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目的探讨肠黏膜通透性改变对肝炎肝硬化腹水患者影响的临床意义。方法对45例肝炎肝硬化腹水患者采用高压液相色谱-示差法检测口服糖分子探针乳果糖、甘露醇后尿液排泄率比值(LAC/MAN),评估患者肠黏膜通透性水平;同时检测病人血浆内毒素(ET)、TNF-α、IL-6水平。分析患者肠黏膜通透性改变与ET、TNF-α、IL-6水平改变的关系。结果①肝炎肝硬化自发性腹水感染(SAI)组、肝硬化无菌性腹水(SA)组和健康对照组尿LAC/MAN分别为:0.100 3±0.003 5,0.071 5±0.007 1和0.020 9±0.000 9(P<0.001)。②肝硬化SAI组血浆ET、TNF-α、lL-6水平均高于肝硬化SA组和健康对照组(P<0.001);③Pearson相关性分析及偏相关性分析结果:肝硬化腹水患者尿LAC/MAN改变与血浆ET水平正相关(r=0.787,P<0.001);血浆ET水平与TNF-α、IL-6水平之间呈正相关(r=0.857,P<0.001;r=0.885,P<0.001)。结论①肝炎肝硬化腹水患者存在肠黏膜通透性异常。②肠黏膜通透性参与了肝硬化腹水病情进展的病理生理过程。
Objective To investigate the clinical significance of the changes of intestinal mucosal permeability on patients with liver cirrhosis and ascites. Methods Forty-five patients with liver cirrhosis and ascites were enrolled in this study. The ratio of urinary excretion rate (LAC / MAN) after oral administration of lactose and mannitol was measured by high pressure liquid chromatography-differential method to evaluate the intestinal mucosal permeability. The levels of plasma endotoxin (ET), TNF-α and IL-6 in patients were measured. The relationship between the change of intestinal mucosal permeability and the changes of ET, TNF-α and IL-6 in patients was analyzed. Results ① The urinary LAC / MAN values of spontaneous ascites infection (SAI) group, cirrhosis aseptic ascites (SA) group and healthy control group were: 0.100 3 ± 0.003 5,0.071 5 ± 0.007 1 and 0.020 9 ± 0.000 9 (P <0.001). ② The levels of plasma ET, TNF-α and IL-6 in cirrhotic SAI group were higher than those in cirrhosis SA group and healthy control group (P <0.001). ③Pearson correlation analysis and partial correlation analysis showed that urinary LAC (R = 0.787, P <0.001). There was a positive correlation between plasma ET levels and TNF-αand IL-6 levels (r = 0.857, P <0.001; r = 0.885, P < 0.001). Conclusion ① There is abnormal intestinal mucosal permeability in patients with liver cirrhosis and ascites. ② intestinal mucosal permeability involved in the pathogenesis of cirrhosis and the progress of the pathophysiology of ascites.