大肠癌术后肠道粘膜免疫功能的改变

目的 探讨大肠癌手术前后肠道粘膜免疫功能的变化,评估常规大肠癌手术对患者肠道粘膜免疫功能的影响,了解术后使用肠道益生菌制剂治疗肠道粘膜免疫功能紊乱的疗效.方法 将大肠癌患者随机分为两组(实验组和对照组).对照组:患者常规实施大肠癌根治术;实验组:患者常规实施大肠癌根治术,并于手术后可以进食起开始补充肠道益生菌制剂.两组均于术前,术后第一次排便,排便后5天,术后1月,4次抽静脉血检测血清CRP及TNF-α的含量,同时留取粪便检测分泌型免疫球蛋白(SIgA)含量.结果 ①两组患者术后第一次粪便SIgA含量与术前相比均明显减少(ρ＜0.05),术后第二次粪便SIgA含量较术后第一次并未明显增多(ρ＞0.05),实验组术后1月粪便SIgA含量较术后第一、二次明显升高,且明显高于对照组(ρ＜0.05);②两组患者术后第一次血清TNF-α含量较术前明显升高(ρ＜0.05),术后第二次较术后第一次血清TNF-α含量有所降低(ρ＜0.05),术后第三次血清TNF-α含量实验组较对照组明显降低(ρ＜0.05);③两组患者血清CRP术后第一次较术前均明显升高(ρ＜0.05),术后第三次较第一次明显降低(ρ＜0.05),术后第三次较第二次也明显降低(ρ＜0.05),但实验组与对照组比较,实验组降低更明显(ρ＜0.05).结论 ①大肠癌患者手术后肠道粘膜免疫功能明显降低.②大肠癌患者术后粪便SIgA水平下降,应用肠道益生菌制剂短期内对升高SIgA效果不明显,但长期应用可显著升高SIgA水平.③大肠癌患者术后血清TNF-α和CRP水平显著升高,应用肠道益生菌制剂后可显著降低.     

益生菌(元)联合肠内营养对重症急性胰腺炎大鼠肠道屏障功能的影响

目的:探讨益生菌(元)联合肠内营养(EN)对重症急性胰腺炎(SAP)大鼠肠道屏障及吸收功能的影响.方法:将24只大鼠诱发重症胰腺炎模型后,随机分为四组,分别给予肠内要素营养(A组)、双歧三联活菌 肠内要素营养(B组)、β-葡聚糖 肠内要素营养(C组)以及双歧三联活菌 β-葡聚糖 肠内要素营养,即合生元 肠内要素营养(D组),共持续7天.四组大鼠营养供给为等热量和等氮量.第7天处死大鼠前,先作木糖吸收实验,取血检测血浆二胺氧化酶(DAO)、内毒素、肿瘤坏死因子(TNF)和白细胞介素-6(IL-6)的变化;再处死大鼠,取空肠观察小肠的病理改变,测量黏膜绒毛高度.结果:B组与A组相比,血浆内毒素、DAO、TNF和IL-6明显降低(P＜0.05),C组和D组虽有下降趋势,但无显著性差异(P＞0.05);B组和C组木糖吸收试验较A组明显改善(P＜0.05);病理检查显示,B组小肠结构较完整,黏膜厚度、绒毛高度均比A组明显增加(P＜0.05).结论:益生菌(元)联合EN可保护SAP大鼠肠道屏障及吸收功能;β-葡聚糖对SAP大鼠肠道功能改善不明显.     

Experience of long-term synbiotic therapy in seven short bowel patients with refractory enterocolitis

Background/Purpose

Probiotic and prebiotic therapies are potent new strategies to treat various intestinal diseases, including inflammatory bowel disease and viral and bacterial infections. Synbiotics is defined as the combined use of probiotics and prebiotics and is expected to have a stronger effect on intestinal diseases than probiotics or prebiotics alone, but there has been no report of its clinical application. The authors designed a protocol for synbiotic therapy composed of Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides and preliminarily ascertained its clinical effects in humans.

Methods

This protocol of synbiotic therapy was applied for more than 1 year to 7 malnourished patients with short bowels who suffered from refractory enterocolitis.

Results

The therapeutic protocol improved the intestinal bacterial flora (inducing the domination by anaerobic bacteria and suppressing the residence of pathogenic bacteria) and increased short chain fatty acids in the feces (from 27.8 to 65.09 μmol/g wet feces). All patients but 1 accelerated their body weight gain, and 5 patients showed increased serum rapid turnover proteins.

Conclusions

This protocol for synbiotic therapy might be a potent modulator of intestinal flora and a promising strategy to treat short bowel patients with refractory enterocolitis.     

Review of probiotics available to modify gastrointestinal flora

There is evidence that the oral consumption of micro-organisms produces a protective effect on the gut flora. A significant number of studies suggests that probiotics might have beneficial effects on several microbial disorders of the gut, but it is very difficult to define the clinical efficacy of such products. In this review, we report the results of studies on traveller’s diarrhoea (TD), antibiotic associated diarrhoea (AAD) and acute diarrhoea (AD) in which various probiotic preparations have been used in controlled trials and been shown to have a beneficial therapeutic or prophylactic effect.     

益生菌在使用抗生素后肝硬化患者中的临床研究

目的探讨益生菌在使用抗生素后的肝硬化患者中的临床效果。方法分析肝硬化患者60例临床资料,随机分配成对照组和研究组,另选住院后1个月内未使用抗生素及益生菌的肝硬化患者30例为正常对照组。结果研究组益生菌使用后LPS、ALT、AST、ALB、TBIL均明显优于对照组,研究组自发性腹膜炎、肝性脑病、上消化道出血发生率均优于对照组,P<0.05,差异均有统计学意义。结论肝硬化患者规律服用益生菌后可以改善肝硬化患者的临床症状,降低内毒素水平,值得临床推广应用。     

PROBIOTICS

The term “probiotic” was first used in 1965, by Lilly and Stillwell, to describe substances secreted by one organism which stimulate the growth of another. The use of antibiotics, immunosuppressive therapy and irradiation, amongst other means of treatment, may cause alterations in the composition and have an effect on the GIT flora. Therefore, the introduction of beneficial bacterial species to GI tract may be a very attractive option to re-establish the microbial equilibrium and prevent disease. Prebiotic is a non-digestible food ingredient that confers benefits on the host by selectively stimulating one bacterium or a group of bacteria in the colon with probiotic properties. Both probiotics and prebiotics are together called as Synbiotics. Various bacterial genera most commonly used in probiotic preparations are Lactobacillus, Bifidobacterium, Escherichia, Enterococcus, Bacillus and Streptococcus. Some fungal strains belonging to Saccharomyces have also been used. Probiotics have been shown to be effective in varied clinical conditions-ranging from infantile diarrhoea, necrotizing enterocolitis, antibiotic-associated diarrhoea, relapsing Clostridium difficle colitis, Helicobacter pylori infections, inflammatory bowel disease to cancer, female uro-genital infection and surgical infections. Lactobacillus rhamnosus strain GG has proven beneficial affects on intestinal immunity. It increases the number of IgA and other immunoglobulins secreting cells in the intestinal mucosa. It also stimulates local release of interferons. It facilitates antigen transport to underlying lymphoid cells, which serves to increase antigen uptake in Peyer’s patches. Probiotics are live microorganisms, so it is possible that they may result in infection in the host. The risk and morbidity of sepsis due to probiotic bacteria should be weighed against the potential for sepsis due to more pathological bacteria and the morbidity of diseases for which probiotic bacteria are being used as therapeutic agents. Also, future, well-designed placebo controlled studies with validated results are required for ascertaining the true health benefits of probiotics The important point in this regard is careful selection of the probiotic agent, its dose standardization and a thorough knowledge of its beneficial effects.     

Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials

Background  Advances in surgery have considerably lowered postoperative morbidity. However, infection remains a considerable morbidity factor. The aim of this review is to identify the potential benefit(s) of the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery. Methods  We searched PubMed, Scopus, Web of Science, and Cochrane library to identify randomized controlled trials (RCTs) that studied the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery. Results  Nine RCTs studying 733 patients were included in our review. The incidence of postoperative pneumonia, cholangitis, and any infections as well as the duration of postoperative hospital stay and length of antibiotic therapy were lower among patients receiving probiotics than in the control group [six RCTs, 355 patients, odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09–0.68; three RCTs, 209 patients, OR 0.18, 95% CI 0.05–0.57; seven RCTs, 514 patients, OR 0.26, 95% CI 0.12–0.55; five RCTs, 313 patients, OR −2.70, 95% CI −5.15 to −0.25; four RCTs, 250 patients, OR  −4.01, 95% CI −5.11 to −2.92, respectively], while the incidence of postoperative wound infection, urinary tract infection, intra-abdominal abscess, and mortality was not different between patients of the compared groups (six RCTs, 355 patients, OR 0.52, 95% CI 0.23–1.18; five RCTs, 313 patients, OR 0.44, 95% CI 0.04–5.54; four RCTs, 226 patients, OR 0.44, 95% CI  0.12–1.59; nine RCTs, 685 patients, OR 0.98, 95% CI 0.29–3.29, respectively). Conclusion  The use of probiotics/synbiotics may reduce postoperative infections after abdominal surgery. This is a promising infection-preventive measure that may decrease morbidity, length of antibiotic therapy, duration of hospital stay, and pressure for emergence of antimicrobial resistance. However, the results of this meta-analysis should be interpreted with caution due to the significant heterogeneity of the studies included.     

Novel therapeutic options in the inflammatory bowel disease world

Advances in the understanding of the pathogenesis of inflammatory bowel disease have encouraged the development of many new therapies targeted at specific and non-specific mediators of the inflammatory bowel disease inflammatory pathway. The role of these therapies, including novel anti-tumour necrosis factor-alpha agents, anti-adhesion molecules, recombinant cytokines, myeloid growth factors, helminths, and probiotics, in the management of paediatric onset inflammatory bowel disease is promising and warrants further investigation.     

益生菌CMS-H002和CMS-H003联用对小鼠急性溃疡性结肠炎的影响

目的：研究肠道益生菌CMS-H002和CMS-H003对小鼠溃疡性结肠炎（UC）的治疗作用。方法：建立硫酸葡聚糖胺（DSS）诱导的小鼠急性UC模型。观察益生菌CMS-H002和CMS-H003治疗后，疾病活动指数（DAI）、肠道菌群及丙二醛（MDA）的变化。结果：肠道益生菌CMS-H002和CMS-H003均可明显降低DAJ的水平及结肠组织的MDA水平。疗效均优于或等于巴柳氮阳性治疗药物。治疗后，各益生菌治疗组粪便乳酸杆菌、双歧杆菌菌数均有不同程度增加；而大肠杆菌及金黄色葡萄球菌菌数均有不同程度减少；其中用CMS-H003和合用组治疗后，丁酸梭菌菌数也有增加。以合用组小鼠粪便菌群更趋近于正常小鼠粪便菌群构成。而巴柳氮阳性治疗组对小鼠粪便的菌群菌数无明显影响。结论：口服肠道益生菌CMS-H002和CMS-H003可明显改善5％DSS诱导的Balb／c小鼠急性UC的一般表现及组织学损伤。两茼舍用效果尤为明显。减少自由基的产生及逆转病态菌群是它们发挥治疗UC作用的部分机制。