益生菌临床应用的研究进展

近年来,研究发现多种疾病的发生与肠道菌群失调密切相关,而益生菌在维持肠道菌群平衡中起重要作用。益生菌在预防和治疗腹泻、肥胖、肝脏损伤、肿瘤等疾病中展示良好的效果,其临床制剂的开发已成为当前研究的热点。随着益生菌制剂的广泛使用,益生菌可能带来的不良反应也需要得到重视。本文阐述了益生菌制剂对疾病的预防、治疗及不良反应的研究进展,旨在为益生菌精准治疗及拓展益生菌临床应用提供理论依据。     

益生菌预防抗生素相关性菌群失调的临床研究

目的:探讨以双歧杆菌为主的益生菌预防抗生素相关性肠道菌群失调的作用。方法:将200例需要长时间应用抗生素的患者随机分为治疗组和对照组,治疗组在使用抗生素治疗的同时加用双歧杆菌三联活菌胶囊(培菲康)630 mg,每天3次,口服,分别观察两组患者肠道菌群失调发生率。结果:肠道菌群失调发生率治疗组为9%,对照组为37%,两组比较差异有统计学意义(P<0.01),肠道菌群失调发生与基础疾病和年龄有相关性。结论:益生菌可以有效预防抗生素相关性肠道菌群失调的发生,使用抗生素患者应该同时服用益生菌药物。     

益生菌临床应用的研究进展

益生菌作为人体肠道正常菌群重要组成部分,对维持肠道菌群平衡起重要作用。近年来的研究发现,越来越多的疾病与肠道菌群失调相关,调节肠道菌群平衡对许多疾病的治疗有重要意义,益生菌也随之在胃肠道疾病、肥胖与代谢紊乱相关疾病、抑郁症的防治等许多方面得到应用。益生菌在肾结石和肿瘤的预防与治疗方面的应用前景也引起国内外学者的高度重视,有可能为我们攻克癌症难题提供新思路。与此同时,应用益生菌可能带来的毒副作用也应该引起临床工作者的重视。     

益生菌对肠易激综合征合并小肠细菌过度生长的治疗作用

目的:探讨应用益生菌治疗肠易激综合征合并小肠细菌过度生长的临床效果.方法:选择我院收治的该类患者实施分组研究,对照组均按照常规方式予以新霉素治疗,研究组联合使用益生菌实施治疗.将两组临床疗效情况进行对比.结果:研究组临床治疗总有效率高达84.38％,显著高于对照组的65.63％,差异具有统计学意义(P＜0.05);两组患者均未发生明显的药物不良反应(P＞0.05).结论:应用益生菌针对肠易激综合征合并小肠细菌过度生长进行治疗,可以产生显著的临床效果,值得推广.     

快速肠道准备方法联合益生菌制剂用于术前肠道准备的效果观察

目的 观察快速肠道准备方法联合益生菌用于术前肠道准备的效果.方法 124例择期行手术治疗结直肠癌患者按照肠道准备方式不同随机分为益生菌组(65例)和对照组(59例),对照组于术前采用传统的3d肠道准备方法;益生菌组于术前采用1d快速肠道准备方法,并给予益生菌制剂口服.观察两组患者的体温、心率变化及术后第1、8天检测全血细菌DNA比值,观察外周血白细胞计数及全身炎症反应综合征(SIRS)和并发症发生情况.结果 益生菌组术后发热时间(4.15±0.89)d、心率(89.91±8.59)次/min,明显低于对照组的(6.34±1.12)d、(104.27±11.67)次/min(t=11.52、20.07,均P＜0.05);益生菌组白细胞计数恢复正常时间(4.59±0.29)d、全血细菌DNA阳性率3.30％( 2/65),与对照组的(7.24±0.24)d、26.67％( 8/59)差异均有统计学意义(t=5.07,x2=34.68,均P＜0.05);益生菌组SIRS发生率72.31％ (47/65),与对照组的76.27％ (45/59)差异无统计学意义(P＞0.05);两组切口感染发生率分别为4.35％ (3/65)、3.39％(2/59),腹腔感染发生率分别为1.45％( 1/65)、1.69％ (1/59),两组差异均无统计学意义(均P＞0.05).结论 快速肠道准备方法联合益生菌制剂能提高肠道准备效果,有利于患者术后早期炎性反应的恢复.     

肠道菌群与慢性便秘关系的研究进展

慢性便秘是一种常见、负担沉重的慢性疾病,很少病人会因症状求医,且治疗后远期效果不甚理想。迄今为止便秘的病因和病理生理也不是完全清楚,但肠道菌群和膳食纤维与便秘之间有着重要关系已是共识。越来越多研究证实便秘病人肠道菌群存在不同程度的紊乱,肠道微生物的改变可能改善便秘相关症状,而益生菌治疗已成为慢性便秘治疗的重要方式。益生菌可能是通过改变肠道菌群结构、代谢产物促进肠蠕动、增加粪便水分等机制改善便秘症状的。该文就从慢性便秘病人肠道菌群差异性和益生菌在慢性便秘治疗中的作用两方面进行文献综述。     

益生菌在感染性疾病中的应用现状

细菌屏障对黏膜的保护作用对人体健康至关重要,微生物群在人体的各个角落发挥作用。一方面有益菌增强人体体质,提高免疫力;另一方面,菌群失调导致炎症等疾病的产生。大量研究证明了益生菌在不同感染性疾病中的功效,因此益生菌在感染性疾病的临床治疗中被用作佐剂。本文总结了益生菌在不同感染性疾病的预防和治疗中的作用,展望了益生菌在未来取代抗菌药物的可能性。     

肠道菌群与健康、疾病和药物作用的影响

肠道菌群作为人体内一个复杂的微生态系统,在维持人体微生态的稳态中,肠道菌群在维持宿主生理功能具有上非常重要的作用,也对许多代谢性疾病、免疫性疾病以及肿瘤都有着密切的关系,且对于药物治疗合理安全有效具有重要意义。本文从正视存在人体的细菌的有益性和有害性、肠道菌群与健康和寿命、肠道菌群与疾病以及药物作用的影响等4方面分析和讨论。肠道菌群与不同类型药物的关系已经成为近些年的热点研究领域,本文分别讨论免疫治疗、化学药物、抗生素和中药的相关问题,希望为认识药物治疗过程、科学合理用药、认识药物作用机制、新药研究开发等研究有所参考。     

基于肠道菌群发现用于治疗Treg缺失免疫缺陷病的新药

目的肠道菌群紊乱与机体多种免疫失衡疾病的发生密切相关,如自身免疫性疾病、肿瘤和代谢综合征等。正是由于肠道菌群的稳定对人体健康至关重要,因此肠道微生态药物已经成为了现在研究与发展的热门产业。本研究挖掘肠道菌群及其代谢产物,发现可用于治疗Treg缺失免疫缺陷病的益生菌和天然产物。方法利用16S r DNA测序技术对Treg缺失介导的自身免疫性疾病模型小鼠的肠道菌群进行检测;用代谢组学技术检测模型小鼠肠道菌群代谢组谱的变化;用分子生物学、基因敲除小鼠等研究益生菌和代谢物作用的分子机制。结果在Treg缺失介导的免疫缺陷病模型小鼠上,肠道菌群发生了严重的紊乱。根据肠道菌群和代谢组谱的变化,选择罗伊氏乳酸杆菌(L. reuteri)和代谢产物肌苷处理Treg缺失小鼠,L. reuteri和肌苷通过激活腺苷受体A2AR抑制了Treg缺失引起的自身免疫性疾病。结论肠道菌群含有大量的微生物以及产生的许多独特代谢产物,可以作为新型天然药物的重要源泉,用于发现治疗自身免疫性疾病、肿瘤等疾病的新型益生菌和活性天然产物。     

人体益生菌药物临床应用新进展

益生菌药物是目前临床治疗消化系统疾病的新的发展和研究方向,随着我国社会经济的飞速发展,医学技术水平也取得了较大的进步,益生菌正在被越来越多的应用于临床的消化系统疾病治疗中。益生菌是一种人体内部的有益菌群,除了能够保持消化系统的菌群平衡之外,益生菌还能治疗人体消化系统的诸多疾病,目前,益生菌被越来越多的应用于消化系统的疾病治疗中,并且取得了满意的疗效。笔者通过本文详细阐述人体益生菌药物临床应用取得的新进展,希望能够为人体益生菌药物的临床应用提供参考和借鉴。     

Probiotics under the regulatory microscope

This review examines current knowledge regarding the safety of probiotic bacteria in man. Tighter and more comprehensive standards and regulations will be developed as probiotic therapy moves from a limited number of products used in the food industry, into more defined therapeutic categories and more complex organisms. A new framework considering probiotics as nonspecific promoters of mucosal immunity, defines probiotic characteristics and the clinical circumstances in which it is used. For example, those with immune deficiency taking a high dose of viable bacteria may have an increased risk. A wider range of bacteria is now being used, sometimes in territories other than the gut mucosa. The question of competition with multiple isolates must be addressed, as does the use of nonselected faecal isolates. Transfer of antibiotic resistance with probiotics acting as a ‘shuttle’ needs clarification. These issues are addressed and reviewed as probiotics evolve into a new therapeutic arena.     

Probiotics under the regulatory microscope

This review examines current knowledge regarding the safety of probiotic bacteria in man. Tighter and more comprehensive standards and regulations will be developed as probiotic therapy moves from a limited number of products used in the food industry, into more defined therapeutic categories and more complex organisms. A new framework considering probiotics as nonspecific promoters of mucosal immunity, defines probiotic characteristics and the clinical circumstances in which it is used. For example, those with immune deficiency taking a high dose of viable bacteria may have an increased risk. A wider range of bacteria is now being used, sometimes in territories other than the gut mucosa. The question of competition with multiple isolates must be addressed, as does the use of nonselected faecal isolates. Transfer of antibiotic resistance with probiotics acting as a 'shuttle' needs clarification. These issues are addressed and reviewed as probiotics evolve into a new therapeutic arena.     

Probiotic bacteria: a viable adjuvant therapy for relieving symptoms of rheumatoid arthritis

The burgeoning use of probiotics has proliferated during the past two decades. However, the effect of probiotic administration for either the prevention or treatment of rheumatoid arthritis (RA) has been investigated in a limited number of studies. Randomized controlled clinical trials have provided evidences that specific probiotics supplementation exhibit anti-inflammatory effects, help to increase daily activities and alleviate symptoms in patients with RA. Therefore, using probiotic bacteria as an adjuvant therapy may be considered as a promising treatment option for RA. This review summarizes the available data about the therapeutic and preventive effect of probiotics in RA, together with probiotic supplement as a possible therapy in clinical treatment.     

Probiotics: Isolated bacteria strain or mixtures of different strains? Two different approaches in the use of probiotics as therapeutics

Probiotics are cultures of beneficial bacteria from the healthy gut microflora that improve the balance of the intestinal milieu by modifying the intestinal microflora and suppressing enhanced inflammatory responses. Probiotics are currently the subject of intense and widespread research as functional foods since they are known to induce health benefits, may be used as pharmaceutical preparations, and have achieved a "generally recognized as safe" (GRAS) status. Lactobacillus strains can also be genetically engineered for use in oral immunotherapeutic applications, such as vaccination and delivery of immunoregulatory substances. In the present review we evaluate the two different approaches to the therapeutic use of probiotics. We also focus on recent findings in the field of molecular biology and genetics of the intestinal immune response related to the microflora and intestinal ecology, in order to understand the mechanisms of action of probiotics and their present indications in gastrointestinal diseases. Finally, with a view to future perspectives we provide some examples of probiotics that are being assessed and have great potential in improving the health of animals and man.     

Probiotics in inflammatory bowel disease--therapeutic rationale and role

The intestinal flora has a conditioning effect on intestinal homeostasis, delivering regulatory signals to the epithelium, the mucosal immune system and to the neuromuscular activity of the gut. Beneficial metabolic activities of the enteric flora include nutrient production, metabolism of dietary carcinogens, conversion of prodrugs to active drugs. However, increasing evidence suggests that some components of the enteric flora are essential ingredients in the pathogenesis of inflammatory bowel disease (IBD); this has prompted interest in therapeutic manipulation of the flora with probiotics. Probiotics are biologic control agents-described as live microbial food supplements which confer a health benefit beyond inherent basic nutrition. Multiple potential beneficial effects have been attributed to the probiotic use of lactic acid bacteria, bifidobacteria and other non-pathogenic commensals. At present, much of the promise of probiotics remains outside the realm of evidence-based medicine and awaits the results of prospective trials, now underway. No reliable in vitro predictors of in vivo efficacy of putative probiotics have been identified. Rigorous comparisons of probiotic performance have not been performed and the suitability of a given probiotic for different individuals is largely unexplored. Notwithstanding, an improved understanding of the normal commensal flora and host-flora interactions has the potential to open up new therapeutic strategies for inflammatory disorders of the gut.     

Probiotics and prebiotics — renaissance of a therapeutic principle

Probiotics are nonpathogenic microorganisms mostly of human origin which, when administered in adequate amounts, confer a health benefit on the host and enable to prevent or improve some diseases. Probiotics may be a natural temporary constituent of the resident intestinal microflora, but their concentration is not sufficient for therapeutic purposes. The microbiota, the intestinal epithelium, and the mucosal immune system constitute the gastrointestinal ecosystem. All three components are essential for complete functional and developmental maturity of the system. The viability of intestinal microflora (including probiotic strains) requires the availability of nutritional substrates (prebiotics), i.e. various types of fiber and oligosaccharides. Prebiotics are cleaved by microbial enzymes to numerous substances (short-chain fatty acids, aminoacids, polyamines, growth factors, vitamins and antioxidants) indispensable for metabolic and functional activities of the intestinal mucosa. The principal probiotics in use include lactobacilli, bifidobacteria, some nonpathogenic strains of Escherichia coli, and Saccharomyces boulardii. These microbiota display favourable effects which qualify them for therapeutic use. For this purpose, probiotics have to fulfill a series of requirements verifying their efficacy and safety. Experimental and clinical studies examine the prerequisites for the administration of probiotics in digestive diseases, allergic and atopic affections, as well as in some extraintestinal conditions. Future goals of probiotic application include genomic analysis, controlled postnatal colonisation of the digestive tract, the use of probiotics as carriers of peroral vaccines, and recombinant probiotics with in-situ production and targeted application of therapeutic molecules.     

H_2受体阻滞剂与微生态制剂联合应用治疗小儿功能性腹痛疗效分析

目的研究H2受体阻滞与微生态制剂对儿童功能性腹痛(FAP)的治疗作用。方法临床诊断为功能性腹痛患儿115例,治疗组65例,对照组50例,对照组给予饮食治疗及心理治疗,腹痛严重患儿服解痉剂,治疗组在饮食及心理治疗基础上加服西咪替丁与妈咪爱,4周为1个疗程,随访半年,观察腹痛缓解情况。结果治疗组显效34例,有效24例,总有效率89.2%,对照组显效11例,有效23例,总有效率68%,χ2=6.48,P<0.05。结论 H2受体阻滞剂与微生态制剂联合应用治疗小儿功能性腹痛有较好的疗效。     

Review article: antibiotics and probiotics in inflammatory bowel disease

Treatment with antibiotics in inflammatory bowel disease has a long tradition and is widely used. The indications for antibiotic therapy are wide ranging, from specific situations such as abscesses or fistulae, to patients with severe disease (as an unspecific 'protective' measure), and to address the hypothesis that the enteric flora as a whole, or specific microorganisms such as mycobacteria, are involved in the pathogenesis of inflammatory bowel disease. The best-studied single antibiotic compound is metronidazole. However, overall, the scientific basis for the use of antibiotics is limited, which may reflect a lack of interest from sponsors within the pharmaceutical industry. Despite this weak evidence base, antibiotics are a globally established therapeutic tool in inflammatory bowel disease. Growing evidence from human and animal studies points towards a pivotal pathogenetic role of intestinal bacteria in inflammatory bowel disease. In view of these experimental findings, clinical trials have been undertaken to elucidate the therapeutic effects of probiotics in inflammatory bowel disease. Probiotics are viable nonpathogenic microorganisms which confer health benefits to the host by improving the microbial balance of the indigenous microflora. So far, of the many candidates, one specific strain (Escherichia coli Nissle 1917) and a mixture of eight different bacteria have demonstrated convincing therapeutic efficacy in controlled studies. Maintenance therapy in ulcerative colitis and prevention therapy, as well as the treatment of pouchitis, have emerged as areas in which probiotic therapy offers a valid therapeutic alternative to current treatments. Further investigations may detect additional clinically effective probiotics and other clinical indications.     

思密达配合微生态制剂治疗小儿腹泻的60例观察

目的研究思密达配合微生态制剂治疗小儿腹泻用药方法对治疗效果的影响。方法将60例小儿腹泻患儿随机分为两组,第一组患儿餐前1h服用思密达,餐后半小时服用益菌康;第二组患儿餐前1h同时服用思密达和益菌康。结果第一组患儿的治疗疗程比第二组患儿缩短2~3d,且康复之后食欲较好。结论思密达和微生态制剂间隔服用能更好的治疗小儿腹泻。     

Probiotics: potential pharmaceutical applications.

Realisation of the importance of human gut microbiota in health restoration and maintenance has kindled an interest in probiotics. Probiotics are defined as the microbial food supplements, which beneficially affect the host by improving its intestinal microbial balance. Probiotics are the health enhancing functional food ingredients used therapeutically to prevent diarrhea, improve lactose tolerance and modulate immunity. They may also have potential to prevent cancer and lower serum cholesterol levels. Lactobacillus, Bifidobacterium and several other microbial species are perceived to exert such effects by changing the composition of the gut microbiota. However, it is important that exogenously administered bacteria reach and establish themselves in the large intestine in an intact form. The use of non-digestible oligosaccharides ('prebiotics') can fortify intestinal microflora and stimulate their growth. The present review encompasses information regarding the probiotics and their proposed uses. It addresses the concepts of prebiotics and synbiotics, the application of genetic engineering to produce newer probiotics. Finally, the list of commercially available products are reviewed with discussion of questions regarding the reliability, utility and the safety of these products.