慢性乙型重型肝炎患者肠道菌群、血浆内毒素动态变化及相关性研究

目的研究慢性乙型重型肝炎治疗过程中肠道菌群、血浆内毒素动态变化以及肠道菌群与血浆内毒素之间的相互关系。方法纳入慢性乙型重型肝炎患者127例，A组63例，B组64例，同期纳入健康者18例作为对照。A组口服金双歧．B组采用金双歧＋乳果糖，对照组不给予任何治疗。治疗前和治疗第5、10、15以及20d，分别检测对照组和患者大便肠球菌、酵母菌、双歧杆菌数量以及内毒素水平。结果①与对照组比较，患者肠道双歧杆菌数量减少（P〈0．001），肠球菌及内毒素增加（P〈0．001）。内毒素与双歧杆菌呈负相关性（r=-0．296，P=0．042），与肠球菌呈正相关性（r=0．331，P〈0．021）。②治疗10d时A组肠道双歧杆菌较治疗前显著升高（P〈0．001），内毒素下降（P=0．021），两者间呈负相关性（r=-0．228，P=0．033）。治疗20d时双歧杆菌以及内毒素较治疗10d时无变化（P分别为0．318和0．484）。③B组肠球菌、酵母菌及内毒素均呈先下降后上升的“V”型变化。肠球菌在第5d、酵母菌和内毒素在第10d下降到最低值（P值分别为0．048、0．033和〈0．001）。之后三者均快速上升，在第20d均超过治疗前水平（P值分别为0．017、〈0．001和〈0．001）。内毒素与肠球菌（r=0．251，P=0．037）及酵母菌（r=0．353，P=0．018）之间呈正相关。④治疗第10dB组内毒素低于A组（P〈0．001）。继续治疗10d，A组内毒素无明显变化，而B组内毒素上升。治疗20d时B组内毒素显著高于A组（P〈0．001）。结论①慢性乙型重型肝炎患者存在肠道菌群失调和高内毒素血症，肠道菌群与内毒素血症相关性存在动态变化。②单用金双歧可轻微改善肠道菌群、降低血浆内毒素。金双歧联合乳果糖治疗可明显降低血浆内毒素，但持续使用可能会加重菌群失调和内毒素血症。

The Relationship between Gastrointestinal Microflora and Endotoxin in Patients with Chronic Severe Hepatitis B.

Objective In order to investigate the relationship and mechanism between microflora and endotoxin in pa- tients with chronic severe hepatitis B. Methods 127 patients were randomly divided into groups A, B. 63 cases of group A and group B 64 eases, in the same period in 18 cases of healthy subjects as control group. Group A to give oral intestinal probiotics, group B to give oral intestinal probiotics ＋ lactulose, the control group didnt give any medication. Respectively before treatment and treatment of 5, 10, 15 and 20 days, group A, B and control group were detected with number of enterococcus, yeast, bifidobacteria and endotoxin. Results （~）The bifidobacterium quantity with patients before treatment significantly reduced （ P 〈 0. 001 ）, enterococcus and endotoxin increased significantly （P 〈 0. 001 ） o Endotoxin levels is negative correlation with bifidobacte- rium（ r = -0. 296 ,P = 0. 042） and enterococcus is positive correlation（ r = 0. 331 ,P 〈 0. 021 ）o @）In group A with early treat- ment, the number of bifidobacteria increased（ P 〈 0. 001 ） , endotoxin levels drop（ P = O. 021 ） , the negative correlation between both（ r = - 0. 228, P = 0. 033 ）. In the treatment of late, bifidobacterium and endotoxin levels has no obvious change （ P was 0. 318 and 0. 484, respectively）. （~）In Group B enterococcus, yeast, and endotoxin levels in ＂V＂ type change. Enterococcus in 5 days, yeast and endotoxin reached the lowest in 10 days （P was 0. 048,0. 033 and 〈0. 001, respectively） o Endotoxin levels exists positive correlation with enterococcus （ r = 0. 251, P = 0. 037 ） and yeast （ r = 0. 353, P = 0. 018 ） , respectively. 4. In the treatment of 10 days, endotoxin lower than group B patients in group A （P 〈0. 001 ）. To continue treatment for 10 days, endotoxin has no obvious changes of the group A, while the rise in group B. In the treatment of 20 days of endotoxin level is significantly higher than group B in group A （P 〈 0. 001 ）. Conclusions （1）The disturbance of microflora and high endotoxemia exist in patients with chronic severe hepatitis B. （2）Correlation between intestinal flora and endotoxin levels, is a dynamic change Intestinal probiotics a- lone can slightly improve the intestinal flora, reducing endotoxin. Intestinal probiotics ＋ lactulose can reduce endotoxin more obvious, but long-term use may enhance the dysbacteriosis, thus aggravating plasma endotoxin.