双歧杆菌三联活菌胶囊对慢性乙肝后肝硬化患者肠道屏障功能及免疫功能的影响

Effects of viable triple Bifidobacterium capsule on intestinal barrier function and immune function in patients with chronic posthepatitis B cirrhosis

目的基于肠道菌群特征探讨双歧杆菌三联活菌胶囊对乙肝后肝硬化患者肠道屏障功能和免疫功能的作用。方法选择2019年1月至2022年12月到我院进行治疗的124例乙肝肝硬化患者作为研究对象,随机将患者分为对照组和观察组,每组62例。对照组患者进行常规治疗,静脉滴注异甘草酸镁注射液,观察组患者在对照组基础上加用双歧杆菌三联活菌胶囊进行治疗。对患者治疗前后的总胆红素(TBIL)、谷草转氨酶(AST)和谷丙转氨酶(ALT)水平进行检测。收集患者治疗前后外周静脉血,应用FACScan流式细胞技术对患者自然杀伤(NK)细胞、CD3细胞和CD4细胞进行检测。收集患者治疗前后粪便样本,应用荧光定量聚合酶链式反应对患者体内肠球菌、双歧杆菌、乳杆菌、肠杆菌和拟杆菌数量进行检测。治疗前后应用高效液相色谱法记录患者尿液乳果糖/甘露醇排除比。应用酶联免疫吸附法对IL-9水平进行检测,应用流式细胞仪检测Th9细胞水平。记录患者治疗过程中不良反应情况。结果治疗后,两组患者的TBIL、AST和ALT水平均降低,且观察组降低更显著(均P<0.05)。治疗后,两组患者的CD3、CD4和NK细胞比例均有升高(均P<0.05),且观察组患者的CD3、CD4和NK细胞比例高于对照组(均P<0.05)。治疗后,相对于对照组,观察组患者的肠球菌和肠杆菌数量均较低,而拟杆菌、乳杆菌和双歧杆菌数量均较高(均P<0.05)。治疗后,两组患者的尿液乳果糖/甘露醇排除比均有降低,且观察组尿液乳果糖/甘露醇排除比低于对照组(P<0.05)。治疗后,两组患者IL-9水平和Th9细胞比例均降低(P<0.05),且观察组患者的IL-9水平和Th9细胞比例低于对照组(P<0.05)。两组患者治疗过程中均未出现药物不良反应。结论双歧杆菌三联活菌胶囊能够改善乙肝后肝硬化患者肠道菌群,而且能够改善患者肝功能以及肠道屏障功能和免疫功能。

Objective To observe the effects of viable triple Bifidobacterium capsule on intestinal barrier function and immune function in patients with posthepatitis B cirrhosis based on the characteristics of intestinal flora.Methods A total of 124 patients with hepatitis B cirrhosis who received treatment in our hospital from January 2019 to December 2022 were enrolled and randomly divided into two groups with 62 patients in each group.The control group received conventional symptomatic treatment and intravenous infusion of magnesium isoglycyrrhizinate.The observation group was additionally treated with viable triple Bifidobacterium capsule on the basis of the control group.The total bilirubin(TBIL),aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were measured before and after treatment.Before and after treatment,peripheral venous blood was collected for detection of natural killer cells,CD3 and CD4 cells by using FACScan flow cytometry.Feces of patients were collected before and after treatment,and the contents of Enterococcus,Bifidobacterium,Lactobacillus,Enterobacter and Bacteroides were detected using fluorescence quantitative polymerase chain valance.High performance liquid chromatography was used to record the lactulose/mannitol exclusion ratio before and after treatment.The content of IL-9 was detected with enzyme-related immunosorbent assay and Th9 cell was detected with flow cytometry.Adverse reactions during treatment were recorded.Results The levels of TBIL,AST and ALT in the observation group were lower than in the control group(all P<0.05).The expressions of CD3,CD4 and NK cells in both groups increased(all P<0.05),with those in observation group being higher than those in control group respectively(all P<0.05).After treatment,compared with control group,the contents of Enterococcus and Enterobacter in observation group were lower,while those of Bacteroides,Lactobacillus and Bifidobacterium were higher(all P<0.05).After treatment,the urine lactulose/mannitol exclusion ratio decreased in both groups,with that in the observation group being lower(P<0.05).The expressions of IL-9 and Th9 cells in both groups decreased(P<0.05),and the expressions of IL-9 and Th9 cells in observation group were lower than those in control group(P<0.05).There was no adverse drug reaction in the two groups during treatment.Conclusion Viable triple Bifidobacterium capsule can improve intestinal flora,liver function,intestinal barrier function and immune function of patients with posthepatitis B cirrhosis.