加用益生菌肠内营养对预防COPD患者菌群失调性腹泻的临床观察

目的探讨在呼吸科ICU住院的COPD患者中应用益生菌预防菌群失调性腹泻的效果。方法选择95例COPD患者随机分成试验组(n=48)和对照组(n=47)。两组病人均给予鼻饲能全力,根据病人耐受程度逐步提高每天供给量至其需要量,其中试验组在此基础上,给予加用益生菌鼻饲10天。观察两组患者腹泻发生率和菌群失调情况并分类;比较观察两组患者EN达到目标供给量的时间和营养支持时间。结果试验组病人腹泻发生率为12.50%,对照组为40.43%,具有显著性差异(P0.05);粪便细菌油镜计数结果试验组菌群失调患者例数明显少于对照组;试验组达到目标供给量的时间显著缩短(P0.05)。结论益生菌干预可减少COPD患者菌群失调性腹泻的发生,提高肠内营养的成功率。     

益生菌联合肠内营养对肺结核与2型糖尿病共病伴营养不良患者治疗效果分析

目的 探索益生菌联合肠内营养对肺结核与2型糖尿病共病(pulmonary tuberculosis-type 2 diabetes mellitus,PTB-T2DM)伴营养不良患者的治疗效果。方法 自2018年1月5日开始按随机数字表将湖南省胸科医院收治的PTB-T2DM伴营养不良患者分别纳入观察组和对照组,至2020年12月15日观察组75例,平均年龄(60.8±8.6)岁;对照组72例,平均年龄(57.9±10.6)岁。对照组予以常规的抗结核治疗、降糖和低GI型肠内营养液治疗;观察组在对照组的治疗方案基础上联合益生菌治疗。观察两组患者营养治疗前与治疗14d后血红蛋白(Hb)、白蛋白(Alb)、体质量指数(BMI)等指标的变化。观察两组患者在营养治疗期间恶心、呕吐等胃肠道不良反应发生情况。结果 营养治疗14d后,观察组Hb、Alb、BMI值分别为(104.69±16.37)g/L、(32.80±6.76)g/L、19.23±3.04,高于对照组的(100.80±15.59)g/L、(32.44±4.77)g/L、20.38±3.11,差异均有统计学意义(t值分别为2.667、2.023、2.288,P值分别为0.008、0.046、0.023)。观察组患者腹胀、便秘发生率分别为5.33%(4/75)、2.67%(2/75),低于对照组的18.06%(13/72)、12.50%(9/72),差异均有统计学意义(χ²值分别为5.841和5.131,P值分别为0.016和0.024)。观察组腹泻发生率为1.33%(1/75),低于对照组的9.72%(7/72),差异有统计学意义(Fisher精确概率法,P=0.031)。结论 益生菌联合肠内营养能更好地改善PTB-T2DM伴营养不良患者的营养状况,改善患者预后,且不良反应少。     

The effect of minimum luminal nutrition on bacterial translocation and atrophy of the jejunum during parenteral nutrition

In situations of catabolic stress, the gut becomes atrophic and may have diminished barrier function as evidenced by an increase in bacterial translocation. The aim of this study was to examine the effect of minimum luminal nutrition during parenteral nutrition on the extent of jejunal atrophy and rate of bacterial translocation. Central venous lines were inserted into 30 rats before they underwent randomization to receive nutritional support with: (a) conventional parenteral nutrition; (b) conventional parenteral nutrition with 3 g/day of rat food (i.e., minimum luminal nutrition); or (c) rat food ad libitum. The rats were assessed after 10 days for nutritional status, extent of jejunal atrophy, caecal flora, as well as the extent of bacterial translocation to the mesenteric lymph nodes, liver and spleen. Rats in the rat food ad libitum group lost the smallest amount of weight and had the least amount of jejunal atrophy, yet had a similar rate of bacterial translocation as the parenterally nourished groups. When compared with the conventional parenteral nutrition group, the minimum luminal nutrition group had better preservation of the weight of the small bowel and its isolated mucosa (P < 0.01), but had a similar rate of bacterial translocation. Minimum luminal nutrition reduced the extent of atrophy of the gut but did not affect the incidence of bacterial translocation. It is inferred that there is no direct relationship between the extent of mucosal atrophy and incidence of bacterial translocation.     

早期肠内营养联合益生菌对呼吸科危重症患者营养状况的影响

目的探讨早期肠内营养联合益生菌对呼吸内科ICU患者营养状况改善的临床效果。方法 80例患者随机分为研究组和对照组各40例,两组患者均采用肠内营养支持,经鼻饲泵入瑞素,研究组患者在此基础上,每日于患者肠内营养支持前半小时,经鼻饲给予合生元益生菌。结果研究组患者不良反应率明显低于对照组(P<0.05),研究组患者达到肠内营养目标供给量所需的平均时间明显快于对照组(P<0.05)。结论联合益生菌的治疗方法可加强患者胃肠道对营养的接受程度和吸收速度,提高治疗效果。     

Influences of enteral nutrition combined with probiotics on gut microflora and barrier function of rats with abdominal infection

AIM: To investigate the influences of enteral, parenteral nutrition and probiotics delivered by gut on intestinal microecology, epithelial tight junctions, immune and barrier function of rats with abdominal infection. METHODS: Rat abdominal infection models established with cecal ligation and perforation method, were divided into three groups: parenteral nutrition (PN group, n = 7), PN enteral nutrition (EN group, n = 7) and PN EN probiotics (probiotics group, n = 7) via the needle jejunostomy and neck vein for five days. The total nutritional supplement of the three groups was isonitrogenic and isocaloric. Probiotics was delivered by jejunostomy 10 mL/d (1×108 cfu/mL). The rats were killed on the sixth day. The feces in the cecum were cultured for anaerobic bacterial growth and analyzed with bacterial group DNA fingerprint profile with random amplified polymorphic DNA. The transmembrane binding proteins (occludin) and IgA level in plasma cells of intestine epithelium in colon and terminal ileum were measured by an immunohistochemistry method. The ultrastructure of intestinal epithelial tight junctions in colon and small intestine was observed by electron-microscopy. Vena cava blood and the homogenated tissue of liver, lung and mesenteric lymph nodes were cultured to determine the bacterial translocations, and endotoxin in the blood from portal vein was detected. RESULTS: (1) The amount of bacteria of gut species in EN group and probiotic group was higher than that in PN group. The DIMA-profiles in EN group and probiotic group were similar to that of normal rats. The number of DNA-profiles in probiotics group was much more than that in PN group and EN group. Moreover, there were strange stripes in PN group. (2) The expression of occludin and IgA in the small and large intestine in EN group (2.309±0.336, 15.440±2.383) and probiotic group (2.938±0.515, 16.230±3.183) was improved as compared with PN group (1.207±0.587, P < 0.05, 11.189±2.108, P < 0.01). The expression of occludin in probiotic group (intestine: 2.93±0.515; cecum: 3.40±0.617) was higher than that in EN group (intestine: 2.309±0.336; cecum: 2.076±0.670; P < 0.05). The expression of IgA, especially in EN group (intestine: 15.440±2.383) and probiotic EN group (large intestine: 12.516±1.542) significantly increased as compared with PN group (intestine: 11.189±2.108; cecum: 10.160±1.643; P < 0.01). The intestinal epithelial tight junctions and microvilli of the probiotic group were more intact than those in the PN group. (3) The bacterial translocations in blood, liver, lung and mesenteric lymph nodes, and the levels of endotoxin were significantly reduced in probiotic (0.082±0.029) and EN (0.125±0.040) groups as compared with PN group (0.403±0.181, P < 0.05). CONCLUSION: Application of EN combined with probiotics could improve the expression of transmembrane binding proteins (occludin) and IgA, correct the intestinal flora disturbance, maintain gut barrier functions and tight junctions, and reduce the occurrence of gut bacterial translocation.     

益肠内营养联合益生菌对非酒精性肝病肝纤维化的治疗效果及临床应用价值

目的 探讨肠内营养联合益生菌对非酒精性肝病肝纤维化的治疗效果及临床应用价值.方法 回顾性选取2018年1月至2020年1月西南医科大学附属医院收治的非酒精性肝病肝纤维化患者80例,分为对照组和干预组各40例,其中对照组给予常规治疗,干预组在常规治疗的基础上予以肠内营养联合肠道益生菌治疗,观察并记录治疗前、治疗后4周两组...     

Early Enteral Feeding After Living Donor Liver Transplantation Prevents Infectious Complications: A Prospective Pilot Study

Infectious complications, including bacteria, virus, and fungus, often occur after liver transplantation and are the most frequent causes of in-hospital mortality. The current study prospectively analyze the effect of early enteral feeding in patients after living donor liver transplantation (LDLT)Between January 2013 and August 2013, 36 patients underwent LDLT. These patients were randomly assigned to receive enteral formula via nasointestinal feeding tubes [enteral feeding (EN) group, n = 17] or maintenance on intravenous fluid until oral diets were initiated (control group, n = 19). All patients completed the study.The pretransplant and perioperative characteristics of patients did not differ between the 2 groups. The incidence of bacterial infection was significantly lower in the EN group (29.4%) than in the control group (63.2%) (P = 0.043). In addition, the incidence of bile duct complications in the EN group was lower than in the control group (5.9% versus 31.6%, P = 0.041). Multivariate analysis showed that early enteral feeding was closely associated with bacterial infections (odds ratio, 0.178; P = 0.041). There was no statistically significant difference in nutritional status between the 2 groups. There were no cases of in-hospital mortality.Early enteral feeding after LDLT prevents posttransplant bacterial infection, suggesting the possibility of a reduction of in-hospital mortality as a result of decreased infectious complications.     

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

BACKGROUNDIntestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis. However, few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis. AIMTo investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis.METHODSPatients were randomly assigned to receive 30% (defined as group A), 60% (group B), or 100% (group C) of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial. The acute gastrointestinal injury (AGI) grades, incidence of feeding intolerance (FI), daily caloric intake, nutritional and inflammatory markers, and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding. The clinical severity and outcome variables were also recorded.RESULTSA total of 54 septic patients were enrolled. The days to goal calorie of group C (2.55 ± 0.82) were significantly longer than those of group A (3.50 ± 1.51; P = 0.046) or B (4.85 ± 1.68; P < 0.001). The FI incidence of group C (16.5%) was higher than that of group A (5.0%) or B (8.7%) (P = 0.009). No difference in the incidence of FI symptoms was found between groups A and B. The serum levels of barrier function biomarkers of group B were significantly lower than those of group A (P < 0.05) on the 7th day of feeding. The prealbumin and IL-6 levels of group A were lower than those of group B (P < 0.05) on the 7^th day of feeding. No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups.CONCLUSIONEarly moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis. However, further large-scale prospective clinical trials and animal studies are required to test our findings. Moreover, the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.     

High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

BACKGROUNDImmunosuppression is an important factor in the incidence of infections in transplant recipient. Few studies are available on the management of immunosuppression (IS) treatment in the liver transplant (LT) recipients complicated with infection. The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection (BSI) in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.AIMTo assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.METHODSA retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery, Renji Hospital from January 1, 2016 through December 31, 2017. All recipients diagnosed with BSI after LT were included. Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial (GNB) infection.RESULTSSeventy-four episodes of BSI were identified in 70 LT recipients, including 45 episodes of Gram-positive bacterial (GPB) infections in 42 patients and 29 episodes of GNB infections in 28 patients. Overall, IS reduction (at least 50% dose reduction or cessation of one or more immunosuppressive agent) was made in 28 (41.2%) cases, specifically, in 5 (11.9%) cases with GPB infections and 23 (82.1%) cases with GNB infections. The 180 d all-cause mortality rate was 18.5% (13/70). The mortality rate in GNB group (39.3%, 11/28) was significantly higher than that in GPB group (4.8%, 2/42) (P = 0.001). All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal, but the deaths in GPB group were all due to graft-versus-host disease. GNB group was associated with significantly higher incidence of intra-abdominal infection, IS reduction, and complete IS withdrawal than GPB group (P < 0.05). Cox regression showed that rejection (adjusted hazard ratio 7.021, P = 0.001) and complete IS withdrawal (adjusted hazard ratio 12.65, P = 0.019) were independent risk factors for 30 d mortality in patients with GNB infections after LT. CONCLUSIONIS reduction is more frequently associated with GNB infection than GPB infection in LT recipients. Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.IS     

微生态调节剂预防机械通气患者继发腹泻的临床疗效

目的探讨预防性应用微生态调节剂对机械通气患者继发腹泻的防治效果。方法将88例机械通气患者随机分成实验组和对照组。两组患者均给予鼻饲瑞先,实验组在此基础上给予微生态调节剂1周。观察两组患者腹泻发生率和菌群失调情况并分类,测定鼻饲当天和第8天粪便中分泌型IgA,比较两组患者EN达到目标供给量和营养支持的时间。结果实验组腹泻和菌群失调发生率、肠内营养液达到目标供给量的时间均明显低于对照组（P〈0．01）,而鼻饲第8天实验组粪便中分泌型IgA含量比对照组明显升高（P〈0．01）;达到目标供给量的时间显著缩短（P〈0．01）。结论微生态制剂可有效防止肠道菌群失调,降低ICU患者肠内营养并发腹泻的发生率。     

益生菌结合早期肠内营养对重症急性胰腺炎患者营养状况、肠黏膜屏障功能及肠内营养耐受性的影响

目的观察分析益生菌结合早期肠内营养对重症急性胰腺炎患者营养状况、肠黏膜屏障功能及肠内营养耐受性的影响。 方法选取2020年1月至2021年5月淮安市第二人民医院收治的92例重症急性胰腺炎患者,按照随机数字表法随机分为试验组与对照组,每组各46例。对照组患者采取早期肠内营养进行治疗,试验组施行益生菌结合早期肠内营养进行治疗。比较2组患者营养状况、肠黏膜屏障功能及肠内营养耐受性等主要指标。 结果治疗后,试验组血清白蛋白、前白蛋白、转铁蛋白、上臂肌围及肱三头肌皮褶厚度等营养指标的增加程度高于对照组,试验组乳杆菌、肠球菌及双歧杆菌等有益菌的总量高于对照组,试验组肠道黏膜屏障中的D-乳酸、二胺氧化酶含量及血浆内毒素水平低于对照组,差异均有统计学意义(P<0.05)。试验组患者肠道菌群和肠道黏膜屏障等指标的改进状况比对照组患者更理想。 结论益生菌结合早期肠内营养应用于重症急性胰腺炎患者可以达到良好的疗效。     

Preoperative Enteral Nutritional Support in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma: A Strengthening the Reporting of Observational Studies in Epidemiology Article

To compare the short-term outcomes between hepatocellular carcinoma (HCC) patients with and those without preoperative nutrition on the basis of postoperative enteral nutrition.HCC patients with postoperative enteral nutrition who underwent liver resection between February 2010 and December 2014 in Nanjing Drum Tower Hospital were considered for the study: 43 patients with and 36 patients without preoperative nutrition. Primary endpoint was the incidence of overall complications. Secondary endpoints were infectious and major complications.In the preoperative enteral nutrition group, shorter length of postoperative hospital stay (10.5 ± 2.7 versus 13.7 ± 6.3 days, P = 0.007), less exogenous albumin infusion (10.2 ± 22.4 versus 47.8 ± 97.7 g, P = 0.030), earlier first exhaust time (2.7 ± 0.8 versus 3.0 ± 0.9 days, P = 0.043), and first defection time (3.5 ± 0.9 versus 4.4 ± 1.4 days, P = 0.001) were observed. No significant differences were observed in the incidence of overall complications (32.6% versus 52.8%, P = 0.070), infectious complications (7.0% versus 8.3%, P = 1), and major complications (14.0% versus 11.1%, P = 0.969) between the preoperative enteral nutrition and control group.Preoperative enteral nutrition could improve short-term outcomes of HCC patients via accelerating the recovery of gastrointestinal function and shortening the length of postoperative hospital stay.     

Major bacterial infections following liver transplantation: a prospective study.

The incidence and characteristics of major bacterial infections were studied prospectively in 50 consecutive adult patients who underwent liver transplantation (LT). All patients received the same protocol of immunosuppression, bowel decontamination, antibiotics prophylaxis, and follow-up. Thirty-two patients (64%) had at least one episode of major bacterial infection. One death was directly related to a bacterial infection, accounting for 13% of postoperative mortality. The most critical period for infection was the first 2 months after surgery, when 69% of the infections occurred. The most frequent clinical presentations were bacteremia, pneumonia and abdominal abscesses. Eighty percent of the bacteremias had an identifiable source, the most frequent being intravascular catheters. Gram-positive microorganisms (69%) predominated over gram-negative rods (26%) and anaerobes (5%). The use of selective bowel decontamination (SBD) with norfloxacin may explain this predominance. Major bacterial infections are an important source of morbidity and mortality after LT. Efforts to prevent these infections and to determine their source and specific treatment, will improve the management and the outcome of these patients in the future.     

微生态制剂联合肠内营养治疗肝性脑病的临床研究

[目的]观察微生态制剂联合肠内营养治疗对肝性脑病患者血清内毒素、肿瘤坏死因子α(TNF-α)、白细胞介素18(IL-18)、血氨水平及全身营养状态的影响。[方法]选取60例肝性脑病患者,随机分为3组,在常规保肝利尿等基础上,3组分别予口服培菲康加肠内营养、单纯口服培菲康、单纯静脉营养,疗程均为2周。分别检测治疗前和治疗后第7天、第14天血清内毒素、TNF-α、IL-18、血氨及白蛋白的水平。[结果]与治疗前相比,培菲康联合肠内营养治疗能明显下调血清内毒素、TNF-α、IL-18及血氨的水平,明显升高血浆白蛋白的水平,与单用培菲康及单用静脉营养治疗相比差异有统计学意义(P0.05)。[结论]微生态制剂联合肠内营养治疗能有效清除血氨、降低内毒素血症、保护肠黏膜屏障及改善机体的营养状态,是临床治疗肝性脑病的一条安全而高效的途径。     

Infections after auxiliary partial liver transplantation. Experiences in the first ten patients

Summary In ten auxiliary partial liver transplant recipients selective bowel decontamination (SBD) was used to reduce infections due to gram-negative microorganisms and fungi. During SBD no gram-negative infections occurred. Candida peritonitis was observed in one patient. After discontinuation of SBD serious infections of gram-negative origin did occur and three fungal infections were seen. SBD seems to have a favourable effect in reducing infections by gram-negative microorganisms and fungi. Most striking was the number of enterococcal infections that occurred. Five out of ten patients developed enterococcal infections which in two cases contributed to a fatal outcome. These infections occurred after increase of the number of enterococci in faeces and concomitant positive cultures of bile, ascites or wound drains. This increase could be due to the use of SBD. Also, the kind of biliary anastomosis may play an important role in the relatively high incidence of enterococcal infections. In the postoperative period, recurrence of hepatitis B infection in the liver graft was observed in all patients with cirrhosis due to this virus. Problems caused by other viral infections or protozoal infections remained limited in these ten patients.

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Infektionen nach partieller auxiliärer Lebertransplantation. Erfahrungen bei den ersten zehn Patienten

Zusammenfassung Bei Patienten, bei denen eine auxiliäre, partielle Lebertransplantation durchgeführt wurde, wurde die selektive Darmdekontamination (SBD) eingesetzt, um Infektionen durch gramnegative Mikroorganismen und Pilze zu vermindern. Während SBD traten keine Infektionen durch gramnegative Bakterien auf. Bei einem Patienten wurde eine Candida-Peritonitis beobachtet. Nach Beendigung der SBD kam es zu schweren Infektionen durch gramnegative Bakterien, außerdem zu drei Pilzinfektionen. SBD hat offensichtlich einen günstigen Einfluß im Hinblick auf eine Verminderung von Infektionen durch gramnegative Erreger und Pilze. Bemerkenswert hoch war die Zahl der aufgetretenen Enterokokkeninfektionen. Bei fünf der zehn Patienten traten Enterokokkeninfektionen auf, die in zwei Fällen den letalen Ausgang mitbestimmten. Diesen Infektionen gingen ein Anstieg der Enterokokkenzahlen im Stuhl und zugleich positive Kulturen in Galle, Aszites und Wunddrainagen voraus. Es ist möglich, daß die SBD die Zunahme von Enterokokkeninfektionen begünstigte. Auch die Art der Gallengangsanastomose kann hierzu wesentlich beigetragen haben. Bei allen Patienten, bei denen die Zirrhose durch Hepatitis B Virus verursacht war, kam es postoperativ zu einem Rezidiv durch dieses Virus im Lebertransplantat. Probleme durch andere virale oder Protozoeninfektionen hielten sich bei diesen zehn Patienten in Grenzen.

     

A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer

BACKGROUND& AIMS: Perioperative nutrition with specialized enteral diets improves outcome when compared with standard formulas. A post-hoc analysis suggested preoperative administration as the most important period. Thus, we designed a study to understand prospectively whether preoperative supplementation could be as efficacious as the perioperative approach and superior to a conventional treatment (no artificial nutrition) in reducing postoperative infections and length of hospital stay. METHODS: A total of 305 patients with preoperative weight loss <10% and cancer of the gastrointestinal tract were randomized to receive the following: (1) oral supplementation for 5 days before surgery with 1 L/day of a formula enriched with arginine, omega-3 fatty acids, and RNA, with no nutritional support given after surgery (preoperative group, n = 102); (2) the same preoperative treatment plus postoperative jejunal infusion with the same enriched formula (perioperative group, n = 101); and (3) no artificial nutrition before and after surgery (conventional group; n = 102). RESULTS: The 3 groups were comparable for all baseline and surgical characteristics. Intention-to-treat analysis showed a 13.7% incidence of postoperative infections in the preoperative group, 15.8% in the perioperative group, and 30.4% in the conventional group (P = 0.006 vs. preoperative; P = 0.02 vs. perioperative). Length of hospital stay was 11.6 +/- 4.7 days in the preoperative group, 12.2 +/- 4.1 days in the perioperative group, and 14.0 +/- 7.7 days in the conventional group (P = 0.008 vs. preoperative and P = 0.03 vs. perioperative). CONCLUSIONS: Preoperative supplementation is as effective as perioperative administration in improving outcome. Both strategies seem superior to the conventional approach.     

Effect of lactobacillus on the gut microfiora and barrier function of the rats with abdominal infection

AIM: To investigate the effect of probiotics supplemented by gut on the tight junctions of epithelial cells, barrier function and the microflora of rats with abdominal infection. METHODS: After the model of cecal ligation and perforation established, SD rats were divided into two groups: parenteral nutrition (PN) group and PN+probiotics (probiotics) group, PN solution was supplemented by neck vein and probiotics was delivered via the jejunostomy tube for five days. Vena cava blood and the homogenated tissue of liver, lung and mesenteric lymph nodes were cultured to determine the bacterial translocation rate (BTR). The ultrastructure of epithelial tight junctions and microvilli of the gut were observed by electron microscopy; occluding expression was measured by indirect-immune fluorescence method; anaerobic bacterial growth by anaerobic culture and DNA fingerprint of bacterial colonies of the feces by PCR. RESULTS: The quantity of lactobacteria and bifydobacteria in probiotics group was higher than that of PN group. The profiles of DNA fingerprint expression in probiotics group were similar to that in the normal group, a new 16S rDNA sequence appeared in the profile in PN group. The occludin expression, the integrality of the gut epithelial tight junctionand microvilli in probiotics group were improved as compared with PN group. The BTR and endotoxin in blood were reduced more significantly in probiotics group as compared with PN group.CONCLUSION: The probiotics could improve the gut microflora disturbance, increase occludin expression, maintain the gut epithelial tight junction and decrease the bacterial translocations rate.     

益生菌型肠内营养对急性坏死性胰腺炎大鼠炎症反应和免疫功能的影响

目的 评价早期应用益生菌型肠内营养对急性坏死性胰腺炎(ANP)大鼠炎症反应和免疫功能的影响.方法 100只SD大鼠按数字表法随机分为对照组、ANP组、传统肠内营养(瑞素)组、益生菌组和瑞素+益生菌(联合)组,每组20只.采用胰胆管道行注射5%牛磺胆酸钠1.5 ml/kg体重方法制备ANP模型.另经胃留置空肠营养管.各组手术后12、24、48、72 h分批处死大鼠,取血检测血清巨噬细胞移动抑制因子(MIF)、淀粉酶水平及T细胞亚群,取胰腺组织常规病理检查,并采用免疫组化法检测胰腺组织MIF的表达.结果 制模后各组MIF、淀粉酶水平较对照组明显升高.制模后72 h,瑞素组、益生菌组和联合组血MIF水平分别为(117.59±1.86)μg/L、(108.39±1.99)μg/L和(95.33±1.96)μg/L,血淀粉酶水平分别为(2799±161)U/L、(2482±140)U/L和(2140±572)U/L,益生菌组和联合组均较瑞素组显著下降(P＜0.05),联合组又较益生菌组显著下降(P＜0.05).制模后各组CD_3~+、CD_4~+细胞和CD_4~+/GD_8~+值较对照组下降.制模后72 h,瑞素组、益生菌组和联合组的CD_4~+/CD_8~+值分别为0.93±0.12、1.31±0.13、1.51±0.10,益生菌组和联合组均较瑞索组显著回升(P＜0.05),联合组又较益生菌组显著回升(P＜0.05).对照组、ANP组,瑞素组,益生菌组和联合组MIF阳性表这率分别为45%,96%、95%、65%和60%,益生菌组和联合组较ANP组和瑞素组显著降低(P＜0.05).制模后72 h联合组大鼠胰腺病理损伤较瑞素组和益生菌组轻.结论 益生菌型肠内营养能有效调节ANP大鼠炎症介质和细胞因子水平,增强机体免疫功能.     

Effect of lactobacillus on the gut microflora and barrier function of the rats with abdominal infection

AIM: To investigate the effect of probiotics supplemented by gut on the tight junctions of epithelial cells, barrier function and the microflora of rats with abdominal infection. METHODS: After the model of cecal ligation and perforation established, SD rats were divided into two groups: parenteral nutrition (PN) group and PIM+probiotics (probiotics) group, PN solution was supplemented by neck vein and probiotics was delivered via the jejunostomy tube for five days. Vena cava blood and the homogenated tissue of liver, lung and mesenteric lymph nodes were cultured to determine the bacterial translocation rate (BTR). The ultra-structure of epithelial tight junctions and microvilli of the gut were observed by electron microscopy; occluding expression was measured by indirect-immune fluorescence method; anaerobic bacterial growth by anaerobic culture and DNA fingerprint of bacterial colonies of the feces by PCR. RESULTS: The quantity of lactobacteria and bifydobacteria in probiotics group was higher than that of PN group. The profiles of DNA fingerprint expression in probiotics group were similar to that in the normal group, a new 16S rDNA sequence appeared in the profile in PN group. The occludin expression, the integrality of the gut epithelial tight junction and microvilli in probiotics group were improved as compared with PN group. The BTR and endotoxin in blood were reduced more significantly in probiotics group as compared with PN group. CONCLUSION: The probiotics could improve the gut microflora disturbance, increase occludin expression, maintain the gut epithelial tight junction and decrease the bacterial translocations rate.     

Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroids

The rate of infectious complications differed significantly in two groups of heart transplant recipients who received different immunosuppressive regimens. Compared with patients who received conventional immunosuppression, patients treated with cyclosporine had a lower rate of infectious complications, and the contribution of infection to observed mortality was lower. Herpes simplex virus caused less morbidity and there were fewer active cytomegalovirus infections in seropositive recipients treated with cyclosporine. The incidence of bacterial pulmonary infections and associated bacteremia also decreased impressively. A decrease in nocardial infections was offset by a rise in those due to Legionella species. The frequency of aspergillosis was decreased by 54% in the cyclosporine-treated group, but half of these infections disseminated beyond the lung and such dissemination was always fatal. Infections with Pneumocystis carinii were significantly less common with cyclosporine-based immunosuppression. Screening serologic tests for toxoplasma should be done routinely and consideration given to prophylaxis in heart transplant recipients at high risk.