Vlachogiannakos J, Saveriadis A S, Viazis N, Theodoropoulos I, Foudoulis K, Manolakopoulos S, Raptis S, Karamanolis D G
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Aliment Pharmacol Ther. 2009 May 1;29(9):992-9. doi: 10.1111/j.1365-2036.2009.03958.x. Epub 2009 Feb 7.
Endotoxaemia is commonly seen in cirrhotic patients with ascites and this may be associated with increased portal pressure.
To investigate the effect of intestinal decontamination on liver haemodynamics in alcohol-related cirrhotic patients with ascites.
We included 30 patients. At day 0, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed. Patients received rifaximin (1200 mg/day) for 28 days. At day 29, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed again.
Median (range) plasma endotoxin levels decreased significantly after rifaximin administration both in systemic [1.45(0-3.1) vs. 0.7(0-2.7), P < 0.0001] and splanchnic circulation [1.8(0-3.4) vs. 0.8(0-2.1), P < 0.0001]. Meanwhile, the difference seen in endotoxin levels between the splanchnic and systemic circulation at day 0 (P = 0.001) was not noted at day 29 (P = 0.137). HVPG measurement was possible in 28 patients. Median (range) HVPG values were 18 mmHg (12.7-26.3) on day 0 vs. 14.7 mmHg (7-20) on day 29 (P < 0.0001). HVPG decreased after rifaximin in 23, remained stable in two and increased in three patients.
Hepatic venous pressure gradient values decreased significantly after intestinal decontamination with rifaximin in patients with alcohol-related decompensated cirrhosis and this might have been achieved through significant reduction of plasma endotoxin levels.
内毒素血症常见于肝硬化腹水患者，这可能与门静脉压力升高有关。
研究肠道去污对酒精性肝硬化腹水患者肝脏血流动力学的影响。
我们纳入了30例患者。在第0天，测定全身和内脏循环内毒素水平并进行肝静脉压力梯度（HVPG）测量。患者接受利福昔明（1200毫克/天）治疗28天。在第29天，再次测定全身和内脏循环内毒素水平并进行HVPG测量。
利福昔明给药后，全身[1.45（0 - 3.1）对0.7（0 - 2.7），P < 0.0001]和内脏循环[1.8（0 - 3.4）对0.8（0 - 2.1），P < 0.0001]的血浆内毒素水平中位数（范围）均显著降低。同时，第0天内脏循环和全身循环内毒素水平的差异（P = 0.001）在第29天未观察到（P = 0.137）。28例患者可行HVPG测量。第0天HVPG值中位数（范围）为18 mmHg（12.7 - 26.3），第29天为14.7 mmHg（7 - 20）（P < 0.0001）。利福昔明治疗后，23例患者的HVPG降低，2例稳定，3例升高。
在酒精性失代偿期肝硬化患者中，用利福昔明进行肠道去污后，肝静脉压力梯度值显著降低，这可能是通过显著降低血浆内毒素水平实现的。
