肠黏膜通透性改变对肝硬化自发性细菌性腹膜炎的影响

目的探讨肠黏膜通透性改变对肝硬化自发性细菌性腹膜炎（SBP）的影响。方法 采用高压液相色谱-示差法，检测45例住院肝硬化腹水患者（34例白发性腹膜炎和11例肝硬化无菌性腹水）治疗前后口服糖分子探针乳果糖、甘露醇后尿液排泄率比值（LAC／MAN）情况，评估病人肠黏膜通透性水平；采用鲎试剂三肽显色基质偶氮法检测病人治疗前后血浆内毒素（LPS）水平，另11例健康志愿者作为对照组结果治疗前肝硬化SBP尿LAC／MAN、血浆内毒素水平均显著高于无菌性腹水（SA）组和健康对照组（P均〈0．001）Pearson相关性分析：肝硬化腹水患者尿LAC／MAN改变与血浆LPS水平呈正相关（r=0．187，P〈0．001）治疗1周后肝硬化SBP患者尿LAC／MAN及血浆LPS水平平行下降。结论肝硬化SBP患者存在肠黏膜通透性异常，且肠黏膜通透性改变与内毒素血症有关．

Effect of intestinal permeability changes on spontaneous bacterial peritonitis in cirrhosis patients

Objective To evaluate the effect of changes in intestinal permeability on spontaneous bacterial peritonitis （SBP） in hepatitis cirrhosis patients. Methods The intestinal permeability and levels of endotoxin were assayed in 45 cirrhosis patients 34 with SBP, 11 with sterile ascilic fluid before and after therepy, and 11 healthy volunteers. To evaluate intestinal permeability, the concentration of lactulose and mannitol in urine was measured using high-pressure liquid chromatograph with refractive index dectector （HPLC-RID）, and the levels of urinary excretion of LAC/MAN ratios were eaculated. Results The levels of urinary excretion of LAC/MAN ratios and the plasma levels of endotoxin were significantly higher in cirrhotic patients with SBP than those in SA group and healthy control group in admitting hospital （P 〈 0. 05 ）. Pearson＇ s correlation analysis showed that in SBP patients, the levels of urinary excretion of LAC/MAN ratios had significant correlation with the level of endotoxin （ r = 0. 187, P 〈0. 001 ）. After being treated for one week, the levels of urinary excretion of LAC/MAN ratios, the plasma and ascitic levels of endotoxin in SBP patients were sig- nificantly decreased （P 〈 0.05 ）. Conclusion The intestinal permeability in cirrhosis patients with SBP is increased. The changes of intestinal permeability are correlated with the endotoxemia in cirrhosis patients with SBP.