摘要
目的观察利福昔明对乙肝肝硬化并发急性肾损伤(AKI)患者肾功能、肠道菌群及全身炎性反应的影响。方法纳入2023年6月—2024年12月于福建医科大学孟超肝胆医院接受诊治的乙肝肝硬化并发AKI患者80例,采用简单随机分组法分为观察组和对照组,各40例。2组患者均接受常规护肝、抗病毒等治疗,观察组增加利福昔明治疗,2组均连续治疗14 d。比较2组治疗前后肾功能指标[血肌酐(SCr)、血尿素氮(BUN)、内生肌酐清除率(CCr)、24 h尿量、尿钠排泄分数(FENa)、尿微量白蛋白/肌酐比值(UACR)]、肠道菌群、肠道通透性标志物[脂多糖(LPS)、D-乳酸、连蛋白]、全身炎性指标[白介素(IL)-10、IL-1β、肿瘤坏死因子-α(TNF-α)]及不良事件。结果治疗14 d后,2组SCr、BUN、FENa、UACR降低,CCr、24 h尿量升高,且观察组改善幅度大于对照组(P<0.01);观察组肠杆菌、肠球菌水平降低,双歧杆菌、乳杆菌水平升高,且改善幅度大于治疗前和对照组(P<0.01),对照组治疗前后比较无统计学差异(P>0.05);2组LPS、D-乳酸、连蛋白、IL-1β、TNF-α水平降低,IL-10水平升高,且观察组低/高于对照组(P<0.01)。2组均未发生严重不良事件。结论利福昔明可选择性抑制肠道有害菌,调节肠道菌群平衡,改善肠道屏障功能,减轻全身炎性反应,进而减轻肾脏炎性损伤,促进乙肝肝硬化并发AKI患者肾功能恢复。
Objective To observe the effects of rifaximin on renal function,intestinal flora and systemic inflammatory response in patients with hepatitis B cirrhosis complicated with acute kidney injury(AKI).Methods A total of 80 patients with hepatitis B cirrhosis complicated with AKI who were treated in Mengchao Hepatobiliary Hospital of Fujian Medical University from June 2023 to December 2024 were enrolled and divided into observation group and control group by simple random group method,with 40 cases in each group.Both groups received routine liver protection and antiviral treatment,and the ob servation group was treated with rifaximin.Both groups were treated for 14 days.The renal function indexes(SCr,BUN,CCr,24-hour urine volume,FENa,UACR),intestinal flora,intestinal permeability markers(LPS,D-lactic acid,and fi bronectin),systemic inflammatory markers(IL-10,Il-1β,TNF-α)before and after treatment,and ad verse events were com pared between two groups.Results After 14 days of treatment,SCr,BUN,FENa and UACR de creased,CCr and 24-hour urine volume increased in both groups,and the improvement in the observation group were greater than those in the control group(P<0.01).The levels of enterobacteriaceae and enterococcus in the observation group decreased,while the lev els of bifidobacterium and lactobacillus increased,and the improvement was greater than that before treatment and that of the control group(P<0.01).There was no significant difference in the control group before and after treatment(P>0.05).The levels of LPS,D-lactic acid,fibronectin,IL-1βand TNF-αin both groups were decreased,while levels of IL-10 increased,and those in the observation group were lower/higher than those in the control group(P<0.01).No serious adverse events occurred in both groups.Conclusion Rifaximin can selectively inhibit harmful intestinal bacteria,regulate the balance of intestinal flora,im prove intestinal barrier function,reduce systemic inflammatory response,thereby reducing renal inflammatory injury and promoting the recovery of renal function in patients with hepatitis B cirrhosis complicated with AKI.
作者
林清标
熊克宫
林太顺
陈晓文
孔金峰
LIN Qingbiao;XIONG Kegong;LIN Taishun;CHEN Xiaowen;KONG Jinfeng(Department of Chronic Liver Disease,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China)
出处
《临床合理用药》
2026年第6期16-20,共5页
Chinese Journal of Clinical Rational Drug Use
基金
福建省自然科学基金项目(2023J011461)。
关键词
乙肝肝硬化
急性肾损伤
利福昔明
肾功能
肠道菌群
全身炎性反应
Hepatitis B cirrhosis
Acute kidney injury
Rifaximin
Renal function
Intestinal flora
Systemic in flammatory response
