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目的研究不同调整肠道菌群治疗方案对慢性乙型重型肝炎患者肠道菌群和血浆内毒素的影响。方法纳入慢性乙型重型肝炎患者127例,分为A、B、C 3组,A组63例,B组32例,C组32例。A组患者口服金双歧,B组患者金双歧口服+乳果糖口服,C组患者金双歧口服+乳果糖灌肠。在治疗前和治疗第5、10、15以及20 d,分别检测3组患者大便肠球菌、酵母菌、双歧杆菌数量以及血浆内毒素水平。结果治疗10 d时A、B和C组患者双歧杆菌数量分别为8.58±1.84、8.21±1.82和8.43±1.94 l gn/g,均较治疗前升高,差异有统计学意义(P均<0.01);治疗20 d时3组患者双歧杆菌数量分别为8.80±1.67、7.82±1.70和7.58±1.85l gn/g,与治疗10 d时比较,A组患者双歧杆菌数量无明显变化,B组和C组均明显减少,差异有统计学意义(P均<0.01)。治疗20 d时3组患者肠球菌数量分别为7.83±1.66、8.17±1.78和8.85±2.03lgn/g,酵母菌数量分别为4.77±1.38、5.38±1.29和5.89±1.45lgn/g,与治疗前比较,A、B组肠球菌无明显变化,C组患者肠球菌明显升高,差异有统计学意义(Pc<0.01);A组酵母菌无明显变化,B、C组患者酵母菌均升高,差异有统计学意义(PB<0.05,PC<0.01)。A组患者在第15天,B、C组患者在第10天血浆内毒素下降至最低值,分别为184.48±69.56、152.71±32.44和122.71±32.61 EU/L,较治疗前下降,差异有统计学意义(P均<0.05);3组最低值比较,C组明显低于A、B组。治疗20d时3组患者血浆内毒素分别为187.62±80.73、265.62±90.55和328.62±101.43 EU/L,与治疗最低值比较,A组无明显变化,B组和C组患者血浆内毒素均明显升高,差异有统计学意义(P均<0.05)。结论单用金双歧口服可以调节肠道菌群、降低血浆内毒素,但作用轻微。金双歧口服联合乳果糖口服或灌肠可以显著降低血浆内毒素水平,但在治疗第5~15 d可能出现新的菌群失调,加重内毒素血症。乳果糖灌肠方式使药物作用更直接,对肠道菌群及内毒素水平影响更明显、迅速。
Objective To study the effects of different regimen of intestinal flora treatment on intestinal flora and endotoxin in patients with chronic severe hepatitis B. Methods A total of 127 patients with chronic severe hepatitis B were enrolled and divided into A, B and C groups, 63 cases in group A, 32 cases in group B and 32 cases in group C. A group of patients with oral gold bifidobacteria, B group patients with oral gold lactose oral lactulose, C group patients with gold bifidobacterium oral lactulose enema. Before treatment and on the 5th, 10th, 15th and 20th day of treatment, the quantity of enterococci, yeast, Bifidobacterium and endotoxin in the three groups were detected respectively. Results The number of Bifidobacterium in groups A, B and C at the 10th day of treatment was 8.58 ± 1.84, 8.21 ± 1.82 and 8.43 ± 1.94 lgn / g, respectively, which were significantly higher than those before treatment (P <0.05) (P <0.01). The numbers of Bifidobacterium in the three groups were 8.80 ± 1.67, 7.82 ± 1.70 and 7.58 ± 1.85 lgn / g on the 20th day after treatment, respectively. Compared with the 10th day after treatment, the number of Bifidobacteria in group A was not significantly Changes, B and C groups were significantly reduced, the difference was statistically significant ( P <0.01). The numbers of enterococci in three groups were 7.83 ± 1.66, 8.17 ± 1.78 and 8.85 ± 2.03lgn / g on the 20th day after treatment, respectively. The numbers of yeasts were 4.77 ± 1.38, 5.38 ± 1.29 and 5.89 ± 1.45lgn / g, respectively, Enterococcus faecalis in group A and group B showed no significant change, and enterococci in group C were significantly increased (P c <0.01). There was no significant change in group A and group B, Were increased, the difference was statistically significant ( P B <0.05, P C <0.01). On the 15th day in group A, the plasma endotoxin in group B and C decreased to the lowest values on the 10th day, which were 184.48 ± 69.56, 152.71 ± 32.44 and 122.71 ± 32.61 EU / L, respectively, which were lower than those before treatment Significance (P <0.05). Compared with the lowest value of the three groups, the C group was significantly lower than the A, B group. The plasma endotoxin in the three groups at the 20th day of treatment was 187.62 ± 80.73, 265.62 ± 90.55 and 328.62 ± 101.43 EU / L, respectively. Compared with the lowest treatment group, the plasma endotoxin in group A and B were significantly increased High, the difference was statistically significant (P <0.05). Conclusions Jinshuangqi alone can regulate intestinal flora and reduce plasma endotoxin, but the effect is slight. Jinshuangqi orally combined with lactulose oral or enema can significantly reduce plasma endotoxin levels, but in the treatment of 5 ~ 15 d may appear new flora, aggravating endotoxemia. Lactulose enema way to make drugs more direct effect on the intestinal flora and endotoxin levels more obvious and rapid.