益生菌辅助治疗小儿支气管肺炎相关腹泻及其对肠道菌群改善的效果

目的探讨益生菌辅助治疗小儿支气管肺炎相关腹泻的效果及其肠道菌群改善。 方法将2019年7月至2021年8月就诊于唐山市工人医院的148例小儿支气管肺炎相关腹泻患儿纳入本研究,按随机数字表法分为对照组和研究组。对照组74例,男39例,女35例;年龄（1.56±0.67）岁（1~3岁）。研究组74例,男40例,女34例;年龄（2.14±0.68）岁（0~3岁）。对照组采用常规治疗,即维持水电解质平衡、补液、抗感染、抗菌等对症治疗,并给予蒙脱石散口服。研究组在对照组基础上采用益生菌辅助治疗。比较两组临床疗效、症状缓解时间、肠道菌群、炎性因子、免疫功能等指标。 结果研究组治疗总有效率为94.59%比对照组的83.78%高,差异有统计学意义（P＜0.05）。研究组大便性状恢复正常时间［（2.44±0.29）d］、大便次数恢复正常时间［（3.43±0.59）d］、止泻时间［（3.17±0.50）d］均比对照组［（3.11±0.41）d、（4.16±0.79）d、（3.92±0.62）d］低,差异均有统计学意义（均P＜0.05）。研究组治疗5d后肠道双歧杆菌、乳酸杆菌、类杆菌、粪肠球菌水平均比对照组高,肠杆菌均比对照组低（均P＜0.05）。研究组治疗5 d后血清白细胞介素-6（IL-6）、白细胞介素-17（IL-17）、C反应蛋白（CRP）水平均比对照组低,免疫球蛋白M（IgM）、免疫球蛋白A（IgA）、免疫球蛋白G（IgG）均比对照组高（均P＜0.05）。 结论双歧杆菌三联活菌用于小儿支气管肺炎相关腹泻患儿的辅助治疗可提高治疗效果,缩短症状缓解时间,改善肠道菌群和免疫功能,缓解肠道炎症。     

Formula fortified with live probiotic culture reduces pulmonary and gastrointestinal bacterial colonization and translocation in a newborn animal model

Background/Purpose

Acidified diets are protective against intestinal bacterial colonization and translocation. Probiotic diets are designed to modulate the intestinal flora to enhance mucosal immunity. This study was designed to determine if formula acidified with live probiotic decreases bacterial gut colonization and translocation, and is equally tolerated as other acidified diets.

Methods

One hundred twenty-eight rabbit pups delivered via cesarean section [cesarean delivery, cesarean birth, abdominal delivery] were randomly assigned to 4 feeding groups: NAN Nestle (control, pH 7.0), NAN acidified with citric acid (pH 4.55), biologically acidified Pelargon (pH 4.55), and NAN with live Lactococcus lactis culture (pH 4.2). Pups were gavage fed every 12 hours with Enterobacter cloacae challenges of 10 colony-forming units/mL per feed and killed on day of life 3. Lungs, liver, spleen, mesenteric lymph nodes (MLNs), stomach, and cecum were cultured and quantitatively analyzed for target organism growth. Results were analyzed using χ² tests.

Results

NAN with live probiotic culture, when compared with Pelargon, acidified NAN, and NAN, significantly reduced the incidence of Enterobacter pulmonary colonization (P < .01), bacterial translocation (liver, P < .025; spleen and MLN, P < .05), and gastric and intestinal colonization (P < .001 for both).

Conclusion

Probiotic-fortified formula provides superior protection against pulmonary and gastrointestinal bacterial colonization and translocation compared with neutral and acidified formulas, and is equally tolerated.     

小剂量红霉素治疗早产儿喂养不耐受的疗效观察

〔摘 要〕 目的：对早产儿喂养不耐受选择益生菌与小剂量红霉素治疗的临床效果进行分析及研究。 方法：纳入 2019 年 12 月至 2020 年 11 月于福建医科大学附属龙岩第一医院分娩并由新生儿科收治的 60 例喂养不耐受早产儿为研究对象,根据 床号奇偶数分为两组（奇数组为观察组,偶数组为对照组）,各 30 例。两组早产儿均接受常规治疗,确诊喂养不耐受后对 照组使用益生菌治疗,观察组使用小剂量红霉素治疗,比较两组早产儿各项临床指标评价临床治疗有效率。 结果：相比于 对照组,观察组早产儿呕吐、腹胀及胃潴留改善所需时间较短,差异具有统计学意义（P ＜ 0.05）;两组早产儿每日奶量增加、 体质量增加、达到全胃肠喂养耗时 3 项指标以及总体治疗效果组间比较,差异无统计学意义（P ＞ 0.05）;两组早产儿用 药期间,实验室指标正常,无相关不良反应发生。 结论：早产儿喂养不耐受选择小剂量红霉素及益生菌进行治疗均可实现 治疗的目的,但是两种药物效果比较,选择使用小剂量红霉素治疗,患儿腹胀、胃潴留及呕吐可得到迅速且有效的缓解。     

On the Benefit of Probiotics in the Management of Pouchitis in Patients Underwent Ileal Pouch Anal Anastomosis: A Meta-analysis of Controlled Clinical Trials

The objective of this study was to evaluate and collect current evidence on the effect of probiotics in preventing pouchitis after restorative ileal pouch anal anastomosis (IPAA). The Pubmed, Medline, EMbase, CINAHL, Web of Science, and Scopus bibliographic, and Google Scholar databases were searched between 1966 and May 2007, and relevant controlled clinical trials were extracted, reviewed, and validated according to the study protocol. The outcome of interest was for pouchitis defined by a pouchitis disease activity index (PDAI) ≥7. Five randomized, placebo-controlled clinical trials were included in the meta-analysis. Pooling of the results from these trials yielded an odds ratio (OR) of 0.04 with a 95% CI of 0.01–0.14 (P < 0.0001) in the treatment group in comparison with the placebo group. In conclusion, the benefit of probiotics in the management of pouchitis after IPAA operation was confirmed by the meta-analysis.     

益生菌治疗的实验性结肠炎中调节性T细胞的作用

目的评价不同剂量益生菌对大鼠实验性结肠炎的疗效,研究治疗后全身及肠道局部调节性T细胞(Tr)的变化情况,探讨益生菌作用机制。方法建立三硝基苯磺酸(TNBS)实验性结肠炎大鼠模型。所用益生菌为双歧三联活菌(商品名:培菲康)。设阴性对照组、泼尼松组、柳氮磺胺吡啶 (SASP)组、益生菌小、大剂量组(剂量分别为150和300 mg·kg-1·d-1)、益生菌+泼尼松或SASP(益生菌剂量为150 mg·kg-1·d-1)组。治疗2周后组织学积分评定疗效;流式细胞仪检测各组外周血、脾脏和结肠上皮内CD4+CD25+及CD8+CD28-两种Tr比例变化。采用t检验行统计学分析。结果组织学评分显示大剂量益生菌对实验性结肠炎有效(2．2±0．8比3．5±0．7,P<0．05),而小剂量益生菌单独作用无明显疗效,联合泼尼松或SASP治疗比单独应用疗效更强;大剂量益生菌治疗后CD4+ CD25+Tr比例在外周血(3．4±0．6比11．7±4．7,P<0．05)及脾脏(2．1±1.9比10．3±3．1,P<0．05) 中下降,在结肠内上升(36．6±15．0比7．9±4．7,P<0．05);CD8+CD28-Tr则相反,在外周血及脾脏中上升(91．7±4．5比59．0±4．2,97．3±0．1比88．2±6．9,P<0．05),在结肠内下降(42．2±6．0比68．5 ±8．6,P<0．05)。Tr的这种变化与泼尼松或SASP治疗存在一定差异。结论益生菌单独大剂量或小剂量联合泼尼松或SASP治疗TNBS诱导的结肠炎有效,CD4+CD25+和CD8+CD28-Tr在发挥疗效过程中可能起一定作用。     

Serum CathepsinD in pregnancy: Relation with metabolic and inflammatory markers and effects of fish oils and probiotics

Background and aimsElevated circulating levels of CathepsinD (CatD) have been linked to metabolic deviations including liver inflammation. We investigated 1) whether supplementation with probiotics and/or fish oil affects CatD and 2) whether the CatD concentration would associate with gestational diabetes (GDM), low-grade inflammation, lipid metabolism, body fat % and dietary composition.Methods and resultsOverweight/obese pregnant women (n = 438) were randomized into fish oil + placebo, probiotics + placebo, fish oil + probiotics or placebo + placebo groups. Fish oil contained 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid and probiotics were Lacticaseibacillus rhamnosus HN001 (formerly Lactobacillus rhamnosus HN001) and Bifidobacterium animalis ssp. lactis 420, 10¹⁰ colony-forming units each). Serum CatD levels were analysed by ELISA, GlycA and lipid metabolites by NMR, high sensitive C-reactive protein (hsCRP) by immunoassay, and intakes of energy yielding nutrients and n-3 and n-6 fatty acids from food diaries at both early and late pregnancy. GDM was diagnosed by OGTT. CatD concentrations did not differ between the intervention groups or by GDM status. Multivariable linear models revealed that body fat % and GlycA affected CatD differently in healthy women and those with GDM.ConclusionThe serum CatD concentration of pregnant women was not modified by this dietary intervention. Serum CatD was influenced by two parameters, body fat and low grade inflammation, which were dependent on the woman's GDM status.Clinical trial reg. noNCT01922791, clinicaltrials.gov (secondary analysis).     

益生菌预防新生儿呼吸机相关性肺炎的研究进展

益生菌是一类对宿主有益,互利共生的微生物,在调节人体营养代谢、免疫功能和肠道微生态平衡方面发挥着重要作用。新生儿呼吸机相关性肺炎是新生儿重症监护病房危重患儿应用呼吸机后常见的并发症,常导致住院时间延长、费用增加、抗菌素耐药等后果;也是新生儿死亡的重要原因之一。近年来有大量研究显示,益生菌与新生儿呼吸系统疾病的转归密切相关。本文就益生菌在新生儿呼吸机相关性肺炎临床预防应用中的研究进展进行综述。     

益生菌对哺乳期乳腺炎的预防与治疗作用

哺乳期乳腺炎通常与病原菌感染、乳汁淤积、乳头损伤和母亲疲劳有关。目前针对哺乳期乳腺炎的治疗多集中在症状管理、抗生素治疗以及外科手术治疗方面。随着致病菌的耐药性越来越高,致病物种中抗生素耐药性的增加也是该疾病治疗关注的一个关键原因,因此开发新的治疗方法、寻求安全有效的抗生素替代品极其重要。近年来对益生菌的识别和使用越来越多,其可能为哺乳期乳腺炎的预防和治疗提供一种新替代品。