炎症性肠病与营养支持疗法

炎症性肠病（IBD）是以反复发作的慢性肠道炎症为特点的一组疾病,包括溃疡性结肠炎(UC)和克罗恩病(CD)。我国IBD发病率呈快速增长趋势,而营养不良好发于IBD患者,尤其是CD患者。合理膳食,补充微量元素、钙、维生素D和益生菌等,有利于病情缓解和控制。营养支持疗法不仅可以改善营养状态,对于CD患者也具有一定的诱导和维持缓解作用。     

肠菌丛在炎症性肠病中的作用与益生菌治疗

细菌是慢性肠炎发生的始动因子,是炎症性肠病(IBD)的特征。现代观点支持IBD是被寄居在肠道的细菌引起异常的免疫反应所触发。益生菌是活菌,对宿主健康有益,益生素是肠道细菌的一种选择性营养物质,它能促进细菌的生长和代谢,并有增进宿主健康的作用。益生菌主要用于治疗过敏、自身免疫和炎症性疾病,它可改善症状并防止其复发。一、肠菌是IBD的始动钥匙感染性小肠-结肠炎和特发性IBD的病因,强有力地怀疑是由感染动因引起,然而摄入病毒或分枝杆菌和IBD之间并无结论性的发现。多方面证据指出,感染动因是引起IBD发生的基础,事实上IBD的…     

硫化氢在炎症性肠病中的作用研究进展

<正>炎症性肠病(inflammatory bowel disease,IBD)是以腹痛、腹泻为主要症状的非特异性慢性肠道炎症性疾病的总称。主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)等。该病发病率逐年升高,易复发且可并发其他多种疾病,严重影响患者生活质量。IBD病因与发病机制至今仍未完全明确,但普遍认为是遗传、环境及免疫等多种因素综合作用的结果。硫化氢(hydrogen sulfide,H₂S)是一种有毒气体,在体内参与包括肠道生理病理状态在内的多种生理过程。本文将就近年来H₂S及其在IBD中的研究进展加以综述。     

添加益生菌的低脂高蛋白肠内营养制剂在炎症性肠病中的疗效观察

目的:观察添加益生菌的低脂高蛋白肠内营养(EN)制剂对炎症性肠病(IBD)病人的治疗效果。方法:总结104例IBD病人的临床资料,按照使用EN不同,分为试验组(n=48)和对照组(n=56)。试验组病人使用添加益生菌的低脂高蛋白EN制剂,对照组使用常规EN制剂。所有病人在入院时和营养支持第14天分别测定营养指标和免疫指标等。结果:试验组病人前清蛋白、血小板计数、淋巴细胞明显高于对照组(P﹤0.05),同时达到目标营养液供给量的时间和腹泻发生率亦明显低于对照组(P﹤0.05)。结论:添加益生菌的低脂高蛋白EN比普通EN更能改善IBD病人的营养状况和改善肠道功能。     

粪菌移植在炎症性肠病中的治疗进展

炎症性肠病(IBD)是肠道慢性、复发性自身免疫性疾病,是由遗传易感的宿主对肠道菌群异常的免疫反应所致。近年来,肠道菌群与IBD患病的关系倍受关注。粪菌移植(FMT)是将健康人肠道菌群移植至病人的胃肠道内,重建具有正常功能的肠道菌群。许多研究结果表明,FMT在IBD治疗中有效。以下就国内外FMT中心发表的FMT在IBD病人中治疗进展作一综述。     

炎症性肠病80例临床观察

目的：总结分析沈阳二四五医院近10 年炎症性肠病（IBD） 的临床特点,观察IBD 的临床表现、并发症和肠外表现.方法：利用富士88 型电子肠镜对本院住院患者有腹痛、腹泻、腹部包块等症状的患者行肠镜检查,内镜活检取标本.结果：80 例明确诊断的IBD 患者并发症和肠外表现占10%、15%、6.25%,患者因并发症或肠外表现就诊.结论：IBD 临床表现多样,短期确诊困难,应通过提高对该病的认识,普及肠镜检查,以提高对IBD 的诊断水平.     

益生菌联合谷参肠安治疗腹泻型肠易激综合征的疗效观察

肠易激综合征（irritable bowel syndrome, IBS） 是最常见的功能性肠道疾病之一,主要症状有腹痛、腹胀、腹泻、排便习惯改变、大便性状异常、黏液便等,有IBS 症状者欧美报道为10%~20%,北京报道为8.7%,以中青年居多.症状常反复发作,迁延难愈,目前尚无规范统一的治疗方案,主要为去除促发因素及对症治疗,强调综合治疗和个体化治疗.IBS 患者普遍存在肠道菌群失调,采用微生态制剂进行治疗已经成为研究热点,本文就益生菌联用谷参肠安治疗这一顽症进行探讨.     

大肠杆菌Nissle 1917与肠屏障功能的研究进展

革兰氏阴性菌大肠杆菌Nissle 1917(Escherichia coli Nissle 1917,EcN)是一种非乳酸类益生菌。研究发现,EcN能长期稳定定殖于肠道,与肠上皮细胞及肠道其它微生物相互作用,发挥生物学效应。肠道屏障功能是维持肠道正常生理的重要机制,屏障功能的受损与多种疾病相关,寻求对肠道屏障功能有维持和修复作用的物质,是治疗诸多相关疾病的重点突破口。既往的研究发现,EcN对屏障功能有一定的保护作用,本文将从EcN对肠屏障功能的保护作用的产生机制方面进行系统文献综述。     

益生菌对肠微生物生态学影响的研究进展

益生菌通过调节肠道微生物生态平衡来纠正肠道菌群失调、改善肠道防御功能、维护肠道屏障功能等方面日益受到重视,并且有重要的理论意义和较大的临床价值.该文作者就益生菌对肠微生物生态学影响及其机制的研究现状作一综述.     

短肠综合征肠适应机制研究进展

短肠综合征残余肠道代偿是一个复杂的过程.许多因素对肠道代偿作用虽然在动物实验中已得到证实,但在临床应用中仍存有争议.阐明肠代偿机制对促进短肠病人残余肠道代偿功能具有重要的指导意义.     

Role of microecology in chronic inflammatory bowel diseases

Inflammatory bowel diseases (IBD) are chronic conditions of unknown etiology. Current therapy mitigates the severity of acute bouts of mucosal inflammation but an eradication therapy is lacking. Growing incidence of IBD is associated with social development. Epidemiology suggests a relationship between the establishment of the individual gut flora and the risk of developing IBD. Patients show an impaired tolerance towards commensal bacteria of the resident flora. Unrestrained activation of the intestinal immune system against some commensal bacteria appears to be responsible for the characteristic relapsing course of these diseases. Wide-spectrum antibiotic therapy reduces bacterial load and mitigates intestinal inflammation in human IBD and in animal models. Current research aims at the identification of probiotics for bacterial antagonism therapies. Probiotics are living microorganisms which upon ingestion in certain numbers exert health benefits beyond inherent basic nutrition. Colonization with a Lactobacillus reuteri strain can prevent the development of colitis in genetically susceptible mice. Other studies have used a bacterium genetically engineered to secrete the antiinflammatory cytokine IL-10 and demonstrated a therapeutic effect in animal models of colitis. Moreover, some probiotics may naturally exhibit antiinflammatory properties when interacting with the human gut mucosa. Prebiotics such as inulin have also been shown to prevent colonic inflammation in animal models. Preliminary clinical trials with probiotics in IBD are encouraging. Probiotics offer a valuable tool for the prevention and control of inflammatory bowel diseases.     

Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials

Human subjects and their enteric microbiota have evolved together to reach a state of mutual tolerance. Mounting evidence from both animal models and human studies suggests that inflammatory bowel disease (IBD) represents a malfunction of this relationship. The enteric microecology therefore represents an attractive therapeutic target with few side effects. Probiotics and prebiotics have been investigated in clinical trials as treatments for IBD, with conflicting results. The evidence for the use of probiotics in the management of pouchitis is persuasive and several studies indicate their effectiveness in ulcerative colitis. Trials of probiotics and prebiotics in Crohn's disease are less convincing. However, methodologies vary widely and a range of probiotic, prebiotic and combination (synbiotic) treatments have been tested in a variety of patient groups with an assortment of end points. Conclusions about any one treatment in a specific patient group can therefore only be drawn on evidence from relatively small numbers of patients. The present article reviews the role of the intestinal microbiota in the pathogenesis of IBD and addresses the clinical evidence for the therapeutic manipulation of bowel microbiota using probiotics, prebiotics and synbiotics in IBD.     

益生菌临床应用新进展

益生菌是对健康有益的活菌或活菌性膳食补充剂,具有改善肠道内环境、增强免疫和抗肿瘤等多种作用,在临床上越来越受到重视,已广泛应用于炎性肠病、手术后贮袋炎和腹泻等领域的研究,显示出良好的功效.现就益生菌的作用机制、临床应用的最新进展作一综述.     

Probiotics for inflammatory bowel diseases: a promising adjuvant treatment

Inflammatory bowel diseases (IBD) encompass ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis (IC), characterising chronic inflammation in the gastrointestinal tract, associated with changes in the immune system and in the intestinal microbiota. Thus, probiotics may offer an alternative or adjuvant approach to conventional therapy. The present review aims to summarise the mechanisms of action of probiotics in IBD and their therapeutic effects. Most of the studies suggest that probiotics are effective in the treatment of UC, especially when several strains are concomitantly administered. Species of Lactobacillus and Bifidobacterium genres are the most commonly used, and some studies even indicate that it is possible to replace medical therapy with probiotic supplementation. Regarding CD, the results of clinical trials are controversial and do not support the use of probiotics in this disease. In conclusion, probiotic supplementation is a promising adjuvant treatment in UC, but not in CD.     

Bioecological control of inflammatory bowel disease

It is today generally accepted, that the intestinal bacterial flora is deeply involved in the pathogenesis of human inflammatory bowel diseases (IBDs), although the exact presence of unwanted or lack of specific crucial bacteria are not yet known. Westerners lack to large extent important immunomodulatory and fibre-fermenting lactic acid bacteria (LAB), bacteria which are present in all with a more primitive rural lifestyle. Acute reduction of flora is observed in disease, including IBD, as well as in mental and physical stress. Some observations suggest the mucosa has lost its ability of holding back the pathogenic flora and prevent close contacts between resident microflora and the epithelial surface. Among the manifestations of IBD are increased inflammation and coagulability, impaired cellular membrane function, exaggerated nitric oxide production and impaired short-chain fatty acid production. Animal studies suggest, in addition to reduced flora, an intimate association with immunostimulatory DNA, malfunctioning trifoil factors, increased splanchnic metabolism and reduced availability of natural antioxidants. Treatment with plant fibres, antioxidants and sometimes probiotics have had limited success. The most dramatic effects are seen in the few cases where total faecal replacement (TFR) has been tried. The general experience this far is that the best effects are obtained with compositions of probiotics rather than with single LAB treatments.     

Emerging Roles of Probiotics in Prevention and Treatment of Breast Cancer: A Comprehensive Review of Their Therapeutic Potential

Breast cancer is the most common cancer among women. Need for novel preventive and curative approaches with more safety than the present one seems inevitable. This review is devoted to potentially favorable role of probiotics in prevention and treatment of breast cancer as well as their alleviating role regarding chemotherapy-induced side effects. Literature was searched for human, animal, and in vitro studies about the role of probiotics in breast cancer. In vitro studies showed that probiotic intervention induces cancer cells apoptosis and inhibits their proliferation. In animal models, treatment with probiotics inhibited tumor growth and reduced tumor size; also, the immunomodulatory, antiangiogenesis and antimetastatic activities of probiotics were illustrated. Human studies showed that intake of Lactobacillus casei shirota reduced the breast cancer incidence and consumption of fermented milk products and yogurt was inversely associated with breast cancer incidence; however, no study regarding the curative role of probiotics in breast cancer is available. Studies on the effect of probiotics on chemotherapy-induced side effects in breast cancer were contradictory but showed potential for more investigation. Probiotics seem to have a potential role in both prevention and treatment of breast cancer. However, more clinical studies are needed to elucidate their efficacy and safety.     

Bile Acid–Gut Microbiota Axis in Inflammatory Bowel Disease: From Bench to Bedside

Inflammatory bowel disease (IBD) is a chronic, relapsing inflammatory disorder of the gastrointestinal tract, with increasing prevalence, and its pathogenesis remains unclear. Accumulating evidence suggested that gut microbiota and bile acids play pivotal roles in intestinal homeostasis and inflammation. Patients with IBD exhibit decreased microbial diversity and abnormal microbial composition marked by the depletion of phylum Firmicutes (including bacteria involved in bile acid metabolism) and the enrichment of phylum Proteobacteria. Dysbiosis leads to blocked bile acid transformation. Thus, the concentration of primary and conjugated bile acids is elevated at the expense of secondary bile acids in IBD. In turn, bile acids could modulate the microbial community. Gut dysbiosis and disturbed bile acids impair the gut barrier and immunity. Several therapies, such as diets, probiotics, prebiotics, engineered bacteria, fecal microbiota transplantation and ursodeoxycholic acid, may alleviate IBD by restoring gut microbiota and bile acids. Thus, the bile acid–gut microbiota axis is closely connected with IBD pathogenesis. Regulation of this axis may be a novel option for treating IBD.     

Testing linkage and gene x environment interaction: comparison of different affected sib-pair methods

The aim of this study was to compare, under different models of gene-environment (G x E) interaction, the power to detect linkage and G x E interaction of different tests using affected sib-pairs. Methods considered were: 1) the maximum likelihood lod-score (MLS), based on the distribution of parental alleles identical by descent (IBD) in affected sibs; 2) the sum of the MLS (sMLS) calculated in affected sib-pairs with 2, 1, or 0 sibs exposed; 3) the predivided sample test (PST), which compares the IBD distribution between affected sib-pairs with 2, 1, or 0 sibs exposed; 4) the triangle test statistic (TTS), which uses the IBD distribution among discordant affected sib-pairs (one exposed, one unexposed); and 5) the mean interaction test (MIT), based on the regression of the proportion of alleles shared IBD among affected sib-pairs on the exposure among sib-pairs. The MLS, sMLS, and MIT allow detection of linkage. However, the sMLS and MIT account for a possible G x E interaction without testing it. In contrast, the PST and the TTS allow detection of both linkage and G x E interaction. Results showed that when exposure cancels the effect of the gene, or changes the direction of this effect (i.e., the protective allele becomes the risk allele), the PST, sMLS, and MIT may provide, under some models, greater power to detect linkage than the MLS. Under models where exposure changes the direction of the effect of the gene, the TTS test may also be more powerful than the other tests accounting for G x E interaction. Under the other models, the MLS remains the most powerful test to detect linkage. However, only the PST and TTS allow the detection of G x E interaction.     

Probiotics in inflammatory bowel diseases and associated conditions

A complex set of interactions between the human genes encoding innate protective functions and immune defenses and the environment of the intestinal mucosa with its microbiota is currently considered key to the pathogenesis of the chronic inflammatory bowel diseases (IBD). Probiotics offer a method to potentially alter the intestinal microbiome exogenously or may provide an option to deliver microbial metabolic products to alter the chronicity of intestinal mucosal inflammation characterizing IBD. At present, there is little evidence for the benefit of currently used probiotic microbes in Crohn's disease or associated conditions affecting extra-intestinal organs. However, clinical practice guidelines are now including a probiotic as an option for recurrent and relapsing antibiotic sensitive pouchitis and the use of probiotics in mild ulcerative colitis is provocative and suggests potential for benefit in select patients but concerns remain about proof from trials.     

Mechanistic Insight of Probiotics Derived Anticancer Pharmaceuticals: A Road Forward for Cancer Therapeutics

Probiotics are living organisms that confer health benefits when administered in adequate amounts. Probiotics are continuously being explored for their different health beneficiary activities. Anticancer activity is one of the most important benefits both from a preventive and therapeutic point of view. Though not many studies have been conducted to date in this area, a number suggest using laboratory animal models and different cell lines that there may be a mechanistic basis for the anticancer effects of probiotics and require more scientific justification and clinical trials. Most studies of probiotics are conducted for colon cancer associated with inflammatory bowel disease. Studies are also being extended to other types of cancer in different cell lines. This review summarizes studied probiotics considered for treatment of colon cancer and some other cancers (in cancer cell lines) and also proposed mechanism how probiotics are inhibiting cancer growth along with some challenges and future perspectives.