小肠细菌过度生长对肝硬化的影响及其治疗对策
DOI: 10.3969/j.issn.1001-5256.2022.09.038
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作者贡献声明:牛国超负责文章撰写;孙东磊协助文章修改;张晓岚负责指导文章书写及修改。
Influence of small intestinal bacterial overgrowth on liver cirrhosis and its treatment
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摘要: 小肠细菌过度生长(SIBO)以小肠内菌群数量或菌群种类改变为特点。肝硬化患者经常出现肠道淤血、水肿和蠕动减慢,常常发生SIBO,而SIBO又可进一步加重肠道异常。在肝硬化患者中,SIBO可导致明显的不良临床后果,由于肠道通透性增加易使细菌移位进入体循环,因此,SIBO被认为是肝硬化患者、自发性细菌性腹膜炎和肝性脑病发病机理中的重要危险因素。抗生素尤其是利福昔明是SIBO最有效的治疗方法。此外,促动力药、益生菌、非选择性β受体阻滞剂以及肝移植术等潜在治疗方法也在研究中。Abstract: Small intestinal bacterial overgrowth (SIBO) is characterized by changes in the number or species of small intestinal flora. Patients with liver cirrhosis often have intestinal congestion, edema, and delayed peristalsis and develop SIBO, which can further aggravate intestinal abnormalities. In patients with liver cirrhosis, SIBO can lead to significant adverse clinical outcomes, and since the increase in intestinal permeability may cause bacterial translocation into systemic circulation, SIBO is considered an important risk factor in the pathogenesis of liver cirrhosis, spontaneous bacterial peritonitis, and hepatic encephalopathy. Antibiotics, especially rifaximin, are the most effective therapies for SIBO, and in addition, studies are being conducted to investigate the efficacy of potential therapies such as prokinetic agents, probiotics, non-selective β-receptor blocker, and liver transplantation.
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