肠道去污剂经不同途径给药对肝硬化患者肠黏膜通透性及血清内毒素水平的影响

目的比较肠道去污剂口服和保留灌肠两种途径给药对肝硬化患者肠黏膜通透性和血清内毒素水平的影响,为肝硬化的治疗提供临床依据。方法选择78例肝硬化患者,按照给药途径分为口服组和保留灌肠组。两组在常规治疗的基础上,口服组将1人1 d的肠道去污剂剂量用0.9%氯化钠注射液制成悬浊液服用,保留灌肠组经肛门插入导管注射去污剂,均治疗14 d。比较治疗前后两组患者的Child-Pugh评分,行肠黏膜通透性以尿液乳果糖/甘露醇排出比(L/M)表示]及血清内毒素水平检测,并对肠黏膜通透性和血清内毒素水平的相关性进行分析。结果治疗前两组肝硬化患者的尿液L/M值、内毒素水平及Child-Pugh评分比较,差异无统计学意义(P>0.05)。治疗后,保留灌肠组患者尿液L/M值、血清内毒素水平及Child-Pugh评分均显著低于口服组,差异有统计学意义(P<0.05)。肠黏膜通透性(尿液L/M值)与血清内毒素水平呈正相关(r=0.8287,P<0.05)。结论肠道去污剂保留灌肠给药较口服给药可以更好地保护和改善肝硬化患者肠道屏障功能,降低内毒素的水平,对肝硬化患者肝功能的恢复有一定的辅助作用。

Influence of Intestinal Detergent by Different Administration on Bowel Mucosa Permeability and Serum Endotoxin Level in Patients with Liver Cirrhosis

Objective To compare the influences and differences of intestinal detergent by administrations of oral and retention enema on bowel mucosa permeability and serum endotoxin level in patients with liver cirrhosis to provide clinical evidence for the treatment of liver cirrhosis.Methods 78 patients with liver cirrhosis were randomly divided into oral group and retention enema group according to different administration methods.Despite routine treatment,oral group was given suspension of intestinal detergent and 0.9% sodium chloride injection,while retention enema group was given detergent by catheter through anal,and the two groups were both treated for 14 days.Child-Pugh score was compared between the two groups before and after treatment.The bowel mucosa permeability indicated by urine lactulose/mannitol discharge rate(L/M)] and serum endotoxin level were measured and the correlation between the two was analyzed.Results The differences of L/M value,serum endotoxin level and Child-Pugh score between the two groups were not statistically significant before treatment(P>0.05).While after treatment,the L/M value,serum endotoxin level and Child-Pugh score were significantly lower in retention enema group than in oral group(P<0.05).The bowel mucosa permeability was positively correlated with serum endotoxin level(r=0.8287,P<0.05).Conclusion Retention enema of intestinal detergent can protect and improve the protective function of the intestine of patients with liver cirrhosis,and it can also decrease the serum endotoxin level,benefiting the recovery of the liver function in liver cirrhosis patients.