Lian X X, Sun Y P, Guo X X
Shanxi University of Traditional Chinese Medicine, Taiyuan 030024, China.
Institute of Chinese Medicine in Shanxi Province, Taiyuan 030012, China.
Zhonghua Gan Zang Bing Za Zhi. 2020 Jan 20;28(1):58-63. doi: 10.3760/cma.j.issn.1007-3418.2020.01.014.
To investigate the correlation between changes in intestinal mucosal permeability and prognosis of patients with liver cirrhosis. Data of 89 cases with liver cirrhosis who were hospitalized in the Hepatology Department of Shanxi Provincial Hospital of Traditional Chinese Medicine from January 2017 to August 2017 were collected as the liver cirrhosis experimental group, and 40 healthy subjects were randomly selected as the healthy control group. JY-DLT, the Intestinal Mucosal Barrier Biochemical Index Analysis System was used to measure the levels of serum diamine oxidase (DAO), D-lactic acid, and endotoxin (ETX) in two groups to evaluate intestinal mucosal barrier function. Spearman's rank correlation test was used to evaluate the correlation between liver cirrhosis prognosis and intestinal mucosal permeability. The results of the two groups were compared by Mann-Whitney H test of two independent samples. One-way Anova was used for intergroup comparison. The pairwise comparison between groups was performed using the LSD or SNK test. The level of ETX in patients with decompensated cirrhosis was significantly higher than that in the compensated phase, and the difference was statistically significant ( < 0.05). The levels of DAO, D-lactic acid and ETX in the liver cirrhosis group were significantly higher than those in the healthy control group, and the differences were statistically significant ( < 0.01). The plasma levels of DAO, D-lactic acid and ETX in the Child-Pugh grade groups of patients with liver cirrhosis were significantly higher than those in the healthy control group, and the differences were statistically significant ( < 0.05). The results of intergroup comparison showed that there were statistically significant differences in DAO, D-lactic acid and ETX levels between Child-Pugh grade A and grade B groups ( = -4.255, 2.527, -2.179, < 0.05). Furthermore, there were statistically significant differences in the levels of D-lactic acid and ETX between the Child-Pugh grade A and grade C groups ( = -2.693, -4.248, < 0.01).The plasma levels of DAO, D-lactic acid and ETX levels were positively correlated ( = 0.205, 0.372, 0.342, < 0.01). D-lactic acid and ETX levels were positively correlated with CTP score, Forns' index, RPR index, APRI score, FIB-4 index and FibroScan score( < 0.01). The three indices (plasma DAO, D-lactic acid, and ETX) can accurately detect the changes in intestinal mucosal permeability. Moreover, the higher index of intestinal mucosal permeability causes the more severe degree of liver cirrhosis and the correlation between the intestinal mucosal permeability and the prognosis score of liver cirrhosis provides a reference for a new evaluation system and new ideas for the treatment of liver cirrhosis.
探讨肝硬化患者肠黏膜通透性变化与预后的相关性。收集2017年1月至2017年8月在山西省中医院肝病科住院的89例肝硬化患者资料作为肝硬化实验组，随机选取40例健康受试者作为健康对照组。采用JY-DLT肠黏膜屏障生化指标分析系统检测两组血清二胺氧化酶（DAO）、D-乳酸和内毒素（ETX）水平，以评估肠黏膜屏障功能。采用Spearman等级相关检验评估肝硬化预后与肠黏膜通透性的相关性。两组结果采用两独立样本的Mann-Whitney H检验进行比较。组间比较采用单因素方差分析。组间两两比较采用LSD或SNK检验。失代偿期肝硬化患者ETX水平显著高于代偿期，差异有统计学意义（<0.05）。肝硬化组DAO、D-乳酸和ETX水平显著高于健康对照组，差异有统计学意义（<0.01）。肝硬化患者Child-Pugh分级组血浆DAO、D-乳酸和ETX水平显著高于健康对照组，差异有统计学意义（<0.05）。组间比较结果显示，Child-Pugh A级和B级组之间DAO、D-乳酸和ETX水平有统计学差异（=-4.255，2.527，-2.179，<0.05）。此外，Child-Pugh A级和C级组之间D-乳酸和ETX水平有统计学差异（=-2.693，-4.248，<0.01）。血浆DAO、D-乳酸和ETX水平呈正相关（=0.205，0.372，0.342，<0.01）。D-乳酸和ETX水平与CTP评分、Forns指数、RPR指数、APRI评分、FIB-4指数和FibroScan评分呈正相关（<0.01）。这三个指标（血浆DAO、D-乳酸和ETX）可准确检测肠黏膜通透性变化。此外，肠黏膜通透性指标越高，肝硬化程度越严重，肠黏膜通透性与肝硬化预后评分的相关性为新的评估体系提供了参考，为肝硬化治疗提供了新思路。
