内毒素血症对肝硬化及重型肝炎各种并发症和预后的影响

目的：探讨内毒素血症与肝硬化和重型肝炎的各种并发症及预后的关系，以便协助判断病情及估计预后。方法：收集86例住院病人血浆内毒素及腹水内毒素检测结果。内毒素检测方法采用鲎试剂与合成基质（鲎三肽）的偶氮显色法，定量检测样品中微量革兰氏阴性细菌内毒素。分别统计内毒素血症（ETM）阳性和ETM阴性两组患者各种并发症的发生率，肝功损害程度以及预后情况。应用统计软件对数据进行X^2检验或Fisher精确检验。结果：86例被检病人中，ETM（＋）者50例，ETM（－）者36例，ETM发病率51．8％。血浆与腹水中内毒素同时阳性者40例。ETM（＋）组，病人消化道出血，肝肾综合征等并发症的发生率明显高于ETM（－）组（P＜0．05）。肝性脑病、DIC的发生率也高于ETM（－）组。同时，ETM（＋）者，肝损害程度重，黄疸程度深，凝血酶原活动度（PTA)明显下降，预后不佳，死亡率明显增高。结论：肝硬化及重型肝炎易发生ETM。内毒素的来源除肠原性因素外，腹水腹腔感染时产生的内毒素进入血循环也是重要原因。ETM（＋）时，各种并发症的发生率明显增高，同时又进一步使肝功能损害加重，影响患者的预后。因此，通过血浆内毒素的测定对判断病情估计预后有重要意义。积极控制腹腔感染可以减少ETM的发生，控制ETM有助于控制肝损害的加重和并发症的发生。

The Influence of Endotoxemia on Various Complications and Prognosis of Liver Cirrhosis and Severe Hepatitis

Objective:to study the relations between endotoxemia(ETM) and the various complications as well as prognosis of liver cirrhosis and severe hepatitis, so as to judge the condition of patients and estimate the prognosis of them Methods: 86 cases of hospitalized patients were studied the endotoxin level in their serum and ascites samples. The endotoxin level was measured by the azocoupling method of limulus test agent and synthetic base material (Boc-Leu-Gly-Arg-PNA), which can detect tiny amount of endotoxin from G- bacteria by quantity in the above samples. Those who are ETM positive are compared with those who are ETM negative by statistics in the aspects of the incidence of various complications, severity of liver function damage and prognosis of patients. Statistics software was applied to do the 2 test or Fisher exact test to data.Results: in 86 patients, 50 cases are ETM positive, 36 negative. The incidence of ETM is 51.8%. Of them 40 cases are both blood sample and ascites sample ETM positive. In ETM positive patients group, incidence of complications such as hemorrhage due to rupture of esophageal varicose vein, hepato-renal syndrome are higher than that of ETM negative group. (P<0.05). Incidence of hepatic cephalopathy and disseminated intravascular coagulation(DIC) are higher too. Meantime cases in ETM positive group have severe liver function damage, high blood bilirubin and greatly declined prothrombin activity. Thus their prognoses are poor and mortality becomes greatly increased.Conclusion: liver cirrhosis and severe hepatitis patients are liable to have endotoxemia. Endotoxin comes not only from intestine tract but also from ascites. Endotoxin from ascites infection to blood circulation is also an important factor. When patients have ETM positive, the incidence of various complications will increase significantly and lead to further more severe liver function damage, thus affecting the prognosis of patients. Therefore, serum ETM assay has important meaning for judging the conditions of patients and predicting prognosis. Control of ascites infection can lower ETM incidence. Control of ETM is beneficial to the control of further liver damage and the occurrence of complications.