实时荧光定量PCR在测定艾滋病患者肠道菌群量变化中的应用及意义

目的:应用实时荧光定量PCR观察艾滋病患者肠道菌群量的变化,研究艾滋病对肠道微生态的影响及其在发病中的作用。方法:分别设计双歧杆菌属、乳酸杆菌属、大肠杆菌、粪肠球菌及屎肠球菌的特异性引物。收集艾滋病患者粪便标本30份及正常对照标本30份,提取细菌基因组DNA,应用实时荧光定量PCR反应测定5种细菌的数量。结果:艾滋病患者组双歧杆菌属、乳酸杆菌属的数量较正常对照组明显减少;大肠杆菌、粪肠球菌、屎肠球菌数量明显增多,差异有统计学意义(P<0.05)。结论:艾滋病患者肠道微生态发生了明显变化,提示艾滋病患者肠道微生态紊乱。     

应用16SrRNA荧光定量PCR技术研究β-内酰胺类抗菌药物对婴儿肠道菌群的影响

目的：探讨β-内酰胺类抗菌药物对婴儿肠道菌群的影响。方法选取0～1岁婴儿，应用16S rRNA 荧光定量 PCR技术，分别测定β-内酰胺类抗菌药物使用前，使用第3 d、5天时，及治愈后第7天粪便中双歧杆菌、乳酸杆菌、肠球菌、大肠杆菌的水平。结果使用过β-内酰胺类抗菌药物者粪便中双歧杆菌、乳酸杆菌、大肠杆菌和肠球菌的数量与未使用者比较，差异无统计学意义（P ＞0．05）。粪便双歧杆菌、乳酸杆菌含量随治疗时间的延长而增加，差异有统计学意义（P ＜0．05）。未使用抗菌药物的患儿肠道双歧杆菌和乳酸杆菌的恢复明显快于使用过抗菌药物的患儿，差异有统计学意义（P ＜0．05）。结论β-内酰胺类抗菌药物对婴儿肠道菌群有普遍的杀灭作用，对婴儿肠道菌群改变的影响是轻微的。β-内酰胺类抗菌药物的使用会延迟患儿肠道微生态的恢复，但若合理使用对疾病的治疗有积极作用。     

艾滋病患者容易忽视的几种肠道细菌感染

收集艾滋病患者粪便标本40例和正常人群粪便标本40例。提取细菌基因组DNA,采用实时荧光定量PCR测定双歧杆菌、乳酸杆菌、大肠杆菌、粪肠球菌和屎肠球菌的数量。结果滋病患者粪便的双歧杆菌、乳酸杆菌的数量明显少于正常人群的。艾滋病患者粪便中大肠杆菌、粪肠球菌和屎肠球菌的数量比正常人群粪便中数量明显增加。差异具有统计学意义。艾滋病患者肠道肠道细菌微生态发生变化,艾滋病患者肠道肠道微生态已经发生紊乱。     

老年首发未经治疗精神分裂症患者肠道菌群的变化

目的观察老年首发未经治疗的精神分裂症患者肠道菌群的变化,分析肠道菌群在精神分裂症中扮演的角色。方法选取30例2016年7月至2016年10月就诊于精神科的老年(≥60岁)首发未经治疗的精神分裂症患者作为观察组,30例同期体检的健康人作为对照组,采用16SrRNA实时荧光定量PCR(qPCR)检测对两组大便标本中的双歧杆菌属、乳酸杆菌属、拟杆菌属进行绝对定量。结果观察组粪便中双歧杆菌水平明显低于对照组,拟杆菌水平明显高于对照组,且肠道拟杆菌/乳酸杆菌与拟杆菌/双歧杆菌的比值明显升高,差异均有统计学意义(P0.05);两组的乳酸杆菌水平比较差异无统计学意义(P0.05)。结论老年首发未经治疗的精神分裂症患者存在肠道菌群的紊乱、肠道菌群比例失调等现象,肠道菌群可能参与了精神分裂症的发病。     

轮状病毒感染婴幼儿与健康婴幼儿肠道菌群对比分析

目的了解轮状病毒感染婴幼儿与健康婴幼儿的肠道菌群差异,探讨益生菌在轮状病毒感染时的作用及意义。方法回顾性收集15例0~3岁轮状病毒感染患儿(轮状病毒感染组)及15份健康婴幼儿(健康对照组)的粪标本,根据16Sr DNA基因序列设计双歧杆菌、乳酸杆菌、大肠杆菌、肠球菌、拟杆菌、梭菌、梭杆菌属的特异性引物,采用SYBR GreenⅠ实时荧光定量PCR法测定7种细菌的在健康组及患儿组的数量,进行比较。结果轮状病毒感染组与健康对照组比较,肠球菌、大肠杆菌、拟杆菌属数量差异无显著性(P0.05);轮状病毒感染组双歧杆菌、乳酸杆菌、梭菌、梭杆菌属数量明显少于健康组,差异均有统计学意义(P0.05)。结论轮状病毒感染对婴儿肠道菌群有影响,临床治疗应注意婴儿肠道菌群的调整。     

双歧杆菌四联活菌辅助治疗对高尿酸血症的临床分析

目的 研究高尿酸血症（HUA）患者肠道菌群变化,观察双歧杆菌四联活菌制剂干预对HUA治疗效果及肠道菌群影响。方法 将100例高尿酸血症患者随机分为实验组A组和标准组B组各50例,另选择同期健康体检者50例作为对照组C组。 A、B组患者均予非布司他治疗,B组加服双歧杆菌四联活菌片,疗程为2周。测定各组治疗前后的血尿酸及粪便结果。结果 治疗前,A、B组粪便中双歧杆菌、乳酸杆菌及粪肠球菌含量明显低于正常对照组,而大肠杆菌含量明显增多（P<0.05）。治疗后A、B患者血尿酸水平明显下降,其中A组明显低于B组（P<0.05）,A组患者粪便内细菌分解尿酸量较治疗前明显升高,且与B组具有统计学意义（P<0.05）,A组粪便中双歧杆菌、乳酸杆菌及粪肠球菌含量较治疗前明显增多,且与B组存在明显统计学意义（P<0.05）。 结论 HUA治疗过程中添加双歧杆菌活菌制剂辅助治疗可明显降低血尿酸,可能与肠道细菌尿酸处理能力增强有关。     

不同月龄婴儿肠道微生态改变的临床研究

目的：通过应用荧光定量PCR技术对不同月龄的正常婴儿、轮状病毒（RV）肠炎患儿肠道微生态进行动态检测,分析其肠道菌群变化,为临床提供数据参考。方法采用病例对照研究,选取不同月龄健康婴儿及RV肠炎患儿为研究对象,运用荧光定量PCR技术测定细菌的16SrRNA,对不同月龄健康婴儿和RV肠炎患儿粪便中双歧杆菌、乳酸杆菌、肠球菌、大肠杆菌进行定量分析。结果不同月龄婴儿肠道中双歧杆菌和肠球菌数量随月龄变化差异有统计学意义（P＜0.05）,乳酸杆菌和大肠杆菌数量差异无统计学意义（P＞0.05）。RV肠炎患儿肠道中双歧杆菌和乳酸杆菌含量在不同月龄阶段均低于健康对照组,差异有统计学意义（P＜0.05）,大肠杆菌和肠球菌含量仅在3月龄阶段低于健康对照组,差异有统计学意义（P＜0.05）,在6月龄和10月龄婴儿与健康对照组婴儿比较,差异无统计学意义（P＞0.05）。结论不同月龄婴儿的肠道微生态存在差异,客观评判婴儿肠道微生态需建立不同月龄的肠道微生态参考区间。RV对患儿肠道中益生菌的数量影响较大。     

绝经后骨质疏松患者骨免疫系统相关因子与肠道菌群的相关性

目的探究绝经后骨质疏松患者骨免疫系统相关因子与肠道菌群的相关关系。方法选取2017年5月—2021年4月收治的绝经后骨质疏松60例作为观察组,另选取绝经后健康体检者60例作为对照组。比较两组核转录因子-κB受体活化因子配体(RANKL)、核转录因子-κB受体活化因子(RANK)、骨保护素(OPG)水平,大肠杆菌、双歧杆菌及乳酸杆菌数量;分析骨免疫系统RANKL/RANK/OPG相关因子、肠道菌群对绝经后骨质疏松的影响,评价其对绝经后骨质疏松的诊断价值;分析骨免疫系统RANKL/RANK/OPG相关因子与肠道菌群的相关性。结果观察组RANKL水平、大肠杆菌数量高于对照组,OPG水平及双歧杆菌、乳酸杆菌数量低于对照组(P<0.01)。骨免疫系统RANKL/RANK/OPG相关因子、肠道菌群对绝经后骨质疏松联合诊断的AUC为0.912。RANKL、大肠杆菌为绝经后骨质疏松独立危险因素,OPG、双歧杆菌、乳酸杆菌为绝经后骨质疏松独立保护因素(P<0.05)。绝经后骨质疏松患者RANKL水平与双歧杆菌、乳酸杆菌数量呈负相关关系(r=-0.594、-0.579,P<0.01),与大肠杆菌数量呈正相关关系(r=0.602,P<0.01);OPG水平与双歧杆菌、乳酸杆菌数量呈正相关关系(r=0.601、0.581,P<0.01),与大肠杆菌数量呈负相关关系(r=-0.613,P<0.01)。结论绝经后骨质疏松患者骨免疫系统RANKL/RANK/OPG与肠道菌群失调有关,临床可通过调节肠道菌群失调治疗骨质疏松,为防治绝经后骨质疏松提供新思路。     

β-内酰胺类抗菌药物对社区获得性肺炎患儿肠道菌群多样性及肠道菌群代谢能力的影响

目的探讨β-内酰胺类抗菌药物对社区获得性肺炎(CAP)患儿肠道菌群多样性及肠道菌群代谢能力的影响。方法选择2018年1月至2019年12月在该院治疗的120例CAP患儿为研究对象,分别对治疗前及治疗后的菌群丰度、肠道菌群菌属以及肠道菌群代谢能力进行比较。结果与治疗前比较,治疗3 d后,患儿粪便中不动杆菌属、肠球菌属、颤螺菌属、埃格特菌属丰度均显著升高,奇异菌属、双歧杆菌属、Dorea、乳酸菌属、链球菌属、萨特菌属、韦荣球菌属的菌群丰度均显著下降,差异有统计学意义(P<0.05);治疗前后,不动杆菌属、肠球菌属、颤螺菌属、埃格特菌属、奇异菌属、双歧杆菌属、Dorea、乳酸菌属、链球菌属、萨特菌属、韦荣球菌属的优势条带相似度之间的差异无统计学意义(P>0.05);治疗后,患儿粪便中乙酸水平显著高于治疗前,异戊酸、戊酸、丙酸、异丁酸、丁酸水平显著低于治疗前(P<0.05)。结论CAP患儿长时间使用β-内酰胺类抗菌药物治疗后,患者的肠道菌群丰度显著下降,肠道代谢能力随之发生改变。     

早期补充益生菌对早产儿喂养及肠道菌群的影响

目的：研究早期口服双歧杆菌三联活菌对早产儿肠道菌群和喂养症状的影响。方法选择60例符合条件的住院早产儿并随机分为2组,分别为口服双歧杆菌三联活菌组（研究组）及对照组,在生后3d、1周及2周龄时分别留取早产儿大便标本,同时记录喂养症状,采用实时荧光定量PCR技术检测标本中的肠道乳酸杆菌及双歧杆菌。结果研究组喂养不耐受的发生率为4例（13.3%）,对照组为12例（40.0%）,2组比较差异具有统计学意义（P=0.0195）。研究组在1周时肠道乳酸杆菌和双歧杆菌的数量分别为7.84±0.35,8.52±0.23,对照组分别为6.39±0.53,7.01±0.48,2组比较差异有统计学意义（P=0.013,P=0.024）。研究组在2周时肠道乳酸杆菌和双歧杆菌的数量分别为8.62±0.28,9.45±0.64,对照组分别为7.34±0.59,7.85±0.43,2组比较差异有统计学意义（P=0.036,P=0.007）。结论早期口服双歧杆菌三联活菌的住院早产儿喂养不耐受发生率低于未口服双歧杆菌三联活菌早产儿,同时肠道的双歧杆菌及乳酸杆菌数量高于未口服双歧杆菌三联活菌早产儿。     

胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡发病中的作用

目的探讨胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡发病中的作用。方法采用病理组织学检查和快速尿素酶试验对76例胆汁反流性胃炎及22例兼有胆汁反流性胃炎和消化性溃疡的患者行幽门螺杆菌检测,并与29例消化性溃疡患者作对照。结果胆汁反流性胃炎组幽门螺杆菌阳性率为31.6%(24/76例),兼有胆汁反流性胃炎和消化性溃疡组幽门螺杆菌阳性率为59.0%(13/22例),消化性溃疡组幽门螺杆菌阳性率为72.4%(21/29例),前二组比较,差异有显著意义(P<0.05),后二组比较,差异无显著意义(P>0.05)。结论胆汁反流在胆汁反流性胃炎的发病中起主要作用,幽门螺杆菌感染在消化性溃疡的发病中起主要作用。胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡的共同发病中互不明显影响,幽门螺杆菌感染所起的作用可能更大一些。     

A Review of the Novel Application and Potential Adverse Effects of Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are known as a class of pharmaceutical agents that target H⁺/K⁺-ATPase, which is located in gastric parietal cells. PPIs are widely used in the treatment of gastric acid-related diseases including peptic ulcer disease, erosive esophagitis and gastroesophageal reflux disease, and so on. These drugs present an excellent safety profile and have become one of the most commonly prescribed drugs in primary and specialty care. Except for gastric acid-related diseases, PPIs can also be used in the treatment of Helicobacter pylori infection, viral infections, respiratory system diseases, cancer and so on. Although PPIs are mainly used short term in patients with peptic ulcer disease, nowadays these drugs are increasingly used long term, and frequently for a lifetime, for instance in patients with typical or atypical symptoms of gastroesophageal reflux disease and in NSAID or aspirin users at risk of gastrotoxicity and related complications including hemorrhage, perforation and gastric outlet obstruction. Long-term use of PPIs may lead to potential adverse effects, such as osteoporotic fracture, renal damage, infection (pneumonia and clostridium difficile infection), rhabdomyolysis, nutritional deficiencies (vitamin B12, magnesium and iron), anemia and thrombocytopenia. In this article, we will review some novel uses of PPIs in other fields and summarize the underlying adverse reactions.     

Management of gastroesophageal reflux disease

Gastroesophageal reflux disease is the most common and expensive digestive disease with complex and multi-factorial pathophysiologic mechanisms. Transient inappropriate relaxation of the lower esophageal sphincter is the predominant mechanism in the majority of patients with mild to moderate disease. Hiatal hernias and a reduced lower esophageal sphincter pressure have a significant role in patients with moderate to severe disease. Typical manifestations of gastroesophageal reflux disease include heartburn, regurgitation, and dysphagia. Atypical symptoms, such as noncardiac chest pain, pulmonary manifestations of asthma, cough, aspiration pneumonia, or ENT manifestations of globus and laryngitis, can be seen in patients with or without typical symptoms of gastroesophageal reflux disease. Endoscopy and ambulatory pH tests are best to evaluate the anatomic and physiologic impact ofgastroesophageal reflux disease. Complications of chronic gastroesophageal reflux disease include peptic strictures and Barrett metaplasia. Barrett esophagus is a major risk factor for esophageal adenocarcinoma, and upper endoscopy with surveillance biopsies is recommended for patients with Barrett esophagus. Medical therapy with anti-secretory agents (H2 blockers and proton pump inhibitors) is effective for most patients with gastroesophageal reflux disease. Surgical fundoplications and endoscopic treatment modalities are mechanical treatment options for patients with gastroesophageal reflux disease.     

Evaluation and management of nonulcer dyspepsia

When no organic cause for dyspepsia is found, the condition generally is considered to be functional, or idiopathic. Nonulcer dyspepsia can cause a variety of symptoms, including abdominal pain, bloating, nausea, and vomiting. Many patients with nonulcer dyspepsia have multiple somatic complaints, as well as symptoms of anxiety and depression. Extensive diagnostic testing is not recommended, except in patients with serious risk factors such as dysphagia, protracted vomiting, anorexia, melena, anemia, or a palpable mass. In these patients, endoscopy should be considered to exclude gastroesophageal reflux disease, peptic or duodenal ulcer, and gastric cancer. In patients without risk factors, consideration should be given to empiric therapy with a prokinetic agent (e.g., metoclopramide), an acid suppressant (histamine-H2 receptor antagonist), or an antimicrobial agent with activity against Helicobacter pylori. Treatment of patients with H. pylori infection and nonulcer dyspepsia (rather than peptic ulcer) is controversial and should be undertaken only when the pathogen has been identified. Psychotropic agents should be used in patients with comorbid anxiety or depression. Treatment of nonulcer dyspepsia can be challenging because of the need to balance medical management strategies with treatments for psychologic or functional disease.     

Proton pump inhibitors: update on their role in acid-related gastrointestinal diseases

Gastric acid is pathogenic in many gastrointestinal disorders, such as gastroesophageal reflux disease and peptic ulcer disease. Proton pump inhibitors (PPIs) are the antisecretory drugs of choice for serious acid-related conditions. Ample recent data exist to explicate virtually every aspect of the clinical management of acid-peptic disorders with PPIs. Although all PPIs are effective, there are some differences in their clinical performance, particularly in terms of the degree and speed of gastric acid suppression. Rapid onset of acid suppression may be particularly relevant to newer approaches, such as 'on-demand' or intermittent therapy for non-erosive reflux disease and shorter regimens for Helicobacter pylori eradication. New data, in addition, highlight differences in PPI metabolism that may both affect efficacy and predispose patients to drug-drug interactions. PPI selection should involve the awareness of these issues.     

反流性食管炎与幽门螺杆菌感染的关系分析

目的探讨和分析反流性食管炎与幽门螺杆菌感染之间的关系。方法回顾性分析2009年1月-2011年11月间胃镜确诊为反流性食管炎334例,所有患者均行快速尿素酶试验;其中反流性食管炎合并消化性渍疡57例,慢性非萎缩性胃炎102例。结果反流性食管炎的幽门螺杆菌感染率为21．6％,在幽门螺杆菌感染阳性的患者中最多见并发消化性溃疡,而在幽门螺杆菌感染阴性的患者中最多见并发慢性非萎缩性胃炎,解剖结构和动力障碍性疾病绝大多数并发于幽门螺杆菌阴性患者。A和B级反流性食管炎的幽门螺杆菌感染阴性的患者多于幽门螺杆菌感染阳性的患者。在A级反流性食管炎中幽门螺杆菌感染率28．0％,B级为8．4％,C＋D级为0．O％。结论反流性食管炎中幽门螺杆菌感染率低,幽门螺杆菌阳性的反流性食管炎多并发于消化性溃疡,提示幽门螺旋杆菌对反流性食管炎发病有一定保护作用。     

Recent Advances in Treatment of Malaria

In patients with reflux esophagitis, the procedure of choice is to restore cardioesophageal competence by ceating a sphincter mechanism at the cardioesophageal junction. Vagotomy and pyloroplasty are not indicated unless the patient has a concomitant peptic ulcer. Circumferential fundoplication with technical modifications proved effective in preventing gastroesophageal reflux in a series of patients treated at the Veterans Administration Hospital, Kansas City, Missouri.     

窄带成像内镜下齿状线观察评价胃食管反流病的价值

目的探讨窄带成像放大内镜结合齿状线形态观察评价胃食管反流病的价值。方法选取GERD组200例和对照组160例,Gred-Q评分法记录症状,通过窄带成像放大内镜观察齿状线形态、食管微血管表现,探讨Gred-Q评分法、齿状线形态、食管微血管表现的相关性及与胃食管反流病的关系。结果 GRED组患者NBI微血管异常阳性率显著高于对照组(P0.05)。GRED组患者齿状线形态异常率显著高于对照组(P0.05)。NBI微血管表现与Gerd-Q评分、齿状线形态与Gerd-Q评分、窄带成像内镜下微血管表现与齿状线形态均呈正相关(r=0.780、0.803、0.586,P0.01)。结论窄带成像放大内镜对胃食管反流病的诊断有重要临床价值。     

PDCA循环护理干预在胃食管反流病患者中的应用

目的探讨PDCA循环护理干预在胃食管反流病患者中的应用效果。方法选取胃食管反流患者100例,随机均分为对照组和观察组各50例。对照组患者在住院期间接受常规护理,观察组患者采用PDCA循环护理干预法。比较2组患者护理前后胃食管反流疾病问卷(RDQ)、抑郁自评量表(SDS)、焦虑自评量表(SAS)评分。结果 2组患者护理干预后,观察组患者的RDQ、SDS、SAS评分均低于对照组(P0.05)。结论 PDCA循环护理干预在胃食管反流术中应用效果较好,可有效缓解患者的负性情绪,对患者的康复状态有积极的影响。