肠道屏障功能在非酒精性脂肪性肝病发病机制中的作用

非酒精性脂肪性肝病患者血清claudin-1、claudin-4的变化及其与病情程度的相关性

目的

观察非酒精性脂肪性肝病患者血清闭锁蛋白1(claudin-1)和闭锁蛋白4(claudin-4)的变化, 分析其与肠道黏膜屏障功能及病情程度的关系.

方法

选取79例非酒精性脂肪性肝病患者, 按病情程度分为轻度(n = 23)、中度(n = 27)、重度(n = 29), 采用ELISA法测定其血清二胺氧化酶(diamine oxidase, DAO)、内毒素(endotoxin, ET)及血清claudin-1及claudin-4含量, 并选取同期健康体检者40例作为对照.

结果

与对照组比较, 患者组血清DAO、ET及claudin-4含量均明显升高(P<0.01, P<0.05), 而血清claudin-1含量则显著上升(P<0.01). 患者组血清DAO、ET及claudin-4含量随着病情程度的加重呈上升趋势, 而血清claudin-1含量出现下降趋势. 重度患者血清DAO、ET及claudin-4含量较轻中度患者明显上升(P<0.01, P<0.05); 血清claudin-1含量则较轻中度患者明显下降(P<0.01, P<0.05). 相关性分析表明, 血清claudin-1含量与血清DAO、ET含量、病情程度呈明显负相关(r = -0.695、-0.738、-0.741, P<0.01); claudin-4含量与血清DAO、ET含量、病情程度呈明显正相关(r = 0.779、0.755、0.875, P<0.01).

结论

非酒精性脂肪性肝病患者存在明显的肠黏膜功能障碍, 且与其病情程度密切相关; 肠黏膜紧密连接蛋白claudin-1、claudin-4表达异常可能是发生肠黏膜功能障碍的重要机制.

Role of stress and intestinal barrier dysfunction in inflammatory bowel disease

Stress, provoked by stressors, can cause a series of physical and psychological reactions and initiate both central and peripheral responses to maintain homeostasis. The causes of inflammatory bowel disease are poorly understood, which may involve complex interactions among environmental, psychological, dietary, immunological and pharmacological factors. This paper reviews the epidemiological and clinical data on how stress may precipitate in the attack, relapse and recurrence of inflammatory bowel disease. A possible biological mechanism is the impaired intestinal barrier including physical barrier, biologic barrier, immunological barrier and chemical barrier. Clinical epidemiological data and many animal studies show that stress may reduce mucous secretion and increase colonic permeability, which are the characteristic changes of inflammatory bowel disease. Understanding the relationship between stress and inflammatory bowel disease can improve the health related quality of life and lower the medical cost.

Effect of reducing portal pressure on intestinal barrier function in patients with decompensated cirrhosis

AIM: To explore the effect of reducing portal pressure on intestinal barrier function in patients with decompensated cirrhosis.

METHODS: Eighty-six patients with decompensated viral liver cirrhosis or alcoholic cirrhosis were randomly divided into either an experiment group or a control group. The control group received conventional symptomatic and supportive treatment, and the experiment group was additionally given propranolol hydrochloride tablets. The width of the portal vein, alanine aminotransferase (ALT), aspartic transaminase (AST), total bilirubin (TBIL), serum albumin (ALB), plasma endotoxin level, D-lactic acid content and plasma diamine oxidase (DAO) were compared between the two groups.

RESULTS: The width of the portal vein in the experiment group posttreatment was significantly lower than that before treatment (1.37 cm ± 0.09 cm vs 1.41 cm ± 0.11 cm, P < 0.05) and that in the control group (1.37 cm ± 0.09 cm vs 1.39 cm ± 0.10 cm, P < 0.05). The levels of ALT, AST and TBIL in both groups posttreatment were significantly lower and the levels of ALB were significantly higher than those before treatment (35.15 U/L ± 11.92 U/L vs 42.76 U/L ± 18.06 U/L, 29.03 U/L ± 13.88 U/L vs 35.04 U/L ± 19.84 U/L, 19.57 μmol/L ± 10.59 μmol/L vs 25.65 μmol/L ± 15.09 μmol/L, 32.69 g/L ± 3.96 g/L vs 30.16 g/L ± 5.63 g/L, 34.03 U/L ± 11.46 U/L vs 42.91 U/L ± 17.67 U/L, 28.36 U/L ± 14.37 U/L vs 36.62 U/L ± 20.54 U/L, 18.94 μmol/L ± 9.56 μmol/L vs 24.92 μmol/L ± 16.60 μmol/L, 32.28 g/L ± 6.13 g/L vs 29.94 g/L ± 5.06 g/L, P < 0.05), although there were no significant differences in the levels of ALT, AST, TBIL and ALB between the two groups posttreatment (35.15 U/L ± 11.92 U/L vs 34.03 U/L ± 11.46 U/L, 29.03 U/L ± 13.88 U/L vs 28.36 ± 14.37 U/L, 19.57 μmol/L ± 10.59 μmol/L vs 18.94 μmol/L ± 9.56 μmol/L, 32.69 g/L ± 3.96 g/L vs 32.28 g/L ± 6.13 g/L, P > 0.05). Plasma endotoxin level, D-lactic acid content and DAO in the two groups posttreatment were significantly lower than those before treatment (0.53 EU/mL ± 0.12 EU/mL vs 0.72 EU/mL ± 0.11 EU/mL, 2.71 Ku/L ± 0.84 Ku/L vs 5.19 Ku/L ± 2.12 Ku/L, 7.85 mg/L ± 0.62 mg/L vs 12.95 mg/L ± 4.27 mg/L, 0.62 EU/mL ± 0.11 EU/mL vs 0.75 EU/mL ± 0.14 EU/mL, 3.83 Ku/L ± 1.70 Ku/L vs 5.34 Ku/L ± 2.08 Ku/L, 9.90 mg/L ± 6.70 mg/L vs 13.24 mg/L ± 4.42 mg/L, P < 0.05). Plasma endotoxin level, D-lactic acid content and DAO in the experiment group were significantly lower than those in the control group (0.53 EU/mL ± 0.12 EU/mL vs 0.62 EU/mL ± 0.11 EU/mL, 2.71 Ku/L ± 0.84 Ku/L vs 3.83 Ku/L ± 1.70 Ku/L, 7.85 mg/L ± 0.62 mg/L vs 9.90 mg/L ± 6.70 mg/L, P < 0.05).

CONCLUSION: Propranolol can not only improve liver function, reduce the width of the portal vein, decrease the levels of plasma endotoxin, D-lactic acid content and DAO, reduce portal hypertension, but also improve intestinal mucosal repair, reduce intestinal permeability, and improve intestinal barrier function.

Progress in treatment of non-alcoholic fatty liver disease

The improvement of people's living standard, the accelerated pace of life and the decreased amount of exercise have significantly increased the prevalence of metabolic syndrome and fatty liver disease. In particular, some obese children have been diagnosed with non-alcoholic fatty liver disease. This should arouse our enough attention. This article reviews the progress in the treatment of non-alcoholic fatty liver disease.