双歧杆菌三联活菌胶囊预防肝硬化肝性脑病再发的临床研究

Clinical study of bifidobacterium triple viable bacteria capsule in preventing recurrence of liver cirrhosis and hepatic encephalopathy

目的探究双歧杆菌三联活菌胶囊预防肝硬化肝性脑病(HE)再发的临床效果。方法选取2019年5月至2021年1月本院收治的74例肝硬化HE患者作为研究对象,随机分为利福昔明组与联合组,各37例。所有患者均接受基础性治疗,利福昔明组给予利福昔明治疗,联合组在利福昔明组基础上联合双歧杆菌三联活菌胶囊治疗。比较两组实验室指标[血氨、血钠、谷丙转氨酶(ALT)、总胆红素(TBiL)、脂多糖(LPS)、白细胞介素-6(IL-6)、白细胞介素-18(IL-18)及肿瘤坏死因子-α(TNF-α)]、数字连接试验-A(NCT-A)时间与数字符号试验(DST)评分及临床疗效。结果治疗前,两组血氨、血钠水平比较差异无统计学意义;治疗后,两组血氨水平均低于治疗前,血钠水平均高于治疗前,且联合组血氨水平低于利福昔明组,血钠水平高于利福昔明组,差异有统计学意义(P<0.05)。治疗前,两组ALT、TBiL、IL-6、IL-18、TNF-α及LPS水平比较差异无统计学意义;治疗后,两组ALT、TBiL、L-6、IL-18、TNF-α及LPS水平均低于治疗前,且联合组低于利福昔明组,差异有统计学意义(P<0.05)。治疗前,两组NCT-A时间、DST评分比较差异无统计学意义;治疗后,两组NCT-A时间均短于治疗前,DST评分均高于治疗前,且联合组NCT-A时间短于利福昔明组,DST评分高于利福昔明组,差异有统计学意义(P<0.05)。联合组治疗总有效率为94.59%,高于利福昔明组的72.97%,差异有统计学意义(P<0.05)。结论双歧杆菌三联活菌胶囊可通过降低血氨浓度、抑制内毒素分泌、延缓炎症因子释放等方式,修复肠黏膜屏障,维系肠道内菌群平衡,有效预防肝硬化HE再发。

Objective To explore the clinical effect of bifidobacterium triple viable bacteria capsule in preventing recurrence of liver cirrhosis and hepatic encephalopathy.Methods A total of 74 patients with liver cirrhosis and hepatic encephalopathy admitted to our hospital from May 2019 to January 2021 were selected as the research subjects,and they were randomly divided into the rifaximin group and the combined group,with 37 cases in each group.All patients received basic treatment,the rifaximin group was given rifaximin treatment,the combined group was combined with bifidobacterium triple live bacteria capsule on the basis of the rifaximin group.The laboratory indexes(blood ammonia,blood sodium,alanine transaminase[ALT],total bilirubin[TBiL],lipopolysaccharide[LPS],interleukin-6(IL-6),interleukin-18[IL-18]and tumor necrosis factor-α[TNF-α]),number connection test-A(NCT-A)time,digit-symbol test(DST)scores and clinical efficacy were compared between the two groups.Results Before treatment,there were no significant differences in blood ammonia and sodium levels between the two groups;after treatment,the blood ammonia level of the two groups was lower than before treatment,and the blood sodium level was higher than before treatment,and the blood ammonia level in the combined group was lower than the rifaximin group,and the blood sodium level was higher than the rifaximin group,the differences were statistically significant(P<0.05).Before treatment,there were no statistically significant differences in ALT,TBiL,IL-6,IL-18,TNF-αand LPS levels between the two groups;after treatment,the levels of ALT,TBiL,L-6,IL-18,TNF-αand LPS of the two groups were lower than before treatment,and the combined group were lower than the rifaximin group,and the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in CNT-A time and DST score between the two groups;after treatment,CNT-A time of the two groups was shorter than before treatment,and DST score was higher than before treatment,and CNT-A time in the combined group was shorter than the rifaximin group,and DST score was higher than the rifaximin group,the differences were statistically significant(P<0.05).The total effective rate in the combined group was 94.59%,which was higher than 72.97%in the rifaximin group,and the difference was statistically significant(P<0.05).Conclusion Bifidobacterium triple viable bacteria capsules can restrain by lowering blood ammonia concentration,endotoxin secretion,delay the release of proinflammatory factor,repair the intestinal mucosal barrier,keep balance of intestinal flora,effective prevention of liver cirrhosis and hepatic encephalopathy.