HBV相关肝硬化腹水患者的肠道微生态特征与中医证型的关系

Correlation between intestinal microecological characteristics and traditional Chinese medicine syndrome in patients with HBV-related cirrhotic ascites

目的从肠道微生态角度研究肝硬化由代偿期发展成失代偿期的发病机制,同时研究不同中医证型的乙型肝炎病毒(HBV)相关肝硬化腹水患者的肠道微生态特点。方法选择HBV相关肝硬化腹水患者30例(肝硬化腹水组)和肝硬化代偿期患者30例(肝硬化组),根据中医证候分型将HBV相关肝硬化腹水患者分为湿热水停组(12例)、血瘀水停组(5例)、阳虚水停组(8例)、阴虚水停组(5例)。检测并比较肝硬化组和肝硬化腹水组患者肝的瞬时弹性成像(FibroScan)测量值、吲哚菁绿15 min滞留率(ICGR15)值、肠道菌群,肝硬化腹水组不同中医证型患者肠道菌群。结果肝硬化腹水组肝的FibroScan测量值(45.25±10.63)kPa明显高于肝硬化组的(14.27±9.95)kPa,差异具有统计学意义(P<0.05)。肝硬化腹水组的ICGR15值(37.47±8.25)%明显高于肝硬化组的(8.56±5.28)%,差异具有统计学意义(P<0.05)。肝硬化腹水组患者双歧杆菌数量(8.01±1.48)lgCFU/g明显少于肝硬化组的(10.86±1.78)lgCFU/g,肠杆菌数量(10.98±1.57)lgCFU/g明显多于肝硬化组的(8.78±1.55)lgCFU/g,差异具有统计学意义(P<0.05);肝硬化组和肝硬化腹水组的肠球菌、乳酸杆菌数量比较差异无统计学意义(P>0.05)。湿热水停组患者的肠杆菌数量(11.59±0.73)lgCFU/g多于血瘀水停组的(10.66±0.84)lgCFU/g、阳虚水停组的(10.49±1.51)lgCFU/g、阴虚水停组的(10.62±1.05)lgCFU/g,差异具有统计学意义(P<0.05);四组的肠球菌、双歧杆菌、乳酸杆菌数量比较差异均无统计学意义(P>0.05)。结论肝硬化患者肠道中有益菌随着病情加重逐渐减少,致病菌逐渐增多,肠道菌群的失调与疾病病情严重程度相关,疾病的进展同时加剧了肠道菌群的失调,湿热水停证肝硬化腹水患者可能存在特征性肠道微生态。

Objective To study the pathogenesis of cirrhosis from compensated stage to decompensated stage from the perspective of intestinal microecology,as well as the characteristics of intestinal microecology in patients with hepatitis B virus(HBV)-related cirrhotic ascites with different traditional Chinese medicine syndromes.Methods 30 patients with HBV-related cirrhotic ascites(cirrhotic ascites group)and 30 patients with compensated cirrhosis(cirrhosis group)were selected,and the patients with HBV-related cirrhotic ascites were divided into the damp-heat-water-retention group(12 cases),blood-stasis-water-retention group(5 cases),yang-deficiency-water-retention group(8 cases),and yin-deficiency-water-retention group(5 cases)according to the traditional Chinese medicine syndromes.Transient elastography(FibroScan)measurements,indocyanine green retention rate at 15 min(ICGR15)values,intestinal flora between cirrhosis group and cirrhotic ascites group,as well as intestinal flora in patients with different traditional Chinese medicine syndromes in the cirrhotic ascites group were detected and compared.Results The FibroScan value(45.25±10.63)kPa in cirrhotic ascites group was significantly higher than(14.27±9.95)kPa in cirrhosis group,and the difference was statistically significant(P<0.05).The ICGR15 value(37.47±8.25)%of the cirrhotic ascites group was significantly higher than(8.56±5.28)%of the cirrhosis group,and the difference was statistically significant(P<0.05).The number of Bifidobacteria(8.01±1.48)lgCFU/g in the cirrhotic ascites group was significantly lower than(10.86±1.78)lgCFU/g in the cirrhosis group;the number of Enterobacter(10.98±1.57)lgCFU/g in the cirrhotic ascites group was significantly higher than(8.78±1.55)lgCFU/g in the cirrhosis group;the differences were all statistically significant(P<0.05).There was no statistically significant difference in the number of Enterococcus and Lactobacillus between the cirrhosis group and the cirrhosis ascites group(P>0.05).The number of Enterobacter(11.59±0.73)lgCFU/g in the damp-heat-water-retention group was more than(10.66±0.84)lgCFU/g in the blood-stasis-water-retention group,(10.49±1.51)lgCFU/g in the yang-deficiency-water-retention group,and(10.62±1.05)lgCFU/g in the yin-deficiency-water-retention group,and the differences were all statistically significant(P<0.05).There was no statistically significant difference in the number of Enterococcus,Bifidobacterium and Lactobacillus among the four groups(P>0.05).Conclusion The beneficial bacteria in the intestinal tract of patients with cirrhosis gradually decrease and the pathogenic bacteria gradually increase with the aggravation of the disease.The dysbiosis of intestinal flora correlates with the severity of the disease condition,and the progression of the disease exacerbates the dysbiosis of intestinal flora at the same time.Patients with cirrhotic ascites with damp-heat-water-retention syndrome may have characteristic intestinal microecology.