肠道屏障功能在肝硬化肝性脑病诊断中的价值：一项回顾性研究

宋莹; 杨梅; 蔡沐; 刘静

doi:10.14188/j.1671-8852.2025.1212

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肠道屏障功能在肝硬化肝性脑病诊断中的价值：一项回顾性研究

临床医学研究 | 更新时间：2026-11-05

- 肠道屏障功能在肝硬化肝性脑病诊断中的价值：一项回顾性研究
- Value of intestinal barrier function in the diagnosis of cirrhosis hepatic encephalopathy: A retrospective study
- 武汉大学学报（医学版） 2026年47卷第10期页码：1325-1329
- 作者机构：
  
  1.武汉大学中南医院消化内科/肠病湖北省重点实验室湖北武汉 430071
  2.鄂州市中心医院消化内科湖北鄂州 436000
- 作者简介：
  
  宋莹，女，2000—，医学硕士生，主要从事肝病及消化内镜研究，E⁃mail: 744662539@qq.com
  杨梅，女，1983—，副主任医师，主要从事肠道疾病研究，E⁃mail: 928783138@qq.com
  刘静，E⁃mail: liujing_GI@whu.edu.cn。
- 基金信息：
  
  国家自然科学基金资助项目(82072753);武汉大学“临床医学+X”青年拔尖项目(413000621);武汉大学中南医院临床研发项目(2025LCYJZX⁃MS003)
- DOI：10.14188/j.1671-8852.2025.1212
  中图分类号： R575.3
- 收稿：2025-10-19，
  
  纸质出版：2026-10-25
- 稿件说明：
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宋莹,杨梅,蔡沐等.肠道屏障功能在肝硬化肝性脑病诊断中的价值：一项回顾性研究[J].武汉大学学报（医学版）,2026,47(10):1325-1329.

SONG Ying,YANG Mei,CAI Mu,et al.Value of intestinal barrier function in the diagnosis of cirrhosis hepatic encephalopathy: A retrospective study[J].Medical Journal of Wuhan University,2026,47(10):1325-1329.
宋莹,杨梅,蔡沐等.肠道屏障功能在肝硬化肝性脑病诊断中的价值：一项回顾性研究[J].武汉大学学报（医学版）,2026,47(10):1325-1329. DOI： 10.14188/j.1671-8852.2025.1212.

SONG Ying,YANG Mei,CAI Mu,et al.Value of intestinal barrier function in the diagnosis of cirrhosis hepatic encephalopathy: A retrospective study[J].Medical Journal of Wuhan University,2026,47(10):1325-1329. DOI： 10.14188/j.1671-8852.2025.1212.

摘要

目的

探讨二胺氧化酶、

⁃乳酸及细菌内毒素等肠道屏障指标对肝性脑病的诊断价值。

方法

该研究为单中心回顾性观察，研究对象为2023年1月至2024年12月期间接受肠道屏障检测的肝硬化合并肝性脑病患者。研究从二胺氧化酶、

⁃乳酸、细菌内毒素、血氨、Child⁃Pugh分级等指标中筛选肝性脑病的危险因素，并据此构建肝性脑病的诊断模型。

结果

共纳入230例患者，其中男性为主（61.7%），平均年龄60.17岁。肝硬化主要病因为乙型肝炎（43.9%）。按8∶2比例将患者分为训练集与测试集，训练集

AUC

达0.94，测试集

AUC

为0.883，表明该模型具有良好泛化能力。

结论

细菌内毒素是肝性脑病的重要危险因素。基于细菌内毒素等指标构建的诊断模型对肝性脑病可能具有良好的诊断价值，但尚需外部数据进一步验证。

Abstract

Objective

To explore the diagnostic value of intestinal barrier indicators

including diamine oxidase

⁃lactate

and bacterial endotoxin

in hepatic encephalopathy.

Methods

A retrospective

monocentric study was conducted in the patients with cirrhosis and hepatic encephalopathy undergoing intestinal barrier testing between January 2023 and December 2024. The risk factors of hepatic encephalopathy were screened from diamine oxidase

⁃lactate

bacterial endotoxin

blood ammonia

Child⁃Pugh grade

etc.

and the diagnostic model of hepatic encephalopathy was constructed accordingly.

Results

In total

230 patients were included. The patients were predominantly male (61.7%)

with an average age of 60.17 years. The main etiology of cirrhosis was hepatitis B (43.9%). The patients were divided into the training set and the test set according to the ratio of 8∶2

and the

AUC

of the training set was 0.94 and the

AUC

of the test set was 0.883

indicating that the model had good generalization ability.

Conclusion

Bacterial endotoxin constitutes a significant risk factor for hepatic encephalopathy. The diagnostic model constructed based on the indices including bacterial endotoxin may have good diagnostic value for hepatic encephalopathy. Further external data are needed for verification.

关键词

Keywords

references

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TILG H , ADOLPH T E , TRAUNER M . Gut⁃liver axis: Pathophysiological concepts and clinical implications [J ] . Cell Metab , 2022 , 34 ( 11 ): 1700 ⁃ 1718 .

ZHU R , LIU L , ZHANG G , et al . The pathogenesis of gut microbiota in hepatic encephalopathy by the gut⁃liver⁃brain axis [J ] . Biosci Rep , 2023 , 43 ( 6 ): BSR20222524 .

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European Association for the Study of the Liver . EASL Clinical Practice Guidelines on the management of hepatic encephalopathy [J ] . J Hepatol , 2022 , 77 ( 3 ): 807 ⁃ 824 .

SHAWCROSS D L , SHARIFI Y , CANAVAN J B , et al . Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis [J ] . J Hepatol , 2011 , 54 ( 4 ): 640 ⁃ 649 .

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EFREMOVA I , MASLENNIKOV R , MEDVEDEV O , et al . Gut microbiota and biomarkers of intestinal barrier damage in cirrhosis [J ] . Microorganisms , 2024 , 12 ( 3 ): 463 .

RIORDAN S M , DUNCOMBE V M , THOMAS M C , et al . Small intestinal bacterial overgrowth, intestinal permeability, and non⁃alcoholic steatohepatitis [J ] . Gut , 2002 , 50 ( 1 ): 136 ⁃ 138 .

LI F C , FAN Y C , LI Y K , et al . Plasma diamine oxidase level predicts 6⁃month readmission for patients with hepatitis B virus⁃related decompensated cirrhosis [J ] . Virol J , 2019 , 16 ( 1 ): 115 .

JAIN L , SHARMA B C , SHARMA P , et al . Serum endotoxin and inflammatory mediators in patients with cirrhosis and hepatic encephalopathy [J ] . Dig Liver Dis , 2012 , 44 ( 12 ): 1027 ⁃ 1031 .

BUTTERWORTH R F . Hepatic encephalopathy: A central neuroinflammatory disorder? [J ] . Hepatology , 2011 , 53 ( 4 ): 1372 ⁃ 1376 .

SOLGA S F DIEHL A M . Gut flora⁃based therapy in liver disease? The liver cares about the gut [J ] . Hepatology , 2004 , 39 ( 5 ): 1197 ⁃ 1200 .

DHIMAN R K . Gut microbiota and hepatic encephalopathy [J ] . Metab Brain Dis , 2013 , 28 ( 2 ): 321 ⁃ 326 .

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