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Clin Gast Hepatol:益生菌可有效抑制肝硬化患者患肝性脑病

  1. 患者
  2. 益生菌
  3. 肝性脑病
  4. 肝硬化

来源:生物谷 2014-06-10 09:10

近日,刊登在国际杂志Clinical Gastroenterology and Hepatology上的两篇研究论文中,来自印度的科学家通过研究表示,益生菌可以有效抑制肝硬化患者患肝性脑病;肝性脑病是一种由肝脏疾病引发的严重并发症,主要表现为大脑功能的退化现象。

2014年6月10日 讯 /生物谷BIOON/ --近日,刊登在国际杂志Clinical Gastroenterology and Hepatology上的两篇研究论文中,来自印度的科学家通过研究表示,益生菌可以有效抑制肝硬化患者患肝性脑病;肝性脑病是一种由肝脏疾病引发的严重并发症,主要表现为大脑功能的退化现象。

研究者David W. Victor III博士说道,这项研究中我们发现,益生菌可以改变患者的机体肠道菌群从而抑制肝硬化患者肝性脑病的发生;这对于开发一种安全、可靠的专一性疗法治疗肝硬化患者的疾病提供了一定的思路。

文章中,研究者对表现出肝性脑病风险因子的肝硬化患者进行了随机试验,当将益生菌试验组和安慰剂组进行对比后,研究者发现益生菌组患者的肝性脑病发生率普遍下降了;益生菌的补充并不会引发任何副作用,而且没有一个病人需要终止治疗,研究结果表明益生菌疗法同当前的标准疗法(乳果糖)非常相似,其都可以有效抑制肝硬化患者肝性脑病的发生。

45%的肝硬化患者都会发展成为肝性脑病,当肝脏不能够移除血液中的毒性物质时患者的大脑就会慢慢丧失功能,而且患者预后不良,患者一年的死亡率是58%,三年的死亡率是77%,因此对于患者来讲开发安全有效的疗法显得非常必要。

人类机体肠道微生物菌群和人类健康及疾病密切相关,因此未来对肠道微生物领域的研究将会是一项研究热点。(生物谷Bioon.com)

Probiotics Prevent Hepatic Encephalopathy in Patients With Cirrhosis: A Randomized Controlled Trial

Manish Kumar Lunia, Barjesh Chander Sharma, Praveen Sharma, Sanjeev Sachdeva, Siddharth Srivastava

Background & Aims Hepatic encephalopathy (HE) is associated with a poor prognosis in patients with advanced liver disease. Probiotics alter the intestinal microbiota with non–urease-producing organisms that reduce production of ammonia. We investigated the efficacy of probiotics for the primary prophylaxis of HE. Methods We conducted a prospective trial at a tertiary care referral institute in New Delhi, India, from January 2012 through March 2013, of patients with cirrhosis without overt HE (age, 48.6 ± 11.1 y; 96 men and 64 women); 25 were Child–Turcotte–Pugh (CTP) class A, 51 were CTP class B, and 84 were CTP class C. Subjects were assigned randomly to groups given probiotics (1 × 108 colony-forming units, 3 times daily; n = 86, 42 with minimal HE) or no test article (control, n = 74; 33 with minimal HE). All subjects underwent psychometric analyses, critical flicker fusion (CFF) threshold assessments, glucose hydrogen breath tests to identify small intestinal bacterial overgrowth (SIBO), and lactulose hydrogen breath tests to measure orocecal transit time (OCTT). The primary end point was the development of overt HE. Results At baseline, subjects in each group had comparable CTP score, model for end-stage liver disease scores, CFF assessments, psychometric hepatic encephalopathy scores, and OCTT. After a mean follow-up period of 38.6 ± 8.80 weeks for patients given probiotics and 40.3 ± 9.8 weeks for controls, 6 patients given probiotics and 7 controls died (P = .81). Three months of probiotic administration significantly reduced levels of arterial ammonia, SIBO, and OCTT; increased psychometric hepatic encephalopathy scores; and increased CFF thresholds, compared with baseline. Seven subjects in the probiotic group and 14 controls developed overt HE (P < .05; hazard ratio for controls vs probiotic group, 2.1; 95% confidence interval, 1.31–6.53). Psychometric hepatic encephalopathy scores, CTP scores, and SIBO correlated with the development of overt HE. Conclusions In a prospective, randomized controlled trial, probiotics were found to be effective in preventing HE in patients with cirrhosis. Trial registration No: CTRI/2012/07/002807.

Hepatic Encephalopathy Involves Interactions Among the Microbiota, Gut, Brain

David W. Victor, Eamonn M.M. Quigley.

Hepatic encephalopathy (HE) refers to a spectrum of neuropsychiatric symptoms associated with liver disease that range from subtle, subclinical alterations in brain function to overt coma.1 Although hepatic coma was recognized as far back as 1860 by Frerichs2 and the clinical features of overt encephalopathy (OHE) are well-known and readily identified by clinicians, the impact of HE on mortality is often underappreciated1; only 42% of patients are expected to survive beyond 1 year after experiencing an episode of OHE.

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