微生态制剂联合莫沙必利治疗肝硬化患者内毒素血症的临床研究

Clinical study on microecological preparation combined with mosapride in the treatment of endotoxemia in patients with liver cirrhosis

目的:探讨微生态制剂联合莫沙必利治疗肝硬化患者内毒素血症的临床效果。方法:纳入2018年6月至2019年6月收治的葡萄糖-氢呼气试验(GHBT)阳性的肝硬化患者78例,随机分为对照组和观察组,对照组患者给予临床常规治疗,观察组患者在临床常规治疗基础上给予微生态制剂联合莫沙必利治疗,对比两组患者干预前后内毒素水平、炎症因子水平,粪便中微生物组分的变化,评估肝功能变化。结果:干预后观察组患者和对照组患者总有效率分别为82.05%(32/39)和87.18%(34/39),观察组显著高于对照组(P<0.05)。与干预前对比两组患者肝功能指标均明显降低(P<0.05),观察组患者干预后血浆内毒素、IL-2、IL-6及TNF-α水平均较治疗前显著降低(P均<0.05),PCoA和OTU结果显示观察组和对照组患者的肠道微生物组成分成两个不同的簇;与对照组相比,观察组患者肠道微生物的组成具有更低的多样性和更高的稳定性。两组患者均无严重不良反应发生。结论:采用微生态制剂联合莫沙必利可缓解肝硬化患者内毒素血症严重程度,纠正患者肠道菌群失调,改善肝功能,可有效缓解肝功能衰竭及降低并发症发生率,为肝硬化内毒素血症患者治疗提供一定参考依据。

Objective:To discuss the clinical effect of microecological preparation combined with mosapride in the treatment of endotoxemia in patients with cirrhosis.Methods:A total of 78 cases of patients with liver cirrhosis from June 2018 to June 2019 were glucose-hydrogen breath test(GHBT)positive,randomly divided into control group and observation group.control group patients received clinical routine treatment,observation group patients received proecologics combined with mosapride,compared two groups of patients before and after the intervention of endotoxin level,inflammation factors,the change of the microbial components in feces and liver function.Results:After intervention,the total effective rates of the observation group and the control group were 82.05%(32/39)and 87.18%(34/39),respectively,which were significantly higher than those of the control group(P<0.05).before intervention of Two groups compared to liver function index were significantly lower(P<0.05),the observation group of patients after the intervention of plasma endotoxin,IL-2,IL-6 and the TNF-a alpha index was significantly lower than before treatment(P<0.05),the PCoA and OTU results showed that the intervention group and control group of gut microbes was divided into two different clusters,and the intervention group than the control group of gut microbes have lower diversity and higher stability;After intervention,all indexes in the observation group were significantly lower than those in the control group(P<0.05).The indicators of liver function and coagulation function were significantly improved compared with those before treatment(All P<0.05),and the improvement amplitude of all indicators in the observation group was significantly higher than that in the control group(P<0.05).No serious adverse reactions occurred in the 2 groups.Conclusion:The combination of microecological preparation and mosabili could alleviate the severity of endotoxemia in patients with cirrhosis,correct the imbalance of intestinal flora in patients,improve liver function,effectively alleviate liver failure and reduce the occurrence of complications,and provide certain reference for the treatment of patients with cirrhosis with endotoxemia.