乳果糖对肠道菌群及SIgA含量的影响

目的分析31名血液病患儿服用乳果糖前后肠道菌群及SIgA含量.方法用培养方法检测肠道菌群,用单向琼脂免疫扩散法测定粪便中SIgA.结果服用乳果糖后,血液病患儿肠道内双歧杆菌数量增加,分泌SIgA水平上升.结论乳果糖刺激机体肠道内双歧杆菌生长以及免疫系统分泌SIgA,增加肠道局部免疫力.     

低聚果糖对双歧杆菌增殖效果及肠道菌群的影响

目的分析低聚果糖体外对双歧杆菌的增殖效果，及体内对肠道菌群的影响。方法在厌氧菌液体培养基中加入低聚果糖，观察双歧杆菌的增殖情况；用培养方法检测肠道菌群。结果在厌氧菌液体培养基中加入低聚果糖前后双歧杆菌菌数分别为1．5亿／ml和3亿／ml；服用低聚果糖后，35～50患者肠道内肠杆菌及类杆菌显著减少，50岁以上者肠道内双歧杆菌显著增多。结论低聚果糖对双歧杆菌有增殖效果，对人体肠道菌群具有一定的调节作用。     

双歧杆菌制剂在烧伤患儿中的应用

由于烧伤所致的一系列的病理改变,使肠道正常菌群所栖居的生物环境改变。临床表现为,大便次数增多及质量的改变,同时可伴不同程度的水电解质紊乱及全身中毒症状。服用双歧杆菌制剂后,肠道内双歧杆菌数量增加,白色念球菌数量下降,患儿失调的肠道菌群趋向正常;双歧杆菌制剂的应用重建了肠道菌群微生态平衡,重建了防御屏障,阻止了外袭菌的定植,达到治疗腹泻的目的,且其价位不高,无毒副作用,     

低聚果糖对双歧杆菌增殖效果及肠道菌群的影响

目的　分析低聚果糖体外对双歧杆菌的增殖效果,及体内对肠道菌群的影响。方法　在厌氧菌液体 培养基中加入低聚果糖,观察双歧杆菌的增殖情况;用培养方法检测肠道菌群。结果　在厌氧菌液体培养基中 加入低聚果糖前后双歧杆菌菌数分别为1.5亿/ml和3亿/ml;服用低聚果糖后,35～50患者肠道内肠杆菌及类 杆菌显著减少,50岁以上者肠道内双歧杆菌显著增多。结论　低聚果糖对双歧杆菌有增殖效果,对人体肠道菌 群具有一定的调节作用。     

早期肠内营养联合合生元制剂对重型颅脑损伤病人肠道菌群及SIgA的影响

[目的]观察早期肠内营养联合合生元制剂对重型颅脑损伤病人肠道主要正常菌群（大肠杆菌、肠球菌、双歧杆菌、乳酸杆菌、类杆菌和梭菌）、粪便分泌型IgA（SIgA）和感染性并发症的影响。[方法]将49例重型颅脑损伤病人随机分为两组,对照组24例,研究组25例;对照组于伤后24h～48h内采用肠内营养制剂（瑞素）开始营养支持;研究组在对照组的基础上,在肠内营养支持的前14d联合合生元制剂（金双歧）。在肠内营养支持0d、4d、8d和15d分别采集粪便标本进行肠道主要正常菌群定量分析和采用酶联免疫吸附法测定粪便SIgA。观察研究期间两组病人感染性并发症的差异。[结果]在肠内营养支持8d和15d,研究组大肠杆菌和肠球菌低于对照组（P〈0.05或P〈0.01）,双歧杆菌和乳酸杆菌高于对照组（P〈0.01）;类杆菌和梭菌组间比较均无统计学意义（P〉0.05）。在肠内营养支持8d和15d研究组大便SIgA含量高于对照组（P〈0.05）;研究组术后的感染性并发症发生率低于对照组（33.33%比50.00%）,但差异无统计学意义（P〉0.05）。[结论]与普通早期肠内营养比较,早期肠内营养联合合生元制剂可有效改善重型颅脑损伤病人肠道菌群失衡,上调肠道局部免疫功能。     

早期肠内营养联合合生元制剂对重型颅脑损伤病人肠道菌群及SIgA的影响

[目的]观察早期肠内营养联合合生元制剂对重型颅脑损伤病人肠道主要正常菌群(大肠杆菌、肠球菌、双歧杆菌、乳酸杆菌、类杆菌和梭菌)、粪便分泌型IgA (SIgA)和感染性并发症的影响.[方法]将49例重型颅脑损伤病人随机分为两组,对照组24例,研究组25例;对照组于伤后24h～48 h内采用肠内营养制剂(瑞素)开始营养支持;研究组在对照组的基础上,在肠内营养支持的前14 d联合合生元制剂(金双歧).在肠内营养支持0 d、4 d、8 d和15 d分别采集粪便标本进行肠道主要正常菌群定量分析和采用酶联免疫吸附法测定粪便SIgA.观察研究期间两组病人感染性并发症的差异.[结果]在肠内营养支持8 d和15 d,研究组大肠杆菌和肠球菌低于对照组(P＜0.05或P＜0.01),双歧杆菌和乳酸杆菌高于对照组(P＜0.01);类杆菌和梭菌组间比较均无统计学意义(P＞0.05).在肠内营养支持8 d和15 d研究组大便SIgA含量高于对照组(P＜0.05);研究组术后的感染性并发症发生率低于对照组(33.33%比50.00%),但差异无统计学意义(P＞0.05).[结论]与普通早期肠内营养比较,早期肠内营养联合合生元制剂可有效改善重型颅脑损伤病人肠道菌群失衡,上调肠道局部免疫功能.     

优菌多颗粒对人体肠道益生菌影响的初步研究

目的探讨服用微生态制剂对人体肠道益生菌的影响。方法通过优菌多颗粒人群试食，对服用前后胃肠道症状、代谢、排便情况和食欲表现及菌群变化等指标进行统计分析，并结合肠道菌群DNA指纹图谱分析，评价优菌多颗粒对人体肠道菌群的调节功能。结果试食人群食欲表现和胃肠道症状在服用优菌多颗粒4—8d后得到显著改善，12d后极显著改善；在服用优菌多颗粒20d后，人体肠道菌群中双歧杆菌和乳酸杆菌与服用前相比有极显著提高，而肠道致病菌产气荚膜梭菌却极显著下降；在服用20d优菌多颗粒后，人体肠道菌群比服用前更具多样性。结论优菌多颗粒具有调节人体肠道菌群的作用，使人体肠道细菌种群更具多样性。     

口服微生态制剂对直肠癌患者术后肠道菌群分布及SIgA的影响

目的探讨低位直肠癌患者行腹、会阴联合直肠癌根治术(Miles术)术后口服微生态制剂对肠道菌群及粪便分泌型免疫球蛋A(SigA)含量的影响。方法将126例Miles术后患者采用随机化原则分成观察组和对照组,每组各63例。观察组患者术后给予口服双歧三联活菌胶囊(培菲康胶囊),对照组常规治疗。分别于入院时、术后第一次排便、术后1个月收集两组患者的新鲜大便,比较两组患者的肠道菌群的改变及粪便SIgA含量。结果术后第一次排便及术后1月观察组双歧杆菌、乳酸杆菌、拟杆菌数量显著高于对照组(P0.05),而肠球菌、肠杆菌数量均显著低于对照组(P0.05)。术后1个月,观察组患者的肠道菌群与手术前相比,基本恢复(P0.05)。术前及术后第一次排便,两组患者粪便中的SIgA水平无显著差异(P0.05);而术后1个月,观察组粪便SIgA含量均显著高于对照组(P0.05),且恢复至术前水平,而对照组仍低于术前水平。结论直肠癌Miles手术后口服微生态制剂可有效纠正患者肠道菌群失调,并通过升高粪便SIgA含量恢复肠道屏障功能和局部免疫力。     

儿童抗幽门螺旋杆菌感染治疗对肠道菌群影响的研究

目的探讨抗幽门螺旋杆菌 (helicobacter pylori,Hp)感染治疗对患儿肠道菌群的影响,为预防抗生素所致肠道不良反应提供实验依据。方法收集2013年12月～2014年7月在陕西省人民医院消化内科、儿科共60例患儿,对Hp阳性患儿使用克拉霉素片、阿莫西林／克拉维酸钾片和奥美拉唑肠溶胶囊抗Hp菌治疗10天后,留取新鲜粪便标本进行肠道菌群分析。分别称取患儿治疗前后的新鲜粪便1.0 g,进行肠道菌群培养,鉴定肠道菌群的菌种,将其数量和检出率等观察指标进行统计学分析。结果肠杆菌、肠球菌、双歧杆菌、类杆菌和乳杆菌在抗Hp感染治疗前后患儿肠道的检出率均为100%。治疗后双歧杆菌、乳杆菌数量下降,差异有统计学意义(t=44.745～49.19,P<0.01),其余肠杆菌、肠球菌、类杆菌、产气荚膜梭菌和酵母菌五类菌种治疗前后的数量差异无统计学意义(P>0.05)。治疗后患儿肠道微生物定植抗力值(B/E值)0.69±0.33,较治疗前1.18±0.44降低(t=7.715,P<0.05)。结论抗Hp感染治疗易引起患儿双歧杆菌和乳杆菌菌群紊乱,患儿肠道定植抗力降低。故抗菌药物治疗Hp感染时须注意及时补充以双歧杆菌和乳杆菌为主要成分的益生菌制剂。     

优菌多颗粒对人体肠道益生菌影响的初步研究

目的探讨服用微生态制剂对人体肠道益生菌的影响。方法通过优菌多颗粒人群试食,对服用前后胃肠道症状、代谢、排便情况和食欲表现及菌群变化等指标进行统计分析,并结合肠道菌群DNA指纹图谱分析,评价优菌多颗粒对人体肠道菌群的调节功能。结果试食人群食欲表现和胃肠道症状在服用优菌多颗粒4~8 d后得到显著改善,12 d后极显著改善;在服用优菌多颗粒20 d后,人体肠道菌群中双歧杆菌和乳酸杆菌与服用前相比有极显著提高,而肠道致病菌产气荚膜梭菌却极显著下降;在服用20 d优菌多颗粒后,人体肠道菌群比服用前更具多样性。结论优菌多颗粒具有调节人体肠道菌群的作用,使人体肠道细菌种群更具多样性。     

Ammonia and glutamine metabolism of the intestine. The effect of lactulose and neomycin

The present work is directed to distinguish between ammonia production by the mucosa and by the intestinal flora, as well as to evaluate the influence of neomycin and lactulose. In vitro studies using rat intestine show that mucosa cells produce ammonia alanine and glutamic acid when incubated with glutamine, whose process can be impaired by neomycin or lactulose. Since the release of the above solutes is virtually the same in germ-free rats, the influence of the bacterial flora might be negligible under the experimental conditions used. Elimination of the aerobic microorganisms results in a minute decrease of ammonia concentration in portal blood in contrast to elimination of the anaerobic flora, which leads to an excessive reduction of ammonia formation. In germ-free rats colonisation with anaerobic microorganisms results in an increment in portal ammonia concentration, whose value, however, is still below levels observed in normal animals. Colonisation with aerobic bacteria has no effect on portal ammonia concentration. Neomycin and lactulose affect ammonia production in the gut by interfering with glutamine uptake in the mucosa cell, thus the influence upon ammonia formation apparently can not be exclusively explained by alterations of the intestinal flora. Possible reasons for the considerable increase in arterial glutamine levels in normal rats are discussed.     

关于肠黏膜屏障功能衰竭临床分期标准的初步探讨

目的 初步建立肠粘膜屏障功能衰竭(Intestinal barrier failure,IBF)的临床分期标准。方法　选取消化系统恶性肿瘤、肝硬化、炎性肠病等患者共50例作为病例组，选取25例健康志愿者作为对照组，均口服双糖探针后检测样本尿液中乳果糖/甘露醇（lactulose/mannitol，L/M）含量以评价肠道通透性，同时采集其新鲜粪便行菌群分析，记录其临床指标及实验室指标，分析病例组与对照组的临床表现、肠道通透性、肠菌群及免疫指标间的关系。结果　同对照组(0.02938±0.00725)相比，病例组尿L/M比值(0.06694±0.02343)显著增高，差异有统计学意义（t＝9.874，P<0.01）。不同程度菌群失调患者肠道通透性无显著差异（F＝2.285，P＝0.113）。随着患者腹胀及腹泻程度的增高，肠道通透性增高及中重度菌群失调的比率也增加。病例组C反应蛋白（47.8±33.5mg/L VS 3.2±2.6mg/L）、血浆内毒素（5.806±4.219EU/ml VS 0.018±0.056EU/ml）及血清IL-6(22.19±8.45pg/ml VS 6.24±0.13pg/ml)水平较之对照组均有显著升高（P均<0.01）。结论 　根据患者的临床症状、肠粘膜通透性、肠菌群状态及免疫指标间的关系，可初步建立IBF的临床分期标准。     

Intestinal permeability and lactose hydrolysis in human rotaviral gastroenteritis assessed simultaneously by non-invasive differential sugar permeation

Changes in intestinal permeability and lactose hydrolysis have been investigated in three adults and fifteen infants with acute rotaviral gastroenteritis by differential sugar absorption. The method involves chromatographic measurement of urinary lactose, lactulose and L-rhamnose excretion following combined ingestion in an iso-osmolar test solution. All patients had abnormal intestinal permeability indicated by raised urine lactulose/L-rhamnose excretion, ratio of percentages recovered in 5 h, of 0.462 (0.100-1.227) mean and range, compared with 0.027 (0.008-0.052) for healthy controls (P less than 0.001). Ten patients also had urinary lactose/lactulose excretion ratios raised above the normal range (0.014-0.41, mean 0.258) during their acute illness, indicating impaired intestinal lactose hydrolysis. Both indices had become normal 4 weeks after the acute illness, serial investigation of five patients showing that improvement was complete much earlier. Except for the short duration these changes are similar to those associated with villous atrophy in coeliac disease. The test procedure was verified with respect to intestinal lactose hydrolysis by demonstrating a linear relationship between lactose/lactulose excretion and log jejunal mucosal lactase activity by in vitro assay (R2 = 0.95) in a further group of subjects. Differential lactose/lactulose/L-rhamnose absorption provides a non-invasive and sensitive index of small intestinal integrity of value for the interpretation of prolonged or otherwise complicated enteritis and the distinction of primary secondary intestinal lactase deficiency.     

溃疡性结肠炎患者肠道菌群与血TNF-α、内毒素水平的关系

目的 探讨溃疡性结肠炎(UC)患者肠道菌群特点及血中肿瘤坏死因子(TNF)-α、内毒素含量变化,为UC治疗和病情评估提供依据.方法 选取确诊的57例UC患者,其中缓解期28例,活动期29例,10例健康体检者作对照.运用可培养细菌菌群分析方法,对每例受试者粪便进行分析;清晨空腹抽血酶联免疫吸附(ELISA) 法测TNF-α含量,采用鲎试剂三肽显色基质偶氮法测内毒素水平.结果 UC活动期组与缓解期组、对照组比较乳酸杆菌数量明显减少,差异显著(P<0.01);双岐菌UC缓解期组数量少于对照组(P<0.05),活动期组数量明显减少,与缓解期组、对照组比较均具有显著性差异(P<0.01);UC活动期组内毒素水平明显升高,与缓解期组、对照组比较均具有显著性差异(P<0.01);UC活动期组TNF-α水平明显升高,与缓解期组、对照组比较均具有显著性差异(P<0.01);乳酸杆菌数量与血桨内毒素水平、血清TNF-α含量均呈负相关(r=-0.860、-1.038,P<0.01);双岐菌数量与血桨内毒素水平、血清TNF-α含量均呈负相关(r=-0.932、-0.843,P<0.01).结论 UC患者存在菌群失调;测定UC患者血TNF-α、内毒素水平有益于评估病情.     

Intestinal permeability,vitamin A absorption and serum alpha-tocopherol during therapy with gefitinib

Abstract

Measurement of intestinal permeability represents one of the potential methods of noninvasive laboratory assessment of gastrointestinal toxicity of anticancer therapy. We have assessed intestinal permeability (by measuring absorption of lactulose, mannitol, and xylose), vitamin A absorption and serum alpha-tocopherol in patients with non-small cell lung carcinoma or head and neck carcinomas treated with gefitinib. Lactulose, mannitol and xylose were determined by capillary gas chromatography, and retinol, alpha-tocopherol, retinyl stearate and retinyl palmitate were determined by high-performance liquid chromatography. Compared to healthy controls, patients had significantly increased lactulose/mannitol ratio and lower postprandial retinyl palmitate and retinyl stearate concentrations. Compared with pre-treatment values, xylose absorption was decreased and lactulose/mannitol and lactulose/xylose ratios were increased during the therapy. A significant decrease of serum alpha-tocopherol was evident throughout the course of therapy. In contrast, only minor alterations of vitamin A absorption were observed. In conclusion, an alteration in intestinal permeability reflected in increased lactulose/mannitol and lactulose/xylose ratios was observed during gefitinib therapy. Potential association between decreased serum alpha-tocopherol concentrations and the toxicity of gefitinib therapy should be further investigated.     

Effects of pre- and post-absorptive factors on the lactulose/rhamnose gut permeability test

It is assumed that the outcome of the lactulose/rhamnose gut permeability test is not influenced by pre- or post-absorptive factors. The aim of our study was to investigate the role of a pre-absorptive factor, i.e. small-intestinal transit, and a post-absorptive factor, i.e. renal clearance. Ten healthy male subjects were studied. Urinary lactulose and rhamnose excretion was measured after intraduodenal administration of lactulose and rhamnose following induction of increased intestinal permeability using chenodeoxycholic acid (chenodiol), in the absence and in the presence of accelerated intestinal transit. Urinary sugar excretion was measured after intravenous administration of either a regular dose (50 mg/50 mg) or a high dose (250 mg/250 mg) of lactulose/rhamnose. The intraduodenal experiments showed that a combination of accelerated small-bowel transit and increased permeability did not lead to significant differences in the recovery of lactulose (P=0.647) or rhamnose (P=0.889), or in the lactulose/rhamnose ratio, compared with those under conditions of increased permeability alone (P=0.68). However, lactulose recovery was significantly lower (P=0.025) after intravenous administration of a high dose of the sugars. There was no significant difference in urinary rhamnose recovery (P=0.575) between the high and the regular doses. This resulted in a significantly lower lactulose/rhamnose ratio (P=0.021) after intravenous administration of a high dose, compared with a regular dose, of the sugars. In conclusion, the assumption that post-absorptive processes do not influence the outcome of the lactulose/rhamnose permeability test appears not to be valid.     

Effectiveness of lactulose syrup after cardiac surgery.

Dutch cardiac surgery centers lack consistency in management with respect to the prevention of postoperative constipation. Although not based on any evidence, the administration of lactulose syrup is widely used. Because it often causes intestinal discomfort such as abdominal pain, bowel cramps, and feelings of distention, a study was performed in postoperative cardiac surgery patients who were given either standard care (routine administration of lactulose syrup twice daily) or laxative on indication. Postoperative constipation appeared equally frequent in both groups, and patients who received lactulose had more symptoms of intestinal discomfort. Based on these findings, it is safe to abolish the routine management of postoperative laxatives on a cardiac surgery ward.