| 周毅骏,应高翔,崔宇胜,荀运浩,李春青,吴午音,金巧菲.逍遥丸对肝郁脾虚证自身免疫性肝炎患者肠道菌群的干预作用[J].浙江中西医结合杂志,2024,34(9): |
| 逍遥丸对肝郁脾虚证自身免疫性肝炎患者肠道菌群的干预作用 |
| Xiaoyaowan alters gut microbiota of autoimmune hepatitis (AIH) patients with liver depression and spleen deficiency syndrome |
| 投稿时间：2024-04-07 修订日期：2024-08-20 |
| DOI： |
| 中文关键词: 自身免疫性肝炎 肝郁脾虚证 肠道菌群 逍遥丸 肠肝轴 |
| 英文关键词:autoimmune hepatitis liver depression and spleen deficiency syndrome gut microbiota Xiaoyaowan gut-liver axis |
| 基金项目:浙江省中医药科技计划项目(编号:2022ZB293)；浙江省医药卫生科技计划项目(编号:2023KY197) |
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| 中文摘要: |
| 目的 基于“肠肝轴”探讨逍遥丸对肝郁脾虚证自身免疫性肝炎(autoimmune hepatitis,AIH)患者肠道菌群的干预作用。方法 共纳入60例在杭州市西溪医院确诊为肝郁脾虚证AIH的浙江省患者,同步入组60例与之匹配的健康志愿者,留取血液标本用于检测肝功能及免疫学指标,采用16S rRNA技术检测粪便肠道菌群。依照随机数字法将60例肝郁脾虚证AIH患者分为西药组和西药+逍遥丸组,两组均服用甲泼尼龙片联合硫唑嘌呤片治疗,后者加用逍遥丸。3个月后再次留取血液及粪便标本,观察血清学指标及肠道菌群的改善情况。结果 与健康对照组相比,肝郁脾虚证AIH患者肠道菌群的α多样性及β多样性发生显著改变(p＜0.05)；该类患者瘤胃球菌科(Ruminococcaceae)、克里斯滕森菌科(Christensenellaceae)、毛螺菌科(Lachnospiraceae)、双歧杆菌科(Bifidobacteriaceae)、梭菌科(Clostridiaceae)显著减少,萨特氏菌属(Sutterella)、屎豆属菌属(Faecalitalea)显著增多,基于上述7个差异菌群构建无创诊断模型,曲线下面积达0.800(95% CI 0.685-0.915)。60例肝郁脾虚证AIH患者分别接受西药(n=30)及西药联合逍遥丸(n=30)干预3个月,两组均获得了良好的生化应答,但西药联合逍遥丸组在降低IgG水平上较西药组更加显著(p＜0.05)；同时,逍遥丸可显著纠正克里斯滕森菌科、梭菌科、双歧杆菌科、瘤胃球菌科的缺失情况(p＜0.05),提高生化应答率。结论 肝郁脾虚证AIH患者存在显著的肠道菌群失调,逍遥丸能显著纠正部分肠道菌群,提高生化学应答率,为实现“肝病肠治”的理念提供了新的中医药干预思路。 |
| 英文摘要: |
| Objective We aim to investigate the effect of Xiaoyaowan towards gut microbiota of autoimmune hepatitis (AIH) patients with liver depression and spleen deficiency syndrome based on "gut-liver axis". Methods 60 AIH patients with liver depression and spleen deficiency syndrome from Zhejiang Province in Hangzhou Xixi Hospital and 60 matched healthy volunteers were included in this study. Blood specimens were collected for the detection of liver function and immunological indexes, and fecal specimens were detected by 16S rRNA technology. According to the random number method, 60 AIH patients with liver depression and spleen deficiency syndrome were divided into the western medicine group and the western medicine plus Xiaoyaowan group. Both groups were treated with methylprednisolone combined with azathioprine, and the latter group was added with Xiaoyaowan. Blood and fecal specimens were collected again after 3 months treatment for observation of the improvement of serological indexes and gut microbiota. Results Compared with control group, the α-diversity and β-diversity of gut microbiota among AIH patients with liver-depression and spleen-deficiency syndrome were significantly altered (p < 0.05). Ruminococcaceae, Christensensenaceae, Lachnospiraceae, Bifidobacteria and Clostridiaceae were significantly reduced, while Sutterella and Faecalitalea was significantly increased in AIH patients with liver-depression and spleen-deficiency syndrome. A noninvasive diagnostic model was constructed based on the above seven differential bacteria, with an area under the curve of 0.800 (95% CI 0.685-0.915). 60 AIH patients with liver depression and spleen deficiency syndrome received western medicines (n=30) and western medicines plus Xiaoyaowan (n=30) for 3 months respectively. Result showed that both groups obtained good biochemical responses, while western medicines plus Xiaoyaowan group had a significant lower level of IgG than western medicines group (p<0.05). Moreover, Xiaoyaowan significantly corrected the defects in the expression of Christensensenaceae, Clostridiaceae, Bifidobacteriaceae and Ruminococcaceae (p<0.05), and improved the biochemical response rate. Conclusion Gut microbiota disorder is quite common in AIH patients with liver depression and spleen deficiency syndrome and Xiaoyaowan can significantly correct part of the gut microbiota and improve the biochemical response rate, which provides a new Chinese medicine intervention idea to realize the concept of "treating liver disease via gut". |
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