The Study Of Increased Intestinal Permeability In Liver Cirrhosis

Background:Liver cirrhosis is a chronic liver disease caused by variouse reasons with progressive process.The patients with liver cirrhosis often died of serious complications,such as infection.It is often accompanied by intestinal barrier dysfunction which caused by bacterial translocation and endotoxaemia that lead to spontaneous bacterial peritonitis(SBP)and multiple organ dysfunction syndrome(MODS).Cholestasis is the pathological state that bile flows into blood instead of intestinal tract,and causes by the dysfunction in the formation,secretion and excretion of bile including bilirubin and bile acid.The existing research considered that cholestasis not only aggravated liver damage but also damaged the intestinal barrier.The intestinal barrier is composed of four parts,including mechanical barrier,chemical barrier,biologic barrier and immune barrier.The mechanical barrier plays a major role.In the Intestinal permeability increas when the barrier damaged,and it could reflect by the level of ET,D-lac,and DAO in blood.ET also reflects the severity of endotoxemia.The mechanism of intestinal barrier damage is still not completely clear.The previous studies on the improvement of intestinal barrier injury in patients with liver cirrhosis mainly concentrated on probiotics to repair biological barrier.The probiotics may be invalid for the patients with liver cirrhosis who had a long course of disease.Aims:Our study aim to investigat the factors that can enhanc the intestinal permeability,find a new way to protect the intestinal barrier in cirrhotic patients.Methods:Total of 10 healthy volunteers,13 patients with chronic hepatitis B and 41 cirrhotic patients were enrolled.The etiology of cirrhosis included hepatitis B virus,alcohol and PBC.The diagnostic criteria was determined by the relevant guidelines.Serum levels of ET,D-lac and DAO were measured by ELISA.The clinical datas were collected such as signs,liver function test indicators and imaging examination of cirrhotic patients,and the Child-Pugh scores were calculated.The measurement datas and numeration datas were statistically analyzed with software SPSS17.0 data processing.Results:1.The levels of ET,D-lac and DAO in patients with chronic hepatitis B and cirrhosis were higher than that in healthy volunteers(P<0.01).And the results in cirrhotic patients were twice than patients with chronic hepatitis B(P<0.01).2.The results of correlative analysis showed that there were positive correlation between ET and D-lac,DAO(r=0.980,P<0.01 & r=0.885,P<0.01).3.These were no differences in the level of ET,D-lacland DAO among the cirrhotic patients with hepatitis B virus,alcohol and PBC(P>0.05).4.The level of ET,D-lac and DAO in cirrhotic patients with portal hypertension were significantly different from those in the cirrhotic patients without portal hypertension.5.Intestinal permeability increased with the increase of Child-Pugh scores(P<0.05).Results of thus it was significantly different from the cirrhotic patients in Grade A and Grade C(P<0.01).6.The level of ET,D-lac and DAO in cirrhotic patients with jaundice were higher than in patients without jaundice(P<0.05).7.These is no difference in the level of ET,D-lacl and DAO between the cirrhotic patients with normal TBA and thus with increased TBA.But it was obviously different from normal TBA when TBA>70umol/L.Conclusions:1.The intestinal permeability in cirrhotic patients was severer than patients with chronic hepatitis B and healthy volunteers.2.Endotoxaemia,portal hypertension,Child-pugh classification,jaundice and increased total bile acid were the factors that can enhanced the intestinal permeability in cirrhotic patients.3.The level of ET,D-lac,DAO in different liver cirrhosis had no statistical significance.