湿热型慢性乙型病毒性肝炎患者肠道菌群失衡的风险模型建立及降酶方干预效果

Establishment of risk model of intestinal flora imbalance in patients with damp heat type chronic hepatitis B and intervention effect of Jiangmei Prescription

目的分析湿热型慢性乙型病毒性肝炎(chronic hepatitis B,CHB)患者发生肠道菌群失衡的危险因素,建立风险预测列线图模型,以及探讨降酶方对肠道菌群失衡的干预效果。方法选择北京中医药大学深圳医院(龙岗)2018年8月至2020年1月220例湿热型CHB患者,其中发生肠道菌群失衡的患者80例,单因素分析和二元Logistic回归分析肠道菌群失衡的危险因素,建立风险预测列线图模型,并将患者随机分为观察组和对照组,对照组给予恩替卡韦片+双环醇治疗,观察组给予恩替卡韦片+降酶方治疗,观察两组治疗相关血清因子以及肠内腐败物质的变化。结果年龄(OR=2.995,95%CI:1.419~6.320)、营养不良(OR=6.767,95%CI:2.485~18.422)、肠功能障碍(OR=2.195,95%CI:0.681~7.072)、压力(OR=5.714,95%CI:2.235~14.612)、不良情绪(OR=6.104,95%CI:2.001~18.620)是湿热型CHB患者发生肠道菌群失衡的危险因素,基于以上危险因素建立风险列线图模型,具有较好的精准度和区分度,两组患者治疗后,观察组患者血清ALT、AST、TBIL与对照组比较,差异有统计学意义(P<0.05);肠内粪便相关腐败物质的氨、硫化物、苯酚、甲基酚、乙基酚、吲哚、粪臭素均有一定程度的下降,观察组治疗后腐败物质水平与对照组比较,差异有统计学意义(P<0.05)。结论年龄、营养不良、肠功能障碍、压力、不良情绪是湿热型CHB患者肠道菌群失衡的独立危险因素,其风险预测列线图模型精确度和区分度较好,对患者行降酶方联合恩替卡韦片治疗临床疗效好,有利于患者体内菌群恢复均衡。

Objective To analyze the risk factors of intestinal flora imbalance in patients with damp heat type chronic hepatitis B(CHB),establish a risk prediction nomogram model,and explore the intervention effect of Jiangmei Prescription on intestinal flora imbalance.Methods 220 patients with damp heat type CHB in the our hospital from Aug.2018 to Jan.2020 were selected,including 80 patients with intestinal flora imbalance.The risk factors of intestinal flora imbalance were analyzed by univariate and multivariate Logistic regression,and the risk prediction nomogram model was established.The patients were randomly divided into observation group and control group.The control group was given Entecavir tablets+Bicyclol treatment,and the observation group was given Entecavir tablets+Jiangmei Prescription.The changes of serum factors and intestinal putrefaction in the two groups were observed.Results Age(OR=2.995,95%CI:1.419-6.320),malnutrition(OR=6.767,95%CI:2.485-18.422),intestinal dysfunction(OR=2.195,95%CI:0.681-7.072),pressure(OR=5.714,95%CI:2.235-14.612)and bad mood(OR=6.104,95%CI:2.001-18.620)were the risk factors of intestinal flora imbalance in patients with damp heat type CHB.Based on the above risk factors,the risk nomogram model was established with good accuracy and differentiation.After treatment,the therapeutic effect of the observation group was better than that of the control group,and there were significant differences in serum ALT,AST,TBIL factors between the two groups(P<0.05).The levels of ammonia,sulfide,phenol,methylphenol,ethyl-phenol,indole,and faecastin in intestinal putrefaction decreased to some extent.The level of putrefaction in the observation group was significantly different from that in the control group after treatment(P<0.05).Conclusion Age,malnutrition,intestinal dysfunction,pressure and bad mood are the independent risk factors of intestinal flora imbalance in patients with damp heat type CHB.The accuracy and differentiation of risk prediction nomogram model are good.The clinical efficacy of Jiangmei prescription combined with Entecavir tablets is good,which is conducive to the recovery of bacterial balance in patients.