Departments of Gastroenterology and Human Nutrition Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Hepatol Res. 2013 Feb;43(2):200-7. doi: 10.1111/j.1872-034X.2012.01054.x. Epub 2012 Jun 21.
Increased intestinal permeability (IP) has been implicated as an important factor for bacterial translocation (BT), leading to bacteremia and endotoxemia, resulting in various septic complications, variceal bleeding (VB), hepatic encephalopathy (HE), hepatorenal syndrome (HRS) and death in patients with liver cirrhosis (LC). This study was planned to assess IP in patients with LC and follow them for the occurrence of complications.
Patients with Child B and C cirrhosis without a history of disease-related complications were followed up for 6 months. IP was measured by lactulose and mannitol excretion ratio (LMR) in patients and 50 healthy controls (HC). Serum endotoxin levels were also assessed in 48 patients and 20 HC.
Eighty patients (74 male), 41 (51.3%) Child B and 56 (70%) Child C, with a mean age of 40.7 ± 9.8 years were enrolled. IP was increased in 28 (35%) patients. LMR of patients was higher than HC (patients vs HC = 0.0238 [0.0010-1.557] vs 0.0166 [0.0018-0.720]; P = 0.007]. No significant difference was seen in the LMR of patients among various Child classes and etiologies. Serum endotoxin levels (GMU/mL) were higher in patients than HC (patients vs HC = 1.42 [0.68-2.13] vs 0.994 [0.067-1.382]; P = 0.001), but comparable between patients with abnormal and normal IP. At follow up, there was no significant difference in the incidence of complications like spontaneous bacterial peritonitis, HRS, VB, HE and death between patients with abnormal and normal IP.
IP was increased in 35% of patients with LC; however, it was not associated with a higher incidence of disease-related complications.
增加的肠道通透性 (IP) 被认为是细菌易位 (BT) 的一个重要因素，导致菌血症和内毒素血症，从而导致各种脓毒症并发症、静脉曲张出血 (VB)、肝性脑病 (HE)、肝肾综合征 (HRS) 和肝硬化 (LC) 患者死亡。本研究旨在评估 LC 患者的 IP 并观察他们发生并发症的情况。
对无疾病相关并发症病史的 Child B 和 C 级肝硬化患者进行随访 6 个月。通过乳果糖和甘露醇排泄率 (LMR) 测量患者和 50 名健康对照者 (HC) 的 IP。还评估了 48 名患者和 20 名 HC 的血清内毒素水平。
共纳入 80 例患者（74 名男性），其中 41 例（51.3%）为 Child B，56 例（70%）为 Child C，平均年龄为 40.7±9.8 岁。28 例（35%）患者存在 IP 增加。患者的 LMR 高于 HC（患者 vs HC=0.0238[0.0010-1.557]vs 0.0166[0.0018-0.720]；P=0.007）。不同 Child 级和病因的患者 LMR 无显著差异。患者的血清内毒素水平（GMU/mL）高于 HC（患者 vs HC=1.42[0.68-2.13]vs 0.994[0.067-1.382]；P=0.001），但 IP 异常和正常的患者之间无差异。随访期间，IP 异常和正常的患者自发性细菌性腹膜炎、HRS、VB、HE 和死亡等并发症的发生率无显著差异。
LC 患者中 35%存在 IP 增加，但与疾病相关并发症的发生率增加无关。
