营养支持对乙型肝炎相关慢加急性肝衰竭患者肠道菌群及预后的影响

Effect of nutritional support on gut microbiota and prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure

目的分析营养支持对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者肠道菌群及预后的影响。方法选取我院2019年1月—2022年1月收治的109例HBV-ACLF患者作为研究对象,采用随机数字表法,将研究对象分为观察组(n=54)和对照组(n=55)。2组患者均给予常规内科治疗及人工肝支持,观察组加用营养支持。比较2组患者治疗前后肝功能指标、营养指标、肠道菌群数量变化情况,并比较2组患者随访期间(12周)的死亡率。结果治疗前,2组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、白蛋白、前白蛋白、转铁蛋白水平及粪肠球菌、酵母菌、双歧杆菌、乳酸杆菌菌群数量比较,差异均无统计学意义(P>0.05)。治疗21 d后,2组患者的ALT、AST、TBIL水平均较治疗前有所下降,且观察组均低于同期对照组(P<0.05);2组患者的白蛋白、前白蛋白、转铁蛋白水平均较治疗前有所升高,且观察组均高于同期对照组(P<0.05);2组患者的粪肠球菌、酵母菌菌群数量较治疗前有所下降,且观察组低于同期对照组,而双歧杆菌、乳酸杆菌菌群数量较治疗前有所升高,且观察组高于同期对照组(P<0.05)。此外,随访期间,观察组患者死亡率为12.96%(7/54),低于对照组的29.09%(16/55),差异有统计学意义(P<0.05)。结论在常规治疗的基础上加用营养支持有助于进一步调节HBV-ACLF患者肠道菌群平衡,改善患者预后。

Objective To analyze the effect of nutritional support on gut microbiota and prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 109 patients with HBV-ACLF admitted to our hospital from January 2019 to January 2022 were selected as the study participants and assigned to the observation group(n=54)and the control group(n=55)using the random number table.Patients in both groups received conventional medical treatment and artificial liver support,and nutritional support was added to the observation group.The changes in liver function indexes,nutritional indexes,and gut microbiota before and after treatment were compared between the two groups;the mortality during follow-up(12 weeks)was compared between the two groups.Results Before treatment,there was no significant difference in alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin,prealbumin,transferrin levels and the number of enterococcus faecalis,yeasts,bifidobacteria,and lactobacilli flora between the two groups(P>0.05).After 21 days of treatment,the ALT,AST and TBIL levels in the two groups were significantly decreased compared with those before treatment,and the observation group was significantly lower than the concurrent control group(P<0.05);the albumin,prealbumin,and transferrin levels in the two groups were significantly increased compared with those before treatment,and the observation group was significantly higher than the concurrent control group(P<0.05);the number of enterococcus faecalis and yeast flora in the two groups was significantly decreased compared with that before treatment,and the observation group was significantly lower than the concurrent control group,while the number of bifidobacterium and lactobacillus flora was significantly increased compared with that before treatment,and the observation group was significantly higher than the concurrent control group(P<0.05).In addition,during the follow-up period,the mortality in the observation group was 12.96%(7/54),which was significantly lower than that(29.09%,16/55)in the control group(P<0.05).Conclusion Nutritional support on the basis of routine treatment is helpful to further regulate the balance of gut microbiota and improve the prognosis of HBV-ACLF patients.