培菲康治疗乙肝性肝硬化患者幽门螺杆菌感染降低血氨浓度的研究

目的探讨益生菌培菲康对乙肝性肝硬化高氨血症患者合并幽门螺杆菌(Hp)感染的治疗作用,同时分析培菲康对此类患者血氨浓度的影响。方法用13C呼气实验和取胃窦粘膜作快速尿素酶实验,在血氨升高的乙肝性肝硬化患者中选择研究对象。其中,存在Hp感染者分3组参与试验。20例予益生菌治疗作为治疗组,20例予传统Hp根治治疗作为对照组1,8例未予任何抗Hp治疗为空白对照组2,余下15例无Hp感染的乙肝性肝硬化高氨血症病人作为对照组3。检测治疗前后血氨浓度、13C呼气实验结果的变化。结果治疗组治疗后的13C呼气值明显低于治疗前(P<0.01),下降幅度明显大于空白对照组2(P<0.01),但略小于对照组1(P<0.05)。治疗组治疗后血氨水平比治疗前明显降低(P<0.01),血氨降低幅度比对照组1大(P<0.01),比空白对照组2大(P<0.01),比对照组3大(P<0.05)。结论在乙肝性肝硬化门脉高压血氨升高患者中,根治幽门螺杆菌感染能降低血氨浓度;益生菌在人体内对Hp有抑制作用,同时由于其多方面综合的降氨机制,益生菌对此类高血氨患者的降氨作用比传统Hp根治治疗更好。     

金双歧片治疗极低出生体质量儿喂养不耐受

目的探讨金双歧片改善极低出生体质量儿(VLBWI)喂养不耐受情况。方法将60例VLBWI随机分成金双歧治疗组及对照组,每组各30例。两组均予静脉营养及早产儿配方奶喂哺,治疗组在早产儿配方奶喂哺时添加金双歧片,每次0.5片,3次/d。记录每次喂奶量、第1次开始喂奶时间和达全胃肠喂养时间、喂奶前胃潴留量,生后d21时体质量。结果治疗组较对照组无胃潴留的比例明显增加(t=6.84P<0.01)。达到全胃肠道喂养所需时间治疗组平均为11d,对照组平均为15d,治疗组较对照组明显缩短(t=11.39P<0.01)。治疗组生后d21体质量较对照组明显增加(t=2.291P<0.05)。微生态制剂治疗过程中无不良反应发生。结论金双歧可改善VLBWI喂养不耐受,促进患儿体质量增长,缩短达到全胃肠喂养时间。     

Efficacy of probiotic Lactobacillus GG on allergic sensitization and asthma in infants at risk

Background Probiotics are perceived to exert beneficial effects in the prevention and treatment of allergic diseases. Objective There are conflicting data from studies as to an impact on allergic sensitization and asthma. Methods Our prospective double‐blind study randomly assigned 131 children (6–24 months old) with at least two wheezing episodes and a first‐degree family history of atopic disease to 6 months of Lactobacillus rhamnosus (LGG, 10¹⁰ colony forming units) or placebo. Atopic dermatitis and asthma‐related events (e.g. need of inhalation, symptom‐free days) were documented throughout the intervention and 6‐month follow‐up. We determined IgE, a representative panel of specific IgE, eosinophils, eosinophilic cationic protein, and TGF‐β before, at the end of intervention, and after 6 months of follow‐up. Results There were no significant differences as to atopic dermatitis or asthma‐related events. In a subgroup with antecedent allergic sensitizations, asthmatic complaints were even slightly worse. We found fewer sensitizations towards aeroallergens after 6 months of LGG (P=0.027) and after 6 months of follow‐up (P=0.03). Supplementation was well‐tolerated and no severe adverse events occurred. Conclusions In young children with recurrent wheeze and an atopic family history, oral LGG had no clinical effect on atopic dermatitis or asthma‐related events, and only mild effects on allergic sensitization. This effect persisted 6 months after the cessation of the supplementation. Cite this as: M. A. Rose, F. Stieglitz, A. Köksal, R. Schubert, J. Schulze and S. Zielen, Clinical & Experimental Allergy, 2010 (40) 1398–1405.     

金银花水提物与益生菌治疗致敏小鼠作用比较

[目的]比较中药金银花水提物(以下简称金银花)与双歧杆菌、乳酸杆菌治疗卵清蛋白(OVA)致敏小鼠免疫调节作用. [方法]BALB/c雌鼠40只均分为5组,按照肠道激发后灌服不同的药物随机分为金银花高(HLT100%)、中(MLT 50%)浓度组,益生菌组(PT),致敏对照(激发后生理盐水灌服),以及正常对照(生理盐水灌服).取空肠标本行HE及甲苯胺蓝染色;取腹腔巨噬细胞行瑞氏染色;平板活菌计数肠道双歧杆菌、乳酸杆菌;ELISA法检测血清OVA特异性IgE(sIgE)、sIgG2a及小肠粘液总IgA、sIgA水平. [结果]金银花和益生菌均可缓解致敏小鼠小肠炎症,改善肥大细胞聚集和脱颗粒,提高腹腔巨噬细胞吞噬率与吞噬指数;肠道双歧杆菌、乳酸杆菌增多,以HLT组显著;致敏小鼠血清sIgE下降,sIgG2a增加,致sIgE/sIgG2a比值下降,肠道总IgA、sIgA水平增加,以高浓度金银花作用更明显.[结论]首次比较研究金银花与益生菌治疗OVA介导的致敏小鼠速发型变态反应,证实金银花与益生菌均可明显改善致敏小鼠的过敏症状作用,高浓度金银花治疗效果更好.     

Cell‐free supernatants of Escherichia coli Nissle 1917 modulate human colonic motility: evidence from an in vitro organ bath study

Abstract Clinical studies have shown that probiotics influence gastrointestinal motility, e.g. Escherichia coli Nissle 1917 (EcN) (Mutaflor^®) proved to be at least as efficacious as lactulose and more potent than placebo in constipated patients. As the underlying mechanisms are not clarified, the effects of EcN culture supernatants on human colonic motility were assessed in vitro. Human colonic circular smooth muscle strips (n = 94, 17 patients) were isometrically examined in an organ bath and exposed to different concentrations of EcN supernatants. Contractility responses were recorded under (i) native conditions, (ii) electrical field stimulation (EFS), (iii) non‐adrenergic non‐cholinergic conditions, and (iv) enteric nerve blockade by tetrodotoxin (TTX). As concentrations of acetic acid were increased in EcN supernatants, contractility responses to acetic acid were additionally tested. EcN supernatants significantly increased the maximal tension forces both at low and high concentrations. Neither blockade of both adrenergic and cholinergic nerves nor application of TTX abolished these effects. EFS‐induced contractility responses were not altered after exposure to EcN supernatants. Acetic acid elicited effects comparable to EcN supernatants only under TTX conditions. EcN supernatants modulate in vitro contractility of the human colon. As neither partial nor TTX blockade of enteric nerves abolished these effects, EcN supernatants appear to enhance colonic contractility by direct stimulation of smooth muscle cells. Active metabolites may include other substances than acetic acid, as acetic acid only partially resembled the effects elicited by EcN supernatants. The data provide a rationale for therapeutical application of probiotics in gastrointestinal motility disorders.     

Future therapies targeted towards eliminating Candida biofilms and associated infections

Introduction: Candida species are common human commensals and cause either superficial or invasive opportunistic infections. The biofilm form of candida as opposed to its suspended, planktonic form, is predominantly associated with these infections. Alternative or adjunctive therapies are urgently needed to manage Candida infections as the currently available short arsenal of antifungal drugs has been compromised due to their systemic toxicity, cross-reactivity with other drugs, and above all, by the emergence of drug-resistant Candida species due to irrational drug use.

Areas covered: Combination anti-Candida therapies, antifungal lock therapy, denture cleansers, and mouth rinses have all been proposed as alternatives for disrupting candidal biofilms on different substrates. Other suggested approaches for the management of candidiasis include the use of natural compounds, such as probiotics, plants extracts and oils, antifungal quorum sensing molecules, anti-Candida antibodies and vaccines, cytokine therapy, transfer of primed immune cells, photodynamic therapy, and nanoparticles.

Expert commentary: The sparsity of currently available antifungals and the plethora of proposed anti-candidal therapies is a distinct indication of the urgent necessity to develop efficacious therapies for candidal infections. Alternative drug delivery approaches, such as probiotics, reviewed here is likely to be a reality in clinical settings in the not too distant future.     

益生菌联合早期肠内营养对ICU机械通气患者感染及胃肠功能障碍的影响

目的 分析在重症监护病房（ICU）机械通气患者中应用益生菌联合早期肠内营养治疗对感染、胃肠功能障碍的影响。方法 采用前瞻性队列研究方法,选取2016年2月—2017年10月入住某院ICU行机械通气的患者,采用随机数字法分为A、B、C三组。A组行早期肠内营养联合益生菌治疗,B组行早期肠内营养治疗,C组行早期肠外营养治疗。比较三组患者感染情况、感染指标水平（治疗后第3天、第7天、第14天）、胃肠功能障碍发生情况、治疗后第14天急性生理功能和慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分值。结果 A组患者感染发生率为6.00%,B组为20.00%,C组为22.00%,三组患者感染发生率比较,差异有统计学意义（χ²=8.57,P=0.01）。第7天、第14天A组患者的C反应蛋白（CRP）、白细胞计数（WBC）均低于B、C组;第3天A、B组患者的降钙素原（PCT）均较C组低;第7天、第14天A组患者的PCT较B、C组低;差异均有统计学意义（均P<0.05）。A组患者腹胀（8.00%）、腹泻（4.00%）、胃潴留（4.00%）的发生率均为三组最低。治疗后第14天A组患者的APACHE Ⅱ评分最低。结论 早期肠内营养联合益生菌治疗ICU机械通气患者能有效降低感染及胃肠功能障碍发生率,促进康复,值得推广、应用。     

Translating probiotic science into practice

Scientific and clinical evidence on the health effects of probiotics has expanded rapidly in recent years and points towards benefits for a number of specific health conditions, particularly those related to the gut. Healthcare professionals are important conduits in the transfer of evidence‐based messages on probiotics, but research indicates many do not consider themselves to have good knowledge in this area. To identify potential solutions to support healthcare professionals, the British Nutrition Foundation held a one‐day roundtable event on 7 February 2019 to gather expert views on the content of, and best delivery mode for, evidence‐based resources to guide healthcare professional advice about the use of probiotics. This report describes the main themes emerging from the discussions and the group's recommendation for the development of a UK‐focused online toolkit for healthcare professionals, which assimilates, appraises and translates current scientific knowledge of probiotics to promote evidence‐based practice for the benefit of patients.     

Bugs and irritable bowel syndrome: The good,the bad and the ugly

Recently, there has been strong interest in the therapeutic potential of probiotics for irritable bowel syndrome (IBS). At the same time, there is a rapidly growing body of evidence to support an etiological role for gastrointestinal infection and the associated immune activation in the development of post‐infectious IBS. In a more controversial area, small intestinal bacterial overgrowth has been associated with a subset of patients with IBS; the issue of whether it is appropriate to treat a subset of IBS patients with antibiotics and probiotics is currently a matter for debate. Thus, it appears that the gastrointestinal microbial flora may exert beneficial effects for symptoms of IBS under some circumstances, while in other situations gut microbes could give rise to symptoms of IBS. How do we make sense of the apparently diverse roles that ‘bugs’ may play in IBS? To address this question, we have conducted an in‐depth review, attempting where possible to draw lessons from Asian studies.