益生菌制剂辅助治疗中重度脂肪肝患者肠功能紊乱的临床疗效
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摘要
目的观察益生菌制剂辅助治疗非酒精性脂肪性肝病(NAFLD)患者肠功能紊乱的疗效,探讨NAFLD与肠道内环境之间的关系和相互作用。方法中重度NAFLD肠功能紊乱患者122例,随机分为A组34例,B组48例,C组40例,在基础治疗(控制饮食+运动)的同时,A组给予多烯磷脂酰胆碱胶囊456 mg; B组给予多烯磷脂酰胆碱胶囊456 mg+胰酶肠溶胶囊0.3 g; C组给予多烯磷脂酰胆碱胶囊456 mg+胰酶肠溶胶囊0.3 g+双歧杆菌三联活菌胶囊420 mg,均为每天3次口服,疗程均为1个月。监测血生化指标及肠功能紊乱症状。结果 B组、C组治疗后肠功能紊乱症状明显好转; B组和C组腹泻有效率分别为50.0%,65.0%,里急后重有效率分别为20.8%,30.0%,肛门排气有效率分别为22.9%,37.5%(均P<0.05)。结论多烯磷脂酰胆碱胶囊+胰酶肠溶胶囊+双歧杆菌三联活菌胶囊联合治疗对NAFLD患者肠功能紊乱具有良好的疗效;肠道内环境与肝脏关系密切,肠菌群失调在NAFLD的发生发展中起着重要的作用。
Objective To observe the therapeutic efficacy of probiotics in the treatment of intestinal dysfunction in patients with non-alcoholic fatty liver disease( NAFLD),and to explore the relationship and interaction between NAFLD and intestinal environment. Methods A total of 122 patients with modest to severe NAFLD complicated by intestinal dysfunction were randomly divided into group A( n = 34),group B( n = 48),group C( n = 40). All patients received a basic treatment of calorie control diet and exercise. Moreover,group A was given polyene phosphatidylcholine( PP) capsule 456 mg; group B was given PP capsule 456 mg + pancreatin enteric-coated( PC) capsule 0. 3 g; and group C was given PP capsules 456 mg + PC capsules 0.3 g + bifidobacterium,lactobacillus and enterococcus( BLE) capsule 420 mg. All medications were taken orally 3 times a day,and the course of treatment was 1 month. The routine blood test and symptoms of intestinal dysfunction were evaluated and monitored. Results Comparing to group A,the symptoms of intestinal dysfunction were significantly improved in group B and group C. The effective rate of diarrhea in group B and group C was 50.0% and 65.0%,respectively( P<0.05). The efficiency of tenesmus in group B and group C was 20.8% and 30.0%( P<0.05); and the anal exhaust efficiency in group B and group C was22.9% and 37.5%( P<0.05). Conclusion The PP capsule + PC capsules + BLE capsule combination therapy has good curative effect on intestinal dysfunction in patients with NAFLD. The intestinal environment is closely related to liver,thus intestinal flora imbalance in NAFLD may play an important role in the disease development.
Objective To observe the therapeutic efficacy of probiotics in the treatment of intestinal dysfunction in patients with non-alcoholic fatty liver disease( NAFLD),and to explore the relationship and interaction between NAFLD and intestinal environment. Methods A total of 122 patients with modest to severe NAFLD complicated by intestinal dysfunction were randomly divided into group A( n = 34),group B( n = 48),group C( n = 40). All patients received a basic treatment of calorie control diet and exercise. Moreover,group A was given polyene phosphatidylcholine( PP) capsule 456 mg; group B was given PP capsule 456 mg + pancreatin enteric-coated( PC) capsule 0. 3 g; and group C was given PP capsules 456 mg + PC capsules 0.3 g + bifidobacterium,lactobacillus and enterococcus( BLE) capsule 420 mg. All medications were taken orally 3 times a day,and the course of treatment was 1 month. The routine blood test and symptoms of intestinal dysfunction were evaluated and monitored. Results Comparing to group A,the symptoms of intestinal dysfunction were significantly improved in group B and group C. The effective rate of diarrhea in group B and group C was 50.0% and 65.0%,respectively( P<0.05). The efficiency of tenesmus in group B and group C was 20.8% and 30.0%( P<0.05); and the anal exhaust efficiency in group B and group C was22.9% and 37.5%( P<0.05). Conclusion The PP capsule + PC capsules + BLE capsule combination therapy has good curative effect on intestinal dysfunction in patients with NAFLD. The intestinal environment is closely related to liver,thus intestinal flora imbalance in NAFLD may play an important role in the disease development.
引文
[1]范建高,曾德明.脂肪性肝病[M].2版.北京:人民卫生出版社,2013:78-85.
[2]茅益民,曾民德.加强非酒精性脂肪性肝病的临床和转化医学研究[J].实用肝脏病杂志,2012,15(4):273-275.
[3]BYRNE C D,TARGHER G.NAFLD:a multisystem disease[J].J Hepatol,2015,62(1 Suppl):47-64.
[4]ARMETRONG M J,ADAMS LA,CANBAY A,et al.Extrahepatic complications of no nalcoholic fatty liver disease[J].Hepatology,2014,59(10):1174-1197.
[5]刘涛,徐秋玲,赵岩.非酒精性脂肪肝大鼠肠道黏膜屏障功能的实验研究[J].医学研究生学报,2015,11(28):1124-1127.
[6]孙之梅,袁瑜,何祥.肠道微生态变化与非酒精性脂肪性肝病研究[J].实用肝脏病杂志,2013,16(3):275-278.
[7]倪曼曼,曾欣,陈岳祥.肠道微生态与非酒精性脂肪性肝病关系的研究进展[J].国际消化病杂志,2016,35(2):40-42.
[8]牛海艳,李海,丁玉平.非酒精性脂肪肝的治疗研究进展[J].临床肝胆病杂志,2018,34(2):436-437.
[9]WU C X,CHEN Y H,ZHOU X L,et al.Effect of polyene phosphatidyl choline combined with lipd-lowering drugs in treatment of nonalcoholic fatty liver disease[J].Chin JLiver Dis(Electr Version),2012,4(2):17-20.
[10]刘义荣,梁珊,聂巍,等.多烯磷脂酰胆碱对非酒精性脂肪肝患者IL-6、TNF-α的影响[J].山东医药,2014,54(29):47-48.
[11]SABEL,NIKOVA E A.Clinical aspects of intestinal dysbacteriosis[J].Eksp Klin Gastroenterol,2011,(3):111-116.
[12]中国预防医学会微生态学分会.中国消化道微生态调节剂临床应用共识[J].中国微生态杂志,2016,28(6):621-631.
[13]QIN Q F,LI H F.The progress of researches on chronic liver disease and intestinal flora[J].Chin J Microecol,2012,24(5):476-477.
[14]曹力,韩四海,高红丽,等.乳酸杆菌调节肠道黏膜屏障功能的研究进展[J].中国免疫学杂志,2016,32(3):419-423.
[15]YANG L H,CAI J,LIU G D,et al.Relationship of disturbance of intestinal flora,intestinal permeability and serum endotoxin in patients with NASH[J].Chin JMicroecol,2012,24(9):801-804.
[2]茅益民,曾民德.加强非酒精性脂肪性肝病的临床和转化医学研究[J].实用肝脏病杂志,2012,15(4):273-275.
[3]BYRNE C D,TARGHER G.NAFLD:a multisystem disease[J].J Hepatol,2015,62(1 Suppl):47-64.
[4]ARMETRONG M J,ADAMS LA,CANBAY A,et al.Extrahepatic complications of no nalcoholic fatty liver disease[J].Hepatology,2014,59(10):1174-1197.
[5]刘涛,徐秋玲,赵岩.非酒精性脂肪肝大鼠肠道黏膜屏障功能的实验研究[J].医学研究生学报,2015,11(28):1124-1127.
[6]孙之梅,袁瑜,何祥.肠道微生态变化与非酒精性脂肪性肝病研究[J].实用肝脏病杂志,2013,16(3):275-278.
[7]倪曼曼,曾欣,陈岳祥.肠道微生态与非酒精性脂肪性肝病关系的研究进展[J].国际消化病杂志,2016,35(2):40-42.
[8]牛海艳,李海,丁玉平.非酒精性脂肪肝的治疗研究进展[J].临床肝胆病杂志,2018,34(2):436-437.
[9]WU C X,CHEN Y H,ZHOU X L,et al.Effect of polyene phosphatidyl choline combined with lipd-lowering drugs in treatment of nonalcoholic fatty liver disease[J].Chin JLiver Dis(Electr Version),2012,4(2):17-20.
[10]刘义荣,梁珊,聂巍,等.多烯磷脂酰胆碱对非酒精性脂肪肝患者IL-6、TNF-α的影响[J].山东医药,2014,54(29):47-48.
[11]SABEL,NIKOVA E A.Clinical aspects of intestinal dysbacteriosis[J].Eksp Klin Gastroenterol,2011,(3):111-116.
[12]中国预防医学会微生态学分会.中国消化道微生态调节剂临床应用共识[J].中国微生态杂志,2016,28(6):621-631.
[13]QIN Q F,LI H F.The progress of researches on chronic liver disease and intestinal flora[J].Chin J Microecol,2012,24(5):476-477.
[14]曹力,韩四海,高红丽,等.乳酸杆菌调节肠道黏膜屏障功能的研究进展[J].中国免疫学杂志,2016,32(3):419-423.
[15]YANG L H,CAI J,LIU G D,et al.Relationship of disturbance of intestinal flora,intestinal permeability and serum endotoxin in patients with NASH[J].Chin JMicroecol,2012,24(9):801-804.