| Background and objective: The prevalence of liver diseases is high in China,and cholestasis usually occurs in many patients at different stages,usually presenting with jaundice.The mechanisms of cholestasis are complicated,which hinder the bile formation,secretion or excretion can lead to cholestasis,so that bile flows into the bloodstream.Clinical manifestations can be manifested as jaundice,itching,fatigue and dark urine and other symptoms,the early symptoms are not obvious,may only show abnormal biochemical indicators,such as serum alkaline phosphatase(ALT)and glutamyl transpeptidase(?-GT)levels.The further progression of the disease will lead to hyperbilirubinemia,liver failure,and even death.Which damages hepatocytes and cholangiocytes or obstructs the biliary tract can lead to cholestasis.Bile and bile acids play an important role in the protection of gut barrier,and bile regulates intestinal flora.Bile acid can regulate mucosal repair and epithelial cell proliferation.Acute cholestasis leads to a decrease or deficiency of intestinal bile,impaired intestinal barrier,and overload of bacteria and endotoxins.Massive endotoxin and bacterial transfuse through the portal vein and lymphatic vessels,causing secondary attack on the liver and aggravating intestinal damage,resulting in intestinal-liver axis damage.More and more studies have found that many gut brain peptides can inhibit inflammatory factors and promote the proliferation and repair of intestinal epithelial cells.Therefore,gut brain peptides can regulate gut barrier function and become a new target for the treatment of cholestatic liver injury.Although these conclusions have been proved by a large numberof experiments,the results of clinical studies are few and there is still no evidence.Therefore,this article discusses the level of gut brain peptides and intestinal mucosal permeability indexes before treatment and two weeks after treatment and the correlation between patients with cholestatic liver injury.Aim to evaluate cholestasis liver disease patients with intestinal barrier damage and provide new ideas for the diagnosis and treatment.Methods: The subjects were outpatients from the first affiliated hospital of Dalian Medical University and Dalian Sixth People's Hospital Affiliated to Dalian Medical University from December 2015 to August 2017,who were diagnosed as cholestatic liver injury for the first time.All patients with complete data were selected which referred to “Consensus on the diagnosis and treatment of cholestasis liver diseases "(2015,China)for diagnosis.Eight patients with cholestatic liver injury caused by viral hepatitis were recruited and divided into two groups before treatment and two weeks after treatment,cholestatic liver injury group(named as group B)and cholestatic liver injury repair group(named as T group).In addition,11 healthy volunteers were selected as normal group(named as N group).Blood samples of the above subjects were collected before and after 2 weeks' treatment.Plasma levels of serotonin(5-HT),ghrelin(GHRL),somatostatin(SS),motilin(MTL)and intestinal barrier function indexes of diamine oxidase(DAO),endotoxin(ET),D-Lactic acid(D-LAC)were measured by enzyme linked immunosorbent assay.General data for all patients with cholestasis,including personal information,symptoms and signs,and liver function tests including alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),glutamyl transferase(?-GT),total bilirubin(TBIL),total bile acid(TBA)were needed.The measurement datas and numeration datas were statistically analyzed with software SPSS23.0 data processing.Results: 1.The liver function indexes(ALP,?-GT,ALT,AST,TBIL,DBIL,TBA)in cholestatic liver injury group were significantly higher than those in normal group(P <0.01).After 2 weeks of reducing enzyme,reducing cholestasis and other treatments,liver function indexes were significantly recovered,and liver function indicators incholestatic liver injury repair group than in cholestatic liver injury group were statistically significant(P <0.05)2.The levels of 5-HT,ghrelin,MTL and SS in patients with cholestatic liver injury were higher than those in normal controls(P<0.01,P<0.05,P<0.05,P<0.01).The levels of 5-HT,ghrelin and MTL in cholestasis liver injury repair is decreased than in the cholestatic liver injury group.There was a significant difference between the two groups(P <0.05).However,SS decreased in cholestatic liver injury repair group compared with cholestatic liver injury group,but there was no significant difference(P> 0.05).3.Cholestatic liver injury group intestinal barrier function test indicators DAO,ET,D-LAC were higher than that in the normal group,the results were statistically significant(P <0.01),DAO?ET?D-LAC in cholestatic liver injury repair group is decreased than the cholestatic liver injury group,The results showed no significant difference(P> 0.05).4.There was a significant negative correlation between SS and ET in patients with cholestatic liver injury(r =-0.854,P <0.01),and negative correlation with D-LAC and D-LAC(r=-0.708,P<0.05;r=-0.805,P<0.05).There is no correlation between 5-HT,ghrelin,MTL and DAO?ET?D-LAC.Conclusions: 1.The plasma level of brain-gut peptides in patients with cholestatic liver injury is higher than normal group.The level of gut-brain peptides recovered after 2 weeks of treatment.2.Intestinal barrier function is impaired in patients with cholestatic liver injury.There is no significant difference in gut barrier indexes after 2 weeks of treatment than in cholestatic liver injury.3.There is correlation between plasma levels of SS and intestinal barrier indexes in patients with cholestatic liver injury.There was no significant correlation between other gut-brain peptides and intestinal barrier indexes of cholestatic liver injury patients. |
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