小肠细菌过度生长对非酒精性肝病肝纤维化指标的影响(1)
[摘要] 目的 探讨非酒精性脂肪性肝病(NAFLD)与小肠细菌过度生长(SIBO)的关系，进一步了解NAFLD患者SIBO的发生率及肠源性内毒素血症(IETM)对肿瘤坏死因子-α(TNF-α)、肝纤维化水平的影响，评价其在NAFLD发生发展过程中的作用。 方法 选择2013年2～8月本院经B超及病史诊断为NAFLD患者32例，行乳果糖氢呼气试验(LHBT)检测，根据LHBT结果将32例NAFLD患者分为SIBO阳性组和SIBO阴性组。对两组IETM、TNF-α、肝纤维化指标进行检测。 结果 IETM、TNF-α在SIBO阳性组和SIBO阴性组比较差异均有统计学意义；SIBO阳性组TNF-α、肝纤维化指标有逐渐增高的趋势，两者均与IETM呈正相关。 结论 SIBO和内毒素血症等机制促进NAFLD的发生和发展。
[关键词] 非酒精性脂肪性肝病；呼吸试验；小肠细菌过度生长；肝纤维化
[中图分类号] R575 [文献标识码] A [文章编号] 1674-4721(2015)05(b)-0035-03
Influence of small intestinal bacterial overgrowth on indicators of hepatic fibrosis in non-alcoholic liver disease
LI Wei-wei1 HAN Hong-bo2
1.Department of Gastroenterology，the Second Affiliated Hospital of Henan University of Science & Technology，Luoyang 471000，China；2.Teaching-Research Office of Pathophysiology，Medical College of Henan University of Science & Technology，Luoyang 471000，China
[Abstract] Objective To explore the relationship between non-alcoholic fatty liver disease(NAFLD) and small intestinal bacterial overgrowth (SIBO) and further get known the incidence of SIBO in NAFLD patients and influences of intestinal endotoxemia(IETM) on tumor necrosis factor-α(TNF-α) and liver fibrosis aiming at evaluating its role in the occurrence and development of NAFLD. Methods 32 patients diagnosed as NAFLD by B ultrasound and medical history in our hospital from February to August 2013 were selected.They were performed with lactulose hydrogen breath test(LHBT).According to LHBT outcomes，these participants were divided into SIBO positive group and SIBO negative group.Indicators of IETM，TNF-α，and liver fibrosis was tested respectively. Results There were statistical differences in IETM and TNF-α after comparisons between two groups.In SIBO positive group，TNF-α and liver fibrosis gradually increased，which both had positive correlations with IETM. Conclusion Mechanisms of SIBO and IETM both promote the occurrence and development of NAFLD.
[Key words] Non-alcoholic fatty liver disease(NAFLD)；Breath test；Small intestinal bacterial overgrowth(SIBO)；Hepatic fibrosis
非酒精性脂肪性肝病(nonalcoholic fatty liver disease，NAFLD)是由多病因引起的肝细胞内脂质过多蓄积的临床病理综合征，胰岛素抵抗和遗传易感性与其发病关系密切。随着肥胖糖尿病发病率增加，成人NAFLD的患病率有明显增高的趋势，其中部分患者病情发展至非酒精性脂肪性肝炎(nonalcoholic steatohepatitis，NASH)、肝纤维化、肝硬化，成为除病毒因素以外肝硬化主要病因之一[1]，对NAFLD患者早期发现及治疗，越来越受到重视。
肠源性内毒素血症(intestinal endotoxemia，IETM)与肝病的关系日益受到重视，是急、慢性肝功能衰竭发生发展的重要机制之一[2-3]。IETM刺激库普弗细胞所释放的诸多细胞因子、炎性介质、自由基等引起的肝细胞坏死、再生及慢性炎症反应，是肝炎慢性化的基础。血清透明质酸(hyaluronidase，HA)、Ⅲ型前胶原(procollagen typeⅢ，PCⅢ)、Ⅳ型胶原(collagen typeⅣ，Ⅳ-C)、层黏连蛋白(laminin，LN)检测在临床中广泛用于肝纤维化诊断。研究表明小肠细菌过度生长(small intestinal bacterial overgrowth，SIBO)、IETM在NAFLD发病中起着重要作用[4]。 (李伟伟 韩红波)
[关键词] 非酒精性脂肪性肝病；呼吸试验；小肠细菌过度生长；肝纤维化
[中图分类号] R575 [文献标识码] A [文章编号] 1674-4721(2015)05(b)-0035-03
Influence of small intestinal bacterial overgrowth on indicators of hepatic fibrosis in non-alcoholic liver disease
LI Wei-wei1 HAN Hong-bo2
1.Department of Gastroenterology，the Second Affiliated Hospital of Henan University of Science & Technology，Luoyang 471000，China；2.Teaching-Research Office of Pathophysiology，Medical College of Henan University of Science & Technology，Luoyang 471000，China
[Abstract] Objective To explore the relationship between non-alcoholic fatty liver disease(NAFLD) and small intestinal bacterial overgrowth (SIBO) and further get known the incidence of SIBO in NAFLD patients and influences of intestinal endotoxemia(IETM) on tumor necrosis factor-α(TNF-α) and liver fibrosis aiming at evaluating its role in the occurrence and development of NAFLD. Methods 32 patients diagnosed as NAFLD by B ultrasound and medical history in our hospital from February to August 2013 were selected.They were performed with lactulose hydrogen breath test(LHBT).According to LHBT outcomes，these participants were divided into SIBO positive group and SIBO negative group.Indicators of IETM，TNF-α，and liver fibrosis was tested respectively. Results There were statistical differences in IETM and TNF-α after comparisons between two groups.In SIBO positive group，TNF-α and liver fibrosis gradually increased，which both had positive correlations with IETM. Conclusion Mechanisms of SIBO and IETM both promote the occurrence and development of NAFLD.
[Key words] Non-alcoholic fatty liver disease(NAFLD)；Breath test；Small intestinal bacterial overgrowth(SIBO)；Hepatic fibrosis
非酒精性脂肪性肝病(nonalcoholic fatty liver disease，NAFLD)是由多病因引起的肝细胞内脂质过多蓄积的临床病理综合征，胰岛素抵抗和遗传易感性与其发病关系密切。随着肥胖糖尿病发病率增加，成人NAFLD的患病率有明显增高的趋势，其中部分患者病情发展至非酒精性脂肪性肝炎(nonalcoholic steatohepatitis，NASH)、肝纤维化、肝硬化，成为除病毒因素以外肝硬化主要病因之一[1]，对NAFLD患者早期发现及治疗，越来越受到重视。
肠源性内毒素血症(intestinal endotoxemia，IETM)与肝病的关系日益受到重视，是急、慢性肝功能衰竭发生发展的重要机制之一[2-3]。IETM刺激库普弗细胞所释放的诸多细胞因子、炎性介质、自由基等引起的肝细胞坏死、再生及慢性炎症反应，是肝炎慢性化的基础。血清透明质酸(hyaluronidase，HA)、Ⅲ型前胶原(procollagen typeⅢ，PCⅢ)、Ⅳ型胶原(collagen typeⅣ，Ⅳ-C)、层黏连蛋白(laminin，LN)检测在临床中广泛用于肝纤维化诊断。研究表明小肠细菌过度生长(small intestinal bacterial overgrowth，SIBO)、IETM在NAFLD发病中起着重要作用[4]。 (李伟伟 韩红波)