茵陈五苓散加味治疗乙型肝炎肝硬化合并自发性细菌性腹膜炎患者的疗效及对肠道菌群的影响OA

Objective:To analyze the clinical efficacy of"Yinchen Wuling Powder Jiawei"on the patients with hepatitis B-related cirrhosis combined with spontaneous bacterial peritonitis(SBP)with"Damp-heat-water-stopping syndrome,where the dampness is more important than the heat",and its effect on their intestinal flora.Methods:A total of 70 patients with hepatitis B-related cirrhosis combined with SBP who attended our hospital from December 2022 to December 2023 and met the inclusion criteria were selected and randomly divided into the control group and the observation group,with 35 cases in each group.Both groups were given comprehensive internal medicine treatment such as antiviral,anti-infection,diuretic,etc.The control group was combined with Bifidobacterium bifidum Lactobacillus terrestris tablets(Jin Shuangqi)for oral administration,and the observation group was combined with"Yinchen Wuling Powder Jiawei"for oral administration for a period of 2 weeks,to compare the clinical efficacy,the time of disappearance of clinical symptoms,the change of the Chinese medicine syndromes scores and indexes of serological inflammation between the two groups before and after the treatment.The intestinal flora was detected by using 16Sr DNA sequencing and analyzed with bioinformatics methods.Results:The total clinical effective rate was 74.3%in the control group and 91.4%in the observation group,and the total effective rate of the observation group was significantly higher than that of the control group(χ2=6.103,P=0.047);the time for the return of body temperature to normal and the disappearance of abdominal pain,the disappearance of abdominal distension,and the disappearance of abdominal pressure were shorter than those of the control group(P<0.05).After treatment,the total TCM symptom scores of both groups decreased significantly(P<0.05).The scores in the observation group were lower than those in the control group.Specifically,the observation group showed lower scores than the control group in four items including abdominal distension,tiredness and fatigue,pallor,and swelling of limbs after treatment(P<0.05).After treatment,the levels of CRP,PCT and IL-6 in both groups were lower than those before treatment(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).On the comparison of intestinal flora,at the phylum taxonomic level,the abundance of Firmicutes was significantly higher and the decrease of Bacteroidetes was more pronounced in the observation group after treatment compared with those in the control group(Z=-2.226,-2.426;P=0.026,0.015).At the genus taxonomic level,the abundance of Blautia,Akkermansia,Roseburia,and Lachnoclostridium was significantly higher in the observation group after treatment(Z=-2.085,-2.204,-2.121,-2.596;P=0.037,0.028,0.034,0.009).Conclusion:Combining"Yinchen Wuling Powder Jiawei"with conventional basic treatment can improve the clinical efficacy on the patients with hepatitis B-related cirrhosis SBP"Dampness-heat-water-stopping syndrome,dampness is more important than heat",reduce the symptoms of traditional Chinese medicine,alleviate the inflammation of peritoneum,and improve liver function.It also increased the abundance of Firmicutes and the ratio of F/T,and decreased the abundance of Bacteroidetes,promoting the proliferation of SCFAs-producing bacteria,such as Akkermansia,Roseburia,and Lachnoclostridium.We think that the underlying mechanism of"Yinchen Wuling Powder Jiawei"for the treatment of hepatitis B-related cirrhosis combined with SBP may be related to the modulation of intestinal microecology.