰胺(Gln)治疗组,每组各40例,均予以保肝、利尿、抗感染治疗,BBR治疗组加用BBR口服,Gln治疗组加用Gln口服。另选取同期健康体检者60例作为健康对照组。观察3组患者治疗7 d后临床症状、D-乳酸(D-Lac)、血清二胺氧化酶(DAO)和内毒素水平变化情况,以及健康对照组D-Lac、DAO、内毒素水平。结果BBR治疗组治疗总有效率高于SBP对照组,差异有统计学意义(P<0.05);Gln治疗组治疗总有效率略高于SBP对照组,但差异无统计学意义(P>0.05)。BBR治疗组及Gln治疗组临床症状缓解时间均短于SBP对照组,差异均有统计学意义(P<0.05),但BBR治疗组与Gln治疗组比较,差异无统计学意义(P>0.05)。SBP组患者血清D-Lac、DAO、内毒素水平明显高于健康对照组,差异有统计学意义(P<0.01)。治疗后,SBP组D-Lac、DAO、内毒素水平明显低于治疗前,BBR治疗组及Gln治疗组下降水平大于SBP对照组,差异有统计学意义(P<0.05),但BBR治疗组与Gln治疗组水平比较,差异无统计学意义(P>0.05)。结论肝硬化SBP患者存在肠黏膜屏障功能减退,BBR能改善肝硬化SBP肠黏膜屏障功能,提高治疗有效率。

Objective To observe the effect of berberine(BBR)on intestinal mucosal barrier function in patients with liver cirrhosis complicated with spontaneous bacterial peritonitis(SBP).Methods A total of 120 patients with liver cirrhosis complicated with SBP were selected as SBP group,which was divided into SBP control group,BBR treatment group and glutamine(Gln)treatment group,40 cases in each group.In addition,60 healthy physical examinees were selected as the healthy control group.The SBP control group was treated with routine treatment,while the two treatment groups were treated with berberine and glutamine respectively on the basis of the control group.The change of clinical symptoms,D-Lac,serum diamine oxidase(DAO)and endotoxin levels of the three groups were observed after 7 days of treatment,and the levels serum DAO,D-Lac and endotoxic of the healthy control groups were detected.Results The total effective rate of treatment in the BBR treatment group was significantly higher than that in the SBP control group(P<0.05).The total effective rate of Gln treatment group was slightly higher than that of SBP control group,but the difference was not statistically significant(P>0.05)The clinical symptom relief time of BBR treatment group and Gln treatment group were shorter than that of SBP control group,and the difference was statistically significant(P<0.05).However,there was no significant difference between the BBR treatment group and the Gln treatment group(P>0.05).The serum levels of D-Lac,DAO and endotoxin in SBP group were significantly higher than those in the healthy control group,with statistically significant differences(P<0.01).After treatment,the level of in D-Lac,DAO and endotoxin SBP group were significantly lower than those before treatment,and the decrease level of BBR treatment group and Gln treatment group were greater than those of SBP control group,with statistically significant difference(P<0.05).There was no statistically significant difference in levels of D-Lac,DAO and endotoxin between the BBR treatment group and Gln treatment group(P>0.05).Conclusion Liver cirrhosis patients complicated with SBP have intestinal mucosal barrier dysfunction.BBR is effective in adjuvant treatment of liver cirrhosis patients with SBP,and it can significantly relieve clinical symptoms and improve intestinal mucosal barrier function.