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目的研究慢性乙型病毒性肝炎(重度)患者肠道屏障功能的变化并探讨不同干预方法对其的影响。方法(1)检测30例正常人和30例慢性乙型病毒性肝炎(重度)患者尿乳果糖、甘露醇排泄率比值(L/M)和血清二胺氧化酶(DAO)的变化,并加以比较。(2)将90例慢性乙型病毒性肝炎(重度)患者随机分为对照组、乳果糖组及谷氨酰胺组(GLN)3组,每组各30例。对照组采用基础治疗,而乳果糖组在基础治疗上加用乳果糖10gtid,GLN组在基础治疗上加用谷氨酰胺颗粒10gtid,疗程均为2周。于治疗前后分别测定3组患者的肝功能、内毒素(ET)、肿瘤坏死因子(TNF-α)、DAO、白介素-2(IL-2)、白介素-8(IL-8)、T淋巴细胞亚群、L/M等,并采用协方差分析法加以比较。结果(1)与正常人相比,慢性乙型病毒性肝炎(重度)患者L/M、DAO水平明显升高(P=0.007及P<0.0001)。(2)2周治疗结束后,与对照组相比,乳果糖组治疗后TBIL、ET、TNF-α的变化差异有显著性(P<0.05)。与对照组相比,GLN组治疗后ALT、TBIL、TNF-α、ET、IL-2、L/M、DAO的变化差异有显著性(P<0.05)。乳果糖组与GLN组相比,治疗后ALT、TBIL、TNF-α、IL-2、L/M的变化差异有显著性(P<0.05)。结论(1)慢性乙型肝炎(重度)患者存在肠黏膜屏障的早期损伤。(2)在常规治疗的基础上加用乳果糖对减轻内毒素血症及炎症反应,降低总胆红素水平有一定的作用,但无法改善肠道屏障损伤。而加用谷氨酰胺则能纠正肠道屏障损伤,减轻内毒素血症与炎症反应,加速肝功能恢复。
Objective To study the changes of intestinal barrier function in patients with chronic hepatitis B (severe) and to explore the influence of different intervention methods. Methods (1) The changes of urinary lactulose, mannitol excretion ratio (L / M) and serum diamine oxidase (DAO) in 30 normal subjects and 30 patients with chronic hepatitis B were detected and compared Compare (2) 90 patients with chronic hepatitis B (severe) were randomly divided into control group, lactulose group and glutamine group (GLN) 3 groups, 30 cases in each group. In the control group, basic treatment was used. In the lactulose group, 10gtid lactulose was added to the basic treatment. The GLN group was given 10gtid glutamine granules on the basis of basic treatment for 2 weeks. The changes of liver function, endotoxin (ET), tumor necrosis factor (TNF-α), DAO, interleukin-2, interleukin-8 and T lymphocyte Subgroups, L / M, etc., and compared using covariance analysis. Results (1) L / M and DAO levels in patients with chronic hepatitis B (severe) were significantly higher than those in healthy controls (P = 0.007 and P <0.0001). (2) After 2 weeks of treatment, the changes of TBIL, ET and TNF-α in lactulose group were significantly different from those in control group (P <0.05). Compared with the control group, the changes of ALT, TBIL, TNF-α, ET, IL-2, L / M and DAO in GLN group were significantly different (P <0.05). Compared with GLN group, the changes of ALT, TBIL, TNF-α, IL-2 and L / M in lactulose group were significantly different (P <0.05). Conclusions (1) The early damage of intestinal mucosal barrier exists in patients with chronic hepatitis B (severe). (2) The addition of lactulose on the basis of routine treatment can reduce the endotoxemia and inflammatory reaction, reduce the level of total bilirubin, but can not improve the intestinal barrier injury. The addition of glutamine can correct intestinal barrier injury, reduce endotoxemia and inflammation, accelerate liver function recovery.