非酒精性脂肪性肝病患者肠道菌群及血清IL-17和INF-γ水平变化

Changes of intestinal flora as well as serum interliukin-17 and interferon-γlevels in patients with nonalcoholic fatty liver diseases

目的探讨非酒精性脂肪性肝病(NAFLD)患者肠道菌群及血清白细胞介素17(IL-17)和γ-干扰素(INF-γ)水平变化。方法2019年1月~2022年1月我院诊治的102例NAFLD患者【单纯性脂肪肝64例和非酒精性脂肪性肝炎(NASH)38例】和同期健康体检者48例,行粪便培养,分离双歧杆菌(B)、乳杆菌、肠杆菌和肠球菌(E),计算B/E比值,采用ELISA法检测血清IL-17和INF-γ水平。结果NAFLD患者粪便乳杆菌、双歧杆菌数量和B/E比值分别为(8.9±0.3)lg CFU/g、(8.6±0.3)lg CFU/g和(0.9±0.2),均显著小于健康体检者【分别为(9.9±0.4)lg CFU/g、(9.7±0.4)lg CFU/g和(1.1±0.3),P<0.05】,而肠球菌和肠杆菌数量分别为(8.2±0.3)lg CFU/g和(9.3±0.4)lg CFU/g,均显著大于健康体检者【分别为(7.4±0.2)lg CFU/g和(8.4±0.3)lg CFU/g,P<0.05】;NAFLD患者血清INF-γ水平为(172.6±28.7)ng/L,显著低于健康体检者【(293.7±48.5)ng/L,P<0.05】,而血清IL-17水平为(46.9±8.2)ng/L,显著高于健康体检者【(13.0±2.4)ng/L,P<0.05】;NASH患者粪便乳杆菌、双歧杆菌数量和B/E比值分别为(8.2±0.3)lg CFU/g、(7.9±0.3)l g CFU/g和(0.9±0.2),均显著小于单纯性脂肪肝患者【分别为(9.3±0.4)lg CFU/g、(8.9±0.4)lg CFU/g和(1.1±0.3),P<0.05】,而肠球菌和肠杆菌数量分别为(8.6±0.3)lg CFU/g和(9.5±0.4)lg CFU/g,均显著大于单纯性脂肪肝患者【分别为(7.7±0.2)lg CFU/g和(8.4±0.3)lg CFU/g,P<0.05】;NASH患者血清IL-17水平为(55.4±9.7)ng/L,显著高于单纯性脂肪肝患者【(41.3±7.2)ng/L,P<0.05】,而血清INF-γ水平为(146.9±21.6)ng/L,显著低于单纯性脂肪肝患者【(212.6±36.4)ng/L,P<0.05】。结论NAFLD患者肠道菌群及血清IL-17和INF-γ水平均发生异常变化,其严重紊乱程度可能提示NASH的发生,个中机制值得进一步探讨。

Objective The purpose of this study was to explore the changes of intestinal flora as well as serum interleukin-17(IL-17)and interferon-gamma(INF-γ)levels in patients with nonalcoholic fatty liver diseases(NAFLD).Methods 102 patients with NAFLD,including simple fatty liver(SFL)in 64 cases and non-alcoholic steatohepatitis(NASH)in 38 cases,and 48 healthy individuals were encountered in our hospital between January 2019 and January 2022.The intestinal flora and serum IL-17 and INF-γlevels were determined and compared.Results The fecal lactobacilli,bifidobacteria numbers and the bifidobacteria/enterococcus(B/E)ratio in patients with NAFLD were(8.9±0.3)lg CFU/g,(8.6±0.3)lg CFU/g and(0.9±0.2),all significantly lower than[(9.9±0.4)lg CFU/g,(9.7±0.4)lg CFU/g and(1.1±0.3),respectively,P<0.05],while the fecal enterococcus and enterobacter numbers were(8.2±0.3)lg CFU/g and(9.3±0.4)lg CFU/g,both significantly higher than[(7.4±0.2)lg CFU/g and(8.4±0.3)lg CFU/g,respectively,P<0.05]in healthy persons;serum INF-γlevel was(172.6±28.7)ng/L,much lower than[(293.7±48.5)ng/L,P<0.05],while serum IL-17 level was(46.9±8.2)ng/L,much higher than[(13.0±2.4)ng/L,P<0.05]in healthy individuals;the fecal lactobacilli,bifidobacteria numbers and the B/E ratio in patients with NASH were(8.2±0.3)lg CFU/g,(7.9±0.3)l g CFU/g and(0.9±0.2),all significantly lower than[(9.3±0.4)lg CFU/g,(8.9±0.4)lg CFU/g and(1.1±0.3),respectively,P<0.05],while the fecal enterococcus and enterobacter numbers were(8.6±0.3)lg CFU/g and(9.5±0.4)lg CFU/g,both significantly higher than[(7.7±0.2)lg CFU/g and(8.4±0.3)lg CFU/g,respectively,P<0.05]in patients with SFL;serum IL-17 level was(55.4±9.7)ng/L,much higher than[(41.3±7.2)ng/L,P<0.05],while serum INF-γlevel was(146.9±21.6)ng/L,much lower than[(212.6±36.4)ng/L,P<0.05]in patients with SFL.Conclusion The intestinal flora,and serum IL-17 and INF-γlevels change abnormally in patients with NAFLD,which might be related to the liver injury,and needs further investigation.