[1]薛顺和,袁东红,王 芳,等.肝硬化患者并发感染及死亡与肠道通透性实验检测的相关性研究[J].现代检验医学杂志,2017,32(01):95-98,102.[doi:10.3969/j.issn.1671-7414.2017.01.026]
　XUE Shun-he,YUAN Dong-hong,WANG Fang,et al.Correlation between Liver Cirrhosis Patients Combined with Infection or Death and Intestinal Permeability Test[J].Journal of Modern Laboratory Medicine,2017,32(01):95-98,102.[doi:10.3969/j.issn.1671-7414.2017.01.026]
点击复制

肝硬化患者并发感染及死亡与肠道通透性实验检测的相关性研究()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第32卷
期数:
2017年01期
页码:
95-98,102
栏目:
论著
出版日期:
2017-01-25

文章信息/Info

Title:
Correlation between Liver Cirrhosis Patients Combined with Infection or Death and Intestinal Permeability Test
文章编号:
1671-7414(2017)01-095-05
作者:
薛顺和; 袁东红; 王 芳; 戴光荣
延安大学附属医院消化内科,陕西延安 716000
Author(s):
XUE Shun-he; YUAN Dong-hong; WANG Fang; DAI Guang-rong
Department of Digestive Medicine,Affiliated Hospital of Yan'an University,Shaanxi Yanan 716000,China
关键词:
肠道通透性;  肝硬化;  感染;  死亡
分类号:
R575.2; R446
DOI:
10.3969/j.issn.1671-7414.2017.01.026
文献标志码:
A
摘要:
目的 探讨肝硬化患者并发感染及死亡与肠道通透性实验检测的相关性。方法 采用前瞻性研究选取2013年～2014年延安大学附属医院收治的48例肝硬化患者和16例健康志愿者。高效液相色谱(HPLC)示差法检测并计算LMR比值(IP指数); 酶联免疫吸附法(ELISA)检测血清LPS结合蛋白(LBP),IL-6,肠型脂肪酸结合蛋白(I-FABP)水平。患者随访1年,观察患者并发感染和死亡情况。Spearman's rho分析IP指数相关因素,ROC曲线、Kaplan-Meiser曲线、Cox回归分析与肝硬化感染及死亡相关因素。结果 肝硬化[40例(83.3%)]患者IP指数增加,显著高于对照组[4例(25%)](χ2=19.006,P=0.001)。Spearman's rho分析IP指数与清蛋白,IL-6,INR,胆红素、Child-Pugh(CTP)评分密切相关(rs=-0.339～0.485,P均＜0.05)。20例(41.7%)肝硬化患者并发感染。肝硬化无感染患者腹腔积液(14),CTP评分[9(5～14)],MELD评分[12(7～27],IL-6[40(10～1 200)pg/ml],I-FABP[1160(800～8 600)pg/ml]与并发感染患者[18,10(7～14),17(9～25),60(10～1 800)pg/ml,4 130(1 520～8 060)pg/ml]比较差异有统计学意义(χ2=8.400,Z=-3.310～2.160,P均＜0.05)。COX回归分析MELD＞9、腹腔积液和I-FABP＞1728pg/ml是影响肝硬化患者并发感染及死亡的独立因素(P均＜0.05)。结论 虽然肝硬化患者IP指数显著增加,但IP指数与肝硬化患者并发感染及死亡无关。
Abstract:
Objective To investigate the relationaship between liver cirrhosis patients comibined with infection or death and intestinal permeability(IP)test.Methods 48 patients with liver cirrhois and 16 healthy volunteers were enrolled in the Affiliated Hospital of Yan'an University during 2 years from 2013 to 2014 in this prospective study.Clinical data of patients were analyzed.LMR(IP index)were caculated and dectected byHPLC differental method.Serum LBP,IL-6 and I-FABP were determined by ELISA.Patients were followed for 1 year and assessed fro survival and the occurrence ofinfections.Related factors with IP index were analyzed by Spearman's rho.ROCcurve,kaplan-meiser curve,cox regression were used to analyze related factorswith the infection-free survival.Results IP index wereincreased in 40(83.3%)patients with liver cirrhosis,compared with 4 increased IP index in healthy controls(χ2=19.006,P=0.001).IP index were correlated with albumin,IL-6,INR,bilirubin and Child-Pugh(CTP)scores by Spearman's rho anaylsis(rs=-0.339～0.485,all P＜0.05).20(41.7%)liver cirrhosis patients developed infection in the one year follow-up.There were signigicant differences in ascites(14 vs 18),CTP scores [9(5～14)vs 10(7～14)],MELD scores [12(7～27)vs 17(9～25),IL-6 [40(10～1 200)vs 60(10～1 800)pg/ml] and I-FABP [1 160(800～8 600)pg/ml vs 4 130(1 520～8 060)pg/ml]between non-infected cirrhosis and infected cirrhosis patients(χ2=8.400,Z=-3.310～-2.160,all P＜0.05).It was found that MELD＞9,acites,I-FABP＞1 728 pg/ml were independent factors of infection-free survial in liver cirrhosis patients by COX regression(all P＜0.05).Conclusion Although increased IP was higher in liver cirrhosis,and it failed to predictinfection-free survial in liver cirrhosis patients.

参考文献/References:

[1] Bunchorntavakul C,Chamroonkul N,Chavalitdhamro-ng D.Bacterial infections in cirrhosis:A critical review and practical guidance[J].World JHepatol,2016,8(6):307-321.
[2] Yan K, Garcia-Tsao G.Novel prevention strategies for bacterial infections in cirrhosis[J].Expert Opin Pharmacother,2016,17(5):689-701.
[3] Albillos A,Lario M,Alvarez-Mon M.Cirrhosis-associated immune dysfunction:distinctive features and clinical relevance[J].J Hepatol,2014,61(6):1385-1396.
[4] 段发兰,李亚新,杨飞翔,等.CT与FIB-4无创诊断慢性乙型病毒性肝炎肝纤维化的效果分析[J].现代检验医学杂志,2015,30(6):119-120,124. Duan FL,Li YX,Yang FX,et al.Analysis of CT and FIB-4 noninvasive diagnosis in liver fibrosis with chronic hepatitis B[J].J Mod Lab Med,2015,30(6):119-120,124.
[5] 何桂珍,舒 红,刘 卫,等.高压液相色谱法检测肠道通透性及临床应用[J].现代检验医学杂志,2010,25(3):12-14,18. He GZ,Shu H,Liu W,et al.Detection of intestinal permeability byhigh performance/pressure liquid chromatography[J].J Mod Lab Med,2010,25(3):12-14,18.
[6] 中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志,2001,19(1):56-62. Chinese Society of Hepatology CMA,Society of Infectious Diseases CMA.Guidelines for the prevention and treatment of viral hepatitis[J].Chin J Infect Dis,2001,19(1):56-62.
[7] 中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010修订版)[J].中华肝脏病杂志,2010,18(3):167-170. Chinese national workshop on fatty liver and alcoholic liver diseasefor the Chinese liver disease association.Guidelines for management of alcoholic liver disease:an updated and revised edition[J].Chin J Hepatol,2010,18(3):167-170.
[8] Pasqualetti P, Di Lauro G, Festuccia V,et al.Prognostic value of Pugh's modification of Child-Tureotte classification in patients with cirrhosis ofthe liver[J].Panminerva Med,1992,34:65-68.
[9] Salerno F,Merli M,Cazzaniga M,et al.MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt[J].J Hepatol,2002,36(4):494-500.
[10] Pericleous M,Sarnowski A,Moore A,et al.The clinical management of abdominal ascites,spontaneous bacterial peritonitis and hepatorenal syndrome:a review of current guidelines and recommendations[J].Eur J Gastroenterol Hepatol,2016,28(3):e10-e18.
[11] Ensaro(¨overq)lu F,Korkmaz M,Geckil A(¨overU),et al.Factors affecting mortality and morbidity of patients with cirrhosis hospitalized for spontaneous bacterial peritonitis[J].Exp Clin Transplant,2015,13(Suppl 3):131-136.
[12] 何桂珍.肠道屏障功能和检测方法的研究进展[J].现代检验医学杂志,2009,24(6):136-141. He GZ.Current methodologies used for evaluation of intestinal permeability[J].J Mod Lab Med,2009,24(6):136-141.
[13] 顾 林,燕善军,王启之,等.肝硬化患者肠黏膜屏障功能的变化[J].中华全科医学,2014,12(11):1733-1736. Gu L, Yan SJ, Wang QZ,et al.Intestinal mucosal barrier function in patients with cirrhosis[J].Chin J Gen Pract,2014,12(11):1733-1736.
[14] 马维娟,许建明,胡 静,等.肝硬化患者肠道粘膜通透性及其与Child-Pugh分级相关性研究[J].中华疾病控制杂志,2015,19(4):411-415. Ma WJ,Xu JM,Hu J,et al.Study on the alteration of intestinal permeability in patients with liver cirrhosis and its relationship with the Child-Pugh classification[J].Chin J Dis Control Prev,2015,19(4):411-415.
[15] Benjamin J,Singla V,Arora I,et al.Intestinal permeability and complications in liver cirrhosis:A prospective cohort study[J].Hepatol Res,2013,43(2):200-207.
[16] Sandler NG,Koh C,Roque A,et al.Host response to translocated microbial products predicts outcomes of patients with HBV or HCV infection[J].Gastroenterology,2011,141(4):1220-1230,1230.e1-e3.

相似文献/References:

[1]李 峰,魏 群,周国雄,等.髓样细胞白血病-1基因 在原发性肝癌组织中的表达及临床意义[J].现代检验医学杂志,2016,31(03):69.[doi:10.3969/j.issn.1671-7414.2016.03.019]
　LI Feng,WEI Qun,ZHOU Guo-xiong,et al.Expression and Significance of Mcl-1 Gene in Hepatocellular Carcinoma[J].Journal of Modern Laboratory Medicine,2016,31(01):69.[doi:10.3969/j.issn.1671-7414.2016.03.019]
[2]任雪维,张吉才.肝细胞肝癌患者血浆miR-29a水平的变化及其临床意义[J].现代检验医学杂志,2017,32(02):33.[doi:10.3969/j.issn.1671-7414.2017.02.009]
　REN Xue-wei,ZHANG Ji-cai.Changes of Plasma miR-29a Levels in Patients with Hepatocellular Carcinoma and Its Clinical Significance[J].Journal of Modern Laboratory Medicine,2017,32(01):33.[doi:10.3969/j.issn.1671-7414.2017.02.009]
[3]卓传尚,柳丽娟,周淑燕.AFP-L3和PIVKA-Ⅱ检测对高危人群良恶性肝病的鉴别诊断价值[J].现代检验医学杂志,2017,32(04):40.[doi:10.3969/j.issn.1671-7414.2017.04.011]
　ZHUO Chuan-shang,LIU Li-juan,ZHOU Shu-yan.Performance of Serum AFP-L3 and PIVKA-Ⅱ in Differential Diagnosis of Benign and Malignant Liver Disease in High Risk Population[J].Journal of Modern Laboratory Medicine,2017,32(01):40.[doi:10.3969/j.issn.1671-7414.2017.04.011]
[4]许 娜a,刘永霞a,高莉莉a,等.肝硬化细菌感染患者血清中Presepsin检测的临床意义[J].现代检验医学杂志,2017,32(06):92.[doi:10.3969/j.issn.1671-7414.2017.06.001]
　XU Naa,LIU Yong-xiaa,GAO Li-lia,et al.Clinical Value of Presepsin in the Diagnosis and Prognosis of Bacterial Infection in Cirrhosis[J].Journal of Modern Laboratory Medicine,2017,32(01):92.[doi:10.3969/j.issn.1671-7414.2017.06.001]

备注/Memo

备注/Memo:
基金项目:延安大学附属医院科研项目,编号2015HM-13。
作者简介:薛顺和(1970-),男,本科,主治医师,研究方向:胃肠消化,Tel:18209113016,E-mail:xueshunhe197003@163.com。
通讯作者:王 芳,女,本科,主治医师,Tel:18009116822,E-mail:470739584@qq.com。
更新日期/Last Update: 2017-01-20