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目的观察枯草杆菌肠球菌二联活菌胶囊对肝硬化失代偿期患者的临床疗效。方法选择2013年6月至2016年6月在湖北医药学院附属人民医院住院治疗的85例肝硬化失代偿期患者为研究对象,随机分为观察组(43例)和对照组(42例)。对照组患者接受肝硬化常规治疗,观察组在对照组基础上加用枯草杆菌肠球菌二联活菌胶囊500mg/次,3次/d,口服。两组患者疗程均为2个月。观察并比较两组患者治疗前后肝肾功能指标[丙氨酸转氨酶(ALT)、总胆红素(TBil)、前白蛋白(PA)、血肌酐(sCr)、胱抑素C(CysC)、β2微球蛋白(β2-MG)]、肠黏膜屏障功能指标[血氨、内毒素、肿瘤坏死因子(TNF-α)、血清二胺氧化酶(DAO)]、Child-Pugh评分及并发症发生率。结果治疗后观察组患者ALT、TBil、CysC、β2-MG水平显著下降,PA水平显著升高(P<0.05或P<0.01),对照组患者治疗后ALT水平也明显下降(P<0.01),且观察组患者ALT、CysC、β2-MG下降幅度较对照组更大(P<0.05或P<0.01)。两组患者血氨、内毒素、TNF-α和DAO水平较治疗前明显下降(P<0.01),且观察组患者下降幅度较对照组更大(P<0.01)。观察组患者Child-Pugh评分显著降低(P<0.01),且其下降幅度较对照组更大(P<0.05)。观察组患者并发症的发生率明显低于对照组(P<0.05)。结论枯草杆菌肠球菌二联活菌胶囊能有效改善肝硬化失代偿期患者的肝肾功能,修复肠黏膜屏障功能,降低血氨、内毒素、TNF-α和DAO水平,减少并发症的发生。
Objective To observe the clinical efficacy of Enterobacter subtilis and Bacillus subtilis in patients with decompensated liver cirrhosis. Methods From June 2013 to June 2016, 85 patients with decompensated cirrhosis who were hospitalized in Peking Union Medical College Hospital were randomly divided into observation group (n = 43) and control group (n = 42) . Patients in the control group received routine treatment of cirrhosis. The observation group was given 500 mg / time of Enterobacter subtilis twice a day with oral administration on the basis of the control group. Two groups of patients were treated for 2 months. The liver and kidney function indexes (ALT, TBil, PA, CSC, CysC, CysC) of two groups were observed and compared before and after treatment. β2 microglobulin (β2-MG)], indicators of intestinal mucosal barrier function [serum ammonia, endotoxin, tumor necrosis factor (TNF-α), serum diamine oxidase (DAO)], Child-Pugh score and complications rate. Results The levels of ALT, TBil, CysC and β2-MG in the observation group decreased significantly (P <0.05 or P <0.01), while the levels of ALT in the control group decreased significantly (P <0.01 or P <0.01) The decrease of ALT, CysC and β2-MG in the observation group was larger than that in the control group (P <0.05 or P <0.01). The levels of serum ammonia, endotoxin, TNF-α and DAO in both groups were significantly lower than those before treatment (P <0.01), and the decrease in observation group was larger than that in control group (P <0.01). The Child-Pugh score in observation group was significantly lower (P <0.01), and the decline was greater than that in control group (P <0.05). The incidence of complications in observation group was significantly lower than that in control group (P <0.05). Conclusion Bacillus subtilis and Enterococcus faecalis can effectively improve the liver and kidney function, repair the barrier function of intestinal mucosa, reduce the levels of serum ammonia, endotoxin, TNF-α and DAO in patients with decompensated liver cirrhosis and reduce the occurrence of complications .