摘要
目的探讨微生态制剂联合营养干预对肝硬化患者套扎术后肠道菌群及预后营养指数(PNI)的影响,以期为促进肝硬化套扎术后患者肠道功能恢复和营养状况改善提供参考。方法选取2022年6月—2024年6月在南京医科大学第一附属医院接受肝硬化套扎术治疗的患者180例,采用随机数字表法分为观察组(n=90)与对照组(n=90)。2组患者均接受保肝、抗病毒、利尿及补充维生素等常规治疗。对照组患者在常规治疗基础上给予营养干预,观察组患者在对照组基础上联合微生态制剂口服治疗,均持续治疗4周。比较2组患者治疗期间并发症发生情况,治疗前后营养指标、肠道菌群构成和PNI变化,并分析PNI与肠道菌群之间的相关性。结果观察组患者并发症发生率为5.55%(5/90),低于对照组的15.55%(14/90),差异有统计学意义(χ^(2)=4.766,P=0.029)。治疗前,2组患者血清白蛋白(Alb)和前白蛋白(PA)水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者血清Alb和PA水平均高于治疗前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者肠道内双歧杆菌、乳酸杆菌、大肠埃希菌及肠球菌数量比较,差异均无统计学意义(P>0.05);治疗后,2组患者肠道内双歧杆菌、乳酸杆菌数量均大于治疗前且观察组均大于对照组,而大肠埃希菌、肠球菌数量均小于治疗前且观察组均小于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者PNI水平比较,差异无统计学意义(P>0.05);治疗后,2组患者PNI水平均高于治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05)。相关分析结果显示,PNI水平与双歧杆菌及乳酸杆菌数量呈正相关,而与大肠埃希菌及肠球菌数量呈负相关(P<0.05)。结论微生态制剂联合营养干预可有效改善肝硬化套扎术后患者的肠道菌群失调状况及营养状态,对促进患者康复具有积极的临床意义。
Objective To investigate the effects of probiotic preparations combined with nutritional intervention on the gut microbiota and prognostic nutritional index(PNI)in cirrhotic patients after variceal ligation,in order to provide a reference for promoting intestinal function recovery and nutritional status improvement in this population.Methods From June 2022 to June 2024,180 cirrhotic patients undergoing variceal ligation at the First Affiliated Hospital of Nanjing Medical University were randomly assigned to an observation group(n=90)or a control group(n=90).Both groups received conventional therapy including hepatoprotection,antiviral treatment,diuresis,and vitamin supplementation.The control group additionally received nutritional intervention,while the observation group received probiotics orally in addition to the control regimen,for four weeks.The complication rates,nutritional indices,gut microbiota composition,and PNI changes before and after treatment were compared;correlations between PNI and microbiota changes were analyzed.Results The complication rate in the observation group was 5.55%(5/90),which was significantly lower than the control group's 15.55%(14/90)(χ^(2)=4.766,P=0.029).Before treatment,serum albumin(Alb)and prealbumin(PA)levels did not differ between groups(P>0.05);after treatment,both biomarkers rose in both groups but were significantly higher in the observation group than in the control group(P<0.05).Gut microbiota analysis showed no pretreatment differences in Bifidobacterium,Lactobacillus,Escherichia coli(E.coli),and Enterococcus counts(P>0.05).Posttreatment,Bifidobacterium and Lactobacillus counts increased significantly in both groups,with greater increases in the observation group,while E.coli and Enterococcus counts decreased significantly in both groups,with greater reductions in the observation group(P<0.05).PNI values demonstrated no pretreatment differences(P>0.05)but rose significantly in both groups posttreatment,with higher values in the observation group(P<0.05).Correlation analysis revealed that PNI levels correlated positively with Bifidobacterium and Lactobacillus counts and negatively with E.coli and Enterococcus counts(P<0.05).Conclusion Probiotic preparations combined with nutritional intervention effectively restore gut microbiota balance and improve nutritional status in cirrhotic patients after variceal ligation,which may facilitate recovery and hold positive clinical promise.
作者
付渝婷
刘梅红
黄蕊
程文芳
陆希
邱新运
董洋
Fu Yuting;Liu Meihong;Huang Rui;Cheng Wenfang;Lu Xi;Qiu Xinyun;Dong Yang(Department of Gastroenterology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;The First School of Clinical Medicine,Nanjing Medical University,Nanjing 210029,China)
出处
《保健医学研究与实践》
2025年第5期64-70,共7页
Health Medicine Research and Practice
基金
国家自然科学基金项目(81600416)。
关键词
微生态制剂
营养干预
肝硬化
套扎术
肠道菌群
预后营养指数
Probiotic preparations
Nutritional intervention
Cirrhosis
Variceal ligation
Gut microbiota
Prognostic nutritional index
作者简介
第一作者:付渝婷,E-mail:jsfuyuting6@163.com;通信作者:刘梅红,E-mail:honglife6@163.com。
