酪酸梭菌对非酒精性脂肪性肝病的疗效及对肠屏障的影响

目的探讨酪酸梭菌对非酒精性脂肪性肝病(NAFLD)患者肠屏障的作用及其对NAFLD的疗效和作用机制。方法选择在该院消化科就诊的NAFLD患者100例纳入NAFLD组,另选取50例健康体检者纳入对照组,比较两组的肠屏障功能指标血清内毒素、二胺氧化酶(DAO)和D-乳酸]。将NAFLD组患者按照随机数字表法又分为A组、B组,两组均予以常规低脂饮食+有氧运动+双环醇1粒tid po,A组在此基础上,予以酪酸梭菌2粒tid po。将NAFLD组根据丙氨酸氨基转移酶(ALT)值分为ALT升高组和ALT正常组,比较两组肠屏障功能障碍发生率及炎性反应指标白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)]水平。分别于给药1个月后复查患者肠屏障功能、血脂三酰甘油(TG)、总胆固醇(TC)]、肝功能、炎性反应指标等,并对A组与B组患者以上指标进行比较。结果NAFLD组的血清内毒素、DAO、D-乳酸水平均高于对照组,差异有统计学意义(P<0.05)。ALT升高组的TNF-α、IL-6水平明显高于ALT正常组,差异有统计学意义(P<0.05)。用药后A组与B组内毒素、D-乳酸、DAO水平均较用药前下降,A组下降比B组更明显,差异有统计学意义(P<0.05)。用药后A组与B组IL-6、TNF-α、TG水平均较用药前下降,A组下降比B组更明显,差异有统计学意义(P<0.05)。A组的总有效率(86.0%)高于B组(70.0%),差异有统计学意义(P<0.05)。结论NAFLD患者存在肠屏障损伤,可能与炎性反应激活有关。联合酪酸梭菌治疗有助于改善NAFLD患者的肠屏障功能,降低血脂水平,提高疗效。

Clinical effect of clostridium butyricum for nonalcoholic fatty liver disease and the effect on intestinal barrier

Objective To investigate the clinic effect and mechanism of clostridium butyricum in patients with nonalcoholic fatty liver disease(NAFLD)and its effect on intestinal barrier.Methods A total of 100 patients with NAFLD treated in the hospital were recruited into NAFLD group,another 50 healthy people were selected into control group,compared intestinal barrier function indexesserum endotoxin,double amine oxidase(DAO)and D-lactic acid]in the two groups.NAFLD group were divided into group A and group B according to random number table method,both set to be low fat diet+aerobic exercise+bicyclol 1 grain,tid po,on this basis,group A was given clostridium butyricum 2 grain,tid po.According to alanine aminotransferase(ALT)level,the NAFLD group was divided into ALT elevated group and ALT normal group,and the incidence of intestinal barrier dysfunction and inflammatory response indicators including interleukin-6(IL-6),tumor necrosis factorα(TNF-α)were compared between the two groups.Intestinal barrier function,blood lipidtriacylglycerol(TG),total cholesterol(TC)],liver function and inflammatory response indicators were reviewed 1 month after administration respectively,and the above indicators were compared between group A and group B.Results The levels of endotoxin,DAO and D-lactic acid in NAFLD group were all higher than those in control group(P<0.05).The levels of TNF-αand IL-6 in ALT elevated group were significantly higher than those in ALT normal group(P<0.05).After treatment,endotoxin,D-lactic acid and DAO levels in both group A and group B decreased compared with those before treatment,and the decrease in group A was more significant than those in group B(P<0.05).After treatment,IL-6,TNF-αand TG levels in both group A and group B decreased compared with those before treatment,and the decrease in group A were more significant than those in group B(P<0.05).The effective rate of treatment in group A(86.0%)was higher than group B(70.0%,P<0.05).Conclusion The intestinal barrier function is impaired in the patients with NAFLD,which might related to the activation of inflammatory reaction.Combined with clostridium butyricum treatment is helpful to improve the intestinal barrier function of NAFLD patients,reduce the blood lipid level and improve the curative effect.