目的 研究HBV相关肝病患者肠道屏障功能的变化及其意义.方法 76例HBV相关肝病住院患者中,慢性乙型肝炎患者17例(CHB组),肝硬化患者23例(LC组),慢加急性肝衰竭患者36例(ACLF组);另取10例健康体检者作对照(C组).比较各组肠道屏障功能指标,分析肠道屏障功能指标与临床指标之间的相关性.利用肠道屏障功能指标构建28-d死亡率的预测模型并判断其预测价值.结果 CHB组、LC组和ACLF组患者血浆二胺氧化酶(DAO)、D-乳酸和内毒素水平均高于C组(P＜0.05),且LC组和ACLF组高于CHB组(P＜0.05),ACLF组高于LC组(P＜0.05).DAO、D-乳酸和内毒素分别与ALT、AST、TBil和凝血酶原时间呈正相关,与Plt和白蛋白呈负相关(P＜0.05).在LC组和ACLF组中,Child-Pugh C级患者DAO、D-乳酸和内毒素水平高于 Child-Pugh B 级和 A 级患者,且 Child-Pugh B 级患者高于 Child-Pugh A 级患者(P＜0.05).DAO联合终末期肝病模型评分对ACLF组患者28-d死亡率有一定的预测价值.结论 HBV相关肝病患者肠道屏障功能受损,受损程度与疾病严重程度及预后相关.
Changes and significance of intestinal barrier function in patients with HBV-associated liver disease
Objective To explore the changes and significance of intestinal barrier function in the patients with HBV-associated liver disease.Methods Of 76 hospitalized patients with HBV-associated liver disease,17 patients were with chronic hepatitis B(group CHB),23 patients were with liver cirrhosis(group LC),and 36 patients were with acute-on-chronic liver failure(group ACLF).Another 10 healthy subjects were taken as the controls(group C).The intestinal barrier function indicators of each group were compared.The correlation between intestinal barrier function indicators and clinical indicators was analyzed.A predictive model for 28-d mortality using intestinal barrier function indicators was constructed and its value was assessed.Results The plasma levels of diamine oxidase(DAO),D-lactate acid and endotoxin in groups of CHB,LC and ACLF were higher than those in group C(P＜0.05),which in groups of LC and ACLF were higher than those in group CHB(P＜0.05),and which in group ACLF were higher than those in group LC(P＜0.05).DAO,D-lactate acid and endotoxin were positively correlated with ALT,AST,TBil and prothrombin time,but negatively correlated with Plt and albumin(P＜0.05).In groups of LC and ACLF,the plasma levels of DAO,D-lactic acid and endotoxin in Child-Pugh C patients were higher than those in Child-Pugh B and A patients,which in Child-Pugh B patients were higher than those in Child-Pugh A patients(P＜0.05).DAO combined with model for end-stage liver disease score had certain predictive value for 28-day mortality in group ACLF.Conclusion The intestinal barrier function is impaired in the patients with HBV-associated liver disease,and the degree of impairment is related to the severity and prognosis of the disease.
Chronic hepatitis BLiver cirrhosisLiver failureIntestinal barrier function
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