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非酒精性脂肪性肝病患者肠道菌群变化及双歧杆菌三联活菌胶囊对肠道菌群、肝功能、血脂及胰岛素抵抗的影响

作者：易艳容曾亚何佳郭浩宇申月明王赛

单位：长沙市中心医院消化内科长沙 410004

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出版年,卷(期):页码：2016,8(3):87-92

摘要：

摘要：目的研究非酒精性脂肪性肝病（NAFLD）患者肠道菌群的变化以及双歧杆菌三联活菌胶囊对
肠道菌群、肝功能、血脂及胰岛素抵抗的影响。方法随机选取2015年1月至2015年10月于本院确诊的
NAFLD患者60例，采集粪便标本检测肠道菌群，同时在门诊健康体检者中随机选取40例作为健康对
照组，比较NAFLD患者与健康对照者肠道菌群的变化情况。将NAFLD患者随机分为A组和B组，每
组30例，其中A组给予口服多烯磷脂酰胆碱胶囊治疗，456 mg/次，3次/天，疗程30天；B组口服多烯
磷脂酰胆碱胶囊（456 mg/次，3次/天）的同时口服双歧杆菌三联活菌胶囊（420 mg/次，3次/天），
疗程30天。比较治疗前后各组患者粪便中肠道菌群及血清中肿瘤坏死因子-α（TNF-α）、白细胞介
素-6（IL-6）、血浆内毒素、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红
素（TBil）、总胆固醇（TC）和甘油三酯（TG）水平的变化。应用稳态模型评估的胰岛素抵抗指
数（HOMA-IR）分析肠道菌群与血浆内毒素水平的相关性。结果治疗前，NAFLD患者与健康对照
组相比，双歧杆菌和乳杆菌的数量显著降低（t值分别为-2.320、2.875，P值分别为0.022、0.002），
肠葡萄球菌和肠杆菌数量显著升高（t值分别为4.352、3.435，P值分别为0.000、0.001），肠球菌和
拟杆菌无显著变化（t值分别为0.834、1.459，P值分别为0.401、0.173）。治疗后A组与B组双歧杆
菌及乳杆菌的数量均有所上升，B组较A组上升更显著（t值分别为2.455、2.526，P值分别为0.027、
0.018），两组治疗后肠葡萄球菌及肠杆菌数量显著下降，B组较A组下降更显著（t值分别为-2.049、
2.758，P值分别为0.041、0.009）。治疗前NAFLD患者与健康对照者相比，血浆内毒素、TNF-α、
IL-6和HOMA-IR均显著升高（t值分别为2.783、3.174、6.173和6.730，P值分别为0.006、0.002、0.000
和0.000）。与A组相比，治疗后B组血浆内毒素、TNF-α、IL-6、HOMA-IR、ALT、AST、TBil及TG
均显著下降（t值分别为-2.452、-3.038、-3.398、-3.276、-2.473、-2.748、-2.474和-2.536，P值分别为
0.023、0.005、0.002、0.004、0.018、0.017、0.019和0.017）。肠道菌群与血浆内毒素的相关性分析
表明需氧菌与血浆内毒素水平呈正相关，厌氧菌与血浆内毒素水平呈负相关。结论 NAFLD患者存
在肠道菌群构成的改变，提示肠道菌群失调可能参与NAFLD的发生发展。双歧杆菌三联活菌辅助治
疗NAFLD可显著改善患者肠道菌群失调，降低肠源性内毒素血症，改善肝功能，具有一定的治疗价
值。

Abstract: Objective To observe the changes of intestinal flora in patients with non-alcoholic fatty liver
disease (NAFLD) and the effects of bifidobacterium triple viable capsules on intestinal flora, liver function,
blood lipid and insulin resistance. Methods Total of 60 patients who were diagnosed as NAFLD from January
2015 to October 2015 in our hospital were randomly selected and the fecal samples were collected. Total of
40 healthy controls were randomly selected. The changes of intestinal flora in feces between the two groups

were compared. Patients with NAFLD were randomly divided into two subgroups (group A and group B),
30 cases in each group. Patients in group A were treated with polyene phosphatidyl choline orally, 456 mg/time, 3 times
daily for 30 days; patients in group B were treated with polyene phosphatidyl choline capsules orally, 456 mg/time,
3 times daily and bifidobacterium triple viable capsules 420 mg/time, 3 times daily for 30 days. Changes of
intestinal flora in the feces, serum tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), plasma endotoxin,
alanine transfer enzymes (ALT), aspartate amino transfer (AST), total bilirubin (TBil), total cholesterol (TC)
and triglyceride (TG) were compared before and after treatment. Homeostasis model was used to assess the
insulin resistance and the correlation between intestinal flora and plasma endotoxin level was analyzed. Results
Before treatment, compared with healthy controls, the number of bifidobacteria and lactobacillus in patients
with NAFLD decreased significantly (t = -2.320, -2.875; P = 0.022, 0.002), and the number of staphylococcus
and intestinal bacteria increased significantly (t = 4.352, 3.435; P = 0.000, 0.001), there were no significant
changes in the numbers of enterococcus and bacteroides (t = 0.834, 1.459; P = 0.401, 0.173). After treatment,
the numbers of bifidobacteria and lactobacillus increased both in group A and group B, and the differences were
statistically significant (t = 2.455, 2.526; P = 0.027, 0.018), the number of staphylococcus and intestinal bacteria
in group B decreased significantly than those in group A (t = -2.049, -2.758; P = 0.041, 0.009). Before treatment,
the levels of plasma endotoxin, TNF-α, IL-6 and HOMA-IR in patients with NAFLD were significantly higher
than those of healthy controls (t = 2.783, 3.174, 6.173, 6.730; P = 0.006, 0.002, 0.000, 0.000). After treatment,
compared with group A, the levels of endotoxin, TNF-α, IL-6, HOMA-IR, ALT, AST, TBil and TG decreased
significantly in group B (t = -2.452, -3.038, -3.398, -3.276, -2.473, -2.748, -2.474, -2.536; P = 0.023, 0.0050 0.002,
0.004, 0.018, 0.017, 0.019, 0.017). Correlation analysis between intestinal flora and plasma endotoxin showed
that the aerobic bacteria was positively correlated with the level of serum endotoxin and the anaerobic bacteria
was negatively correlated with the level of serum endotoxin. Conclusions The composition of intestinal flora
changes in patients with NAFLD, which indicates that the intestinal flora probably participate in the occurrence
and development of NAFLD. The bifidobacteria triple viable bacteria adjuvant treatment can significantly
improve the intestinal flora imbalance and liver function, which can also reduce the intestinal source of
endotoxin and has a certain treatment value in patients with NAFLD.

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