摘要
背景乙肝相关慢加急性肝衰竭(hepatitis-B-related acute-on-chronic liver failure, ACLF)是慢加急性肝衰竭中的常见类型,病情进展快,短期死亡率高.全身炎症反应是慢加急性肝衰竭重要的机制,而肠道通透性增加、内毒素移位增加是引起炎症反应的原因之一.肠道短链脂肪酸(short chain fatty acids, SCFAs)可减少肠道通透性、参与肝脏能量供应,可能在ACLF中起到一定保护作用.因此研究ACLF患者的肠道SCFAs水平变化,可能为该疾病的治疗提供新的方向.目的探讨ACLF患者与正常人相比肠道SCFAs浓度的变化及其临床意义.方法 25名ACLF患者(病例组)、15名健康者(对照组).应用高效液相色谱法检测两组粪便SCFAs(乙酸、丙酸、丁酸、异丁酸、异戊酸及总SCFAs)的水平.根据病例组是否合并肝性脑病, Child-Pugh分级等不同病情分组,对SCFAs水平差别进行分析.结果 ACLF患者肠道丙酸、异戊酸、总SCFAs水平显著低于对照组(P<0.05).病例组伴肝性脑病患者的肠道乙酸、丙酸、总SCFAs水平显著低于不伴肝性脑病患者(P<0.05). Child-Pugh C级的患者乙酸水平低于Child-Pugh B级患者(P <0.05).结论 ACLF患者肠道SCFAs水平下降;肠道乙酸、丙酸、总SCFAs水平下降,可能参与肝性脑病的发病;肠道乙酸水平可在一定程度上反映肝脏的储备功能.
BACKGROUND Hepatitis-B-related acute-on-chronic liver failure(ACLF)is a common type of ACLF,which has rapid progression and a high short-term mortality.Systemic inflammation is an important mechanism,and the increase of intestinal permeability and endotoxin translocation are the main causes of inflammatory reaction.Intestinal short chain fatty acids(SCFAs)can reduce intestinal permeability and participate in liver energy supply,which may play a protective role in hepatitis-B-related ACLF.Therefore,to study the changes of intestinal SCFA levels in patients with hepatitis-B-related ACLF may provide a new direction for the treatment of this disease.AIM To find out the difference of fecal SCFA levels between hepatitis-B-related ACLF patients and normal controls,and to explore its clinical significance.METHODS The levels of fecal acetic acid,propionic acid,butyric acid,isobutyric acid,isovaleric acid,and total SCFAs were measured by high performance liquid chromatography(HPLC),and twenty-five ACLF patients and 15 healthy individuals were measured separately.The levels of SCFAs were compared when patients were divided into different groups by the characteristics of encephalopathy or Child-Pugh score.RESULTS The levels of propionic acid,isovaleric acid,and total SCFAs in the ACLF group were significantly lower than those in the control group.In the ACLF group,the levels of acetic acid,propionic acid,and total SCFAs of the patients with hepatic encephalopathy were significantly lower than those without(P < 0.05).The acetic acid level in the Child-Pugh C group was significantly lower than that in the Child-Pugh B group(P < 0.05).CONCLUSION The levels of intestinal SCFAs in ACLF patients are lower than those in normal controls,and the levels of intestinal acetic acid,propionic acid,and total SCFAs in ACLF patients with hepatic encephalopathy are lower than those without.These changes may be associated with the pathogenesis of hepatic encephalopathy.The level of intestinal acetic acid may reflect ACLF patients’ liver rese
作者
蒙丹丽
梁列新
陈建红
宋怀宇
Dan-Li Meng;Lie-Xin Liang;Jian-Hong Chen;Huai-Yu Song(Department of Gastroenterology,People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Guangxi Testing Center,Nanning 530021,Guangxi Zhuang Autonomous Region,China)
出处
《世界华人消化杂志》
CAS
2019年第6期408-414,共7页
World Chinese Journal of Digestology
基金
广西医疗卫生适宜技术研究与开发项目
No.S201313-04
广西壮族自治区卫生厅医疗卫生科研课题
No.Z2004002~~
