肝炎后肝硬化患者血浆内毒素和TNF-α、IL-6的变化与整肠生对内毒素吸收的干预作用

目的探讨肝炎后肝硬化患者血浆内毒素和TNF-α的变化及意义,以及微生态制剂对内毒素吸收的干预作用。方法将76例肝炎后肝硬化患者随机分为实验组（n=38）和对照组（n=38）,两组患者均经综合治疗和护理,实验组在综合治疗的基础上口服整肠生胶囊,4粒／次,3次／d,共30d。分别检测两组治疗前后内毒素、TNF-α和肝功能水平。结果两组肝炎后肝硬化患者在治疗前血浆内毒素、TNF-α和IL-6均高于正常健康组（P〈0．05）,实验组治疗后内毒素、TNF-α和IL-6水平均较对照组明显下降,肝功能改善优于对照组。内毒素与TNF-α、IL-6之间呈显著正相关。结论在肝炎后肝硬化患者的肝细胞损害中,血浆内毒素具有重要作用。微生态制剂能改善肠道环境,减少内毒素的吸收,在肝炎后肝硬化的治疗上具有潜在的临床应用价值。     

肝硬化患者红细胞CD58与肝细胞功能关系的研究

目的 探讨肝硬化患者红细胞CD58与肝细胞功能的关系.方法 用流式细胞仪检测48例肝硬化患者及30例对照者的红细胞CD58,同时检测血清白蛋白(ALB)、总胆红素(TBIL)和胆碱酯酶(CHE),对两组结果进行比较.结果 肝硬化患者红细胞CD58和TBIL高于正常对照组(P＜0.01),而ALB、CHE较对照组低;红细胞CD58升高与ALB(τ=-0.658)、CHE(τ=-0.582)呈负相关(P＜0.01),与TBIL(τ=0.490)呈正相关(P＜0.01).结论 肝硬化患者存在红细胞免疫功能紊乱,红细胞CD58高表达与肝细胞功能受损存在相关性.     

肝硬化患者肝功能分级与低钙血症的临床分析

目的 探讨肝硬化患者低钙血症的发生规律及其临床意义.方法 回顾性地对比分析我院收治的235例肝炎肝硬化患者的临床资料,测定血清钙水平,并与正常对照组比较.结果 肝硬化组血清钙水平(1.96±0.19)mmol/L明显低于对照组(2.39±0.19)mmol/L(P<0.01),Chi1d-Push分级后B、C级患者的低钙血症发生率高于A级,三组之间的比较有统计学差异(P<0.05).肝硬化组低钙血症的发生率明显高于对照组(P<0.01).结论 肝硬化患者低钙血症发生率明显高于正常人,但临床症状不典型,其发生及严重程度与肝硬化严重程度相关.     

无症状性心肌缺血患者心率震荡现象的临床研究

目的 探讨心率震荡(HRT)在无症状性心肌缺血 (SMI)患者中的变化及其临床意义. 方法 对87例SMI患者和80例正常对照者行24 h动态心电图(DCG),计算HRT的两个量化指标震荡初始(TO)和震荡斜率(TS)并进行分析. 结果 SMI患者与正常对照组比较HRT明显异常,其中TS显著低于对照组(P＜0.001)而阳性率却显著高于对照组(P＜0.005),TO显著高于对照组(P＜0.001),阳性率也明显高于对照组(P＜0.005).SMI患者HRT分级异常率为68.96%. 结论 SMI患者HRT现象异常,提示SMI患者自主神经功能受损明显.     

肝硬化腹水并发自发性细菌性腹膜炎的临床研究

目的　探讨肝硬化腹水并发自发性细菌性腹膜炎 (SBP)菌株种类、临床特点和预后。方法　对 336例住院肝硬化腹水并发SBP临床资料进行前瞻性调查。结果　 2 5 3例 (75 75 % )患者多核粒细胞 (PMN)相对值≥0 5 0。 84例腹水细菌培养阳性 ,共分离细菌 4 2株 ,大肠埃希菌占 4 5 2 4 % ,腹水蛋白≤ 10g/L并发SBP患病率高于腹水蛋白 >10 g/L患者 ,两者差异显著 (χ2 =6 4 6 ,P <0 0 5 )。结论　肝硬化腹水并发SBP临床症状大多不典型 ,腹水PMN比值是诊断SBP比较可靠的参数。病原菌以大肠杆菌为主。腹水蛋白 <10 g/L患者应警惕SBP发生 ,应及早做腹水常规检查。     

Effects of lactulose on intestinal endotoxin and bacterial translocation

Objective To investigate the effects of lactulose on intestinal bacterial overgrowth (IBO), bacterial translocation (BT), intestinal transit and permeability in cirrhotic rats.
Methods BT in all animals was assessed by bacterial culture of mesenteric lymph node (MLN), liver and spleen, and IBO was assessed by a jejunal bacterial count of the specific organism. Intestinal permeability was determined by the 24-hour urinary 99mTc-diethylenetriaminepentaacetate (99mTc-DTPA) excretion, and intestinal transit was determined by measuring the distribution of 51Cr in the intestine.
Results BT and IBO were found in 48% and 80% of the cirrhotic rats, respectively, while not in the control rats. Cirrhotic rats with IBO had significantly higher levels of intestinal endotoxin higher rates of bacterial translocation, shorter intestinal transit time and higher intestinal permeability than those without IBO. It was also found that BT was closely associated with IBO and injury of the intestinal barrier. Compared with the placebo group, lactulose-treated rats had lower rates of BT and IBO, which was closely associated with increased intestinal transit and improved intestinal permeability by lactulose.
Conclusions Our study indicate that endotoxin and bacterial translocation in cirrhotic rats may attribute to IBO and increased intestinal permeability. Lactulose that accelerates intestinal transit and improves intestinal permeability might be helpful in preventing intestinal bacterial and endotoxin translocation.     

Effects of lactulose on intestinal endotoxin and bacterial translocation in cirrhotic rats

Objective To investigate the effects of lactulose on intestinal bacterial overgrowth (IBO), bacterial translocation (BT), intestinal transit and permeability in cirrhotic rats.Methods BT in all animals was assessed by bacterial culture of mesenteric lymph node ( MLN), liver and spleen, and IBO was assessed by a jejunal bacterial count of the specific organism. Intestinal permeability was determined by the 24-hour urinary ^99mTc-diethylenetriamine pentaacetatic acid (^99mTc-DTPA) excretion, and intestinal transit was determined by measuring the distribution of ^51Cr in the intestine.Results BT and IBO were found in 48% and 80% of the cirrhotic rats, respectively, while not in the control rats. Cirrhotic rats with IBO had significantly higher levels of intestinal endotoxin higher rates of bacterial translocation, shorter intestinal transit time and higher intestinal permeability than those without IBO. It was also found that BT were closely associated with IBO and injury of the intestinal barrier. Compared with the placebo group, lactulose-treated rats had lower rates of BT and IBO,which were closely associated with increased intestinal transit and improved intestinal permeability by lactulose.Conclusions Our study indicate that endotoxin and bacterial translocation in cirrhotic rats may attribute to IBO and increased intestinal permeability. Lactulose that accelerates intestinal transit and improves intestinal permeability might be helpful in preventing intestinal bacterial and endotoxin translocation.     

肝硬化小肠细菌过度生长情况分析

目的了解肝硬化患者不同CTP分级及出现不同并发症时与小肠细菌过度生长(SIBO)的关系。方法对68例肝硬化患者,均行葡萄糖氢呼气试验(GHBT)检测SIBO情况,按不同CTP分级、不同并发症分组统计,并设立健康对照组,对检测结果作对比分析。结果 (1)肝硬化患者SIBO与健康对照组比较差异有统计学意义(P<0.05);(2)CTP级A级、B级、C级患者SIBO阳性率及氢呼气浓度平均值呈渐进性增高,A级、B级与C级相比组间差异有统计学意义(P<0.05);(3)不同并发症患者SIBO阳性率及氢呼气浓度不一,其中无并发症患者与上消化道出血患者、肝性脑病患者、自发性腹膜炎患者及多种并发症患者相比差异均有统计学意义(P<0.05)。结论肝硬化患者往往合并有SIBO,其与CTP分级相关,而且与肝硬化出现的不同并发症密切相关。     

肝硬化腹水并发自发性细菌性腹膜炎167例临床分析

目的探讨肝硬化腹水并发自发性细菌性腹膜炎(SBP)细菌种类以及临床特点,减少漏诊,提高患者生存率.方法对167例肝硬化腹水并发SBP患者的临床资料进行回顾性分析.结果167例肝硬化腹水并发SBP患者中69例腹水细菌培养阳性(41.32%),共分离细菌21株,包括7种细菌,以革兰氏阴性杆菌为主,大肠杆菌为主要致病菌,占43.72%;139例(83.2%)患者腹水多形核白细胞(PMN)比值≥0.50.结论肝硬化腹水并发SBP临床表现大多数不典型,腹水PMN比值是诊断SBP的可靠指标;病原菌以大肠杆菌为主,对第三代头孢菌素和第三代氟喹诺酮类药物敏感.     

Bacterial translocation and change in intestinal permeability in patients after abdominal surgery

The purpose of this study was to investigate bacterial translocation and change in intestinal permeability in patients after abdominal surgery. Sixty-three patients undergoing elective abdominal surgery were enrolled in the study. Blood samples were collected prior to operation and 2, 24, 48 h after surgery for bacterial culture, microbial DNA extraction, plasma D-lactate and endotoxin measurement. PCR analysis was performed after DNA extraction, with β-lactosidase gene of E. coli and 16S rRNA gene as target genes. All patients were observed for a period of 30 days for infectious complications. Our results showed that no bacterial DNA was detected before surgery, but after operation it was found in 12 patients （19.0%）. Bacterial DNA was detected in 41.7% （10/24） of SIRS patients and 5.1% （2/39） of non-SIRS patients （P〈0.01）. About 83.3% of PCR-positive patients developed systemic inflammatory response syndrome （SIRS）, but only 27.5% of PCR-negative patients did so （P〈0.01）. Two thirds of PCR-positive patients developed infectious complications, while none of PCR-negative patients did （P〈0.01）. The blood culture was positive only in 3 patients （4.8%）, who were all PCR-positive. E. coli DNA was found in 66.7% of the PCR-positive patients. The plasma levels of D-lactate and endotoxin were elevated significantly 2, 24 and 48 h after operation in PCR-positive patients, with a significant positive correlation found between them （r=0.91, P〈0.01）. It is concluded that increased intestinal permeability was closely related with bacterial translocation. Intestinal bacterial translocation （most commonly E. coli） might occur at early stage （2 h） after abdominal surgery. Postoperative SIRS and infection might bear a close relationship with bacterial translocation.     

肝创伤时细菌移位及小肠Fas表达的实验研究

目的 研究肝外伤时小肠肠粘膜屏蔽损伤、细菌移位和Fas表达意义。方法 对肝损伤后不同时间进行血中IL－6、TNF、NO、内毒素、肠粘膜通透性的测定以及荧光标记菌示踪、组织学形态学及Fas免疫组化等观察。结果 肝创伤后血中IL－6、TNF、NO升高，内毒素、肠粘膜通透性、荧光标记菌总阳性率均升高；组织学可见损伤，并可见Fas表达的增加。结论 在肝损伤时可引起肠粘膜屏障损伤和细菌移位，肠道是闭合性肝外伤腹腔感染的重要来源。Fas表达增加可能与肠粘膜屏障损伤相关。     

急性坏死性胰腺炎后肠道微生态失调与细菌移位关系的研究

15只杂种犬,分为实验组（n＝8）和对照组（n＝7）。七天后活杀。结果发现,实验组犬肠粘膜及内容物中大肠杆菌计数高出对照组10－300倍,而双歧杆菌及乳杆菌则明显减少（P＜0.01）;肠粘膜双歧杆菌／大肠杆菌比值严重倒置（P＜0．05）;肝、胰、脾、肺、肾及肠系膜淋巴结出现了肠道细菌移位;第1、2天血培养结果分别为6／8和5／8。本研究证实,急性坏死性胰腺炎后肠道出现明显的微生态失调,肠道细菌移位到胰腺及其它脏器,成为胰腺及胰周感染的根源。     

急性坏死性胰腺炎后肠道细菌与胰腺感染关系的研究

为探讨急性坏死性胰腺炎（ANP）的感染源，将PUC18质粒菌JM109置入15只犬肠道内，定植后，随机分为胰腺炎组（n＝8）及对照组（n＝7）。每日抽血作细菌培养。第7天活杀后，作脏器细菌培养。对耐氨苄青霉素菌株进行酶切分析及琼脂糖凝胶电泳。结果显示，除肾及脾脏外，其余脏器均发现有JM109菌移位，以胰腺移位率最高（6／8）；血培养及腹水中同样找到质粒菌JM109，发病后24h血培养阳性率高达4／8。提示肠道细菌移位是继发性胰腺感染的感染源。     

肝炎肝硬化自发性腹水感染患者肠黏膜通透性检测

目的:探讨肝炎肝硬化自发性腹水感染(SAI)患者肠黏膜通透性改变的临床意义。方法:采用高压液相色谱 示差法检测 34例肝炎肝硬化SAI患者、11例肝炎肝硬化无菌性腹水 (SA)患者及 11名健康对照口服糖分子探针乳果糖(LAC)、甘露醇(MAN)后尿液排泄率比值情况,评估患者肠黏膜通透性水平;采用鲎试剂三肽显色基质偶氮法检测患者血浆、腹水内毒素(LPS)水平。结果:治疗前肝炎肝硬化SAI组、SA组和健康对照组尿LAC/MAN分别为0. 100±0. 004、0. 072±0. 007和 0. 021±0. 001(3组比较,P<0. 05);血浆LPS水平分别为 (0. 265±0. 010)Eu/ml、(0. 098±0. 015)Eu/ml、(0. 029±0. 003)Eu/ml(3组比较,P<0. 05);治疗前肝硬化SAI组、SA组腹水LPS水平分别为(0. 264±0. 007)Eu/ml、(0. 055±0. 009)Eu/ml(P<0. 05);肝硬化腹水患者尿LAC/MAN与血浆LPS水平呈正相关(r=0. 787,P<0. 001);肝硬化SAI患者治疗 1周后尿LAC/MAN( 0. 067±0. 004 )及血浆、腹水LPS水平( (0. 068±0. 003)Eu/ml, (0. 047±0. 004)Eu/ml)均较治疗前下降 (P<0. 05)。结论:肝炎肝硬化SAI患者存在肠黏膜通透性异常。