基于肠道菌群探讨益生菌对儿童营养不良的影响

营养不良严重威胁儿童生长发育，是急需解决的公共健康问题。肠道菌群调解人体的多项生理功能，影响机体健康。研究发现提高肠道菌群的稳定性可为治疗相关疾病提供新思路，近年来相关研究也佐证了营养支持和益生菌介入对肠道菌群的有益影响。因此本综述从肠道菌群的生理功能入手，探讨其与儿童营养不良的关系，着重分析益生菌在治疗儿童营养不良方面的影响，从而根据“个性化”的肠道菌群特征制定益生菌“精准治疗”方案，为预防及治疗儿童营养不良提供新思路。     

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。     

抗生素合理使用是关键

1928年青霉素的发现,使人类感染性疾病的致死率大大的降低了,同时抗生素的研究也得到了飞跃式的发展。抗生素类药物已成为临床使用率最高,受众群众最广的药物。抗生素的发展已大大的改善了人们的生存质量,被评为世界上近一百年内最伟大的发现之一。 随着抗生素在临床治疗中的广泛使用,由抗生素的不合理使用而产生的问题也随之而来。现已越来越引起人们的关注,与之相关的报道也日益增多,同时对它的研究也日渐深入。     

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。     

益生菌治疗小儿抗生素相关性腹泻的疗效观察

目的观察益生菌在治疗小儿抗生素相关性腹泻方面的疗效。方法收集临床上应用抗生素治疗后并发腹泻的患儿病例80例,随机分为对照组和益生菌治疗组各40例,所有病例均给予口服蒙脱石散做基础治疗,治疗组口服益生菌三联菌片。比较两组临床疗效,并使用实时定量PCR法分析粪便中的优势菌的细菌构成。结果益生菌治疗后腹泻症状明显减轻,并增加粪便中益生菌的数量,改善肠道菌群结构。结论益生菌能通过改善粪便中的菌群结构治疗小儿抗生素相关性腹泻。     

益生菌预防小儿抗生素相关性腹泻的疗效探讨

目的:探讨在抗生素使用同时加服益生菌能否有效预防小儿抗生素相关性腹泻病,维持小儿肠道菌群稳定。方法:采用随机数表法将101例确诊为支气管肺炎的患儿分为两组,益生菌组51例,在使用抗生素的同时加服益生菌(金双歧)复方制剂;对照组50例,单一使用同种抗生素,不添加任何益生菌制剂。比较两组腹泻发生率和抗生素治疗前及治疗后第3天、第6天肠道中双歧杆菌、乳酸杆菌和大肠埃希菌菌群的差异。结果:益生菌组重型腹泻发生率和总腹泻发生率均明显低于对照组,差异有统计学意义(P<0.05);抗生素使用同时添加益生菌能够维持肠道中双歧杆菌、乳酸杆菌和大肠埃希菌菌群的稳定。结论:在抗生素使用同时加服益生菌能有效减少腹泻发生率、稳定肠道正常菌群。     

五种人急需补充益生菌

微生态学是生命科学中的一门新学科。它是研究微生物和微生物之间、微生物和人体之间形成的统一与环境之间相互关系的科学。根据这些研究成果，可以设计和采用补充益生菌、调节微生态关系的方法来防治疾病和增进健康，这一方法称微生态调节治疗。著名微生物专家魏曦教授曾指出：“光辉的抗生素时代之后的时代是益生菌制剂的时代。”     

肠内营养混悬液联合金双岐治疗老年抗生素相关性腹泻疗效分析

随着社会的老龄化,老年患者越来越多,住院的老年患者感染后使用抗生素的概率也越来越大,抗生素相关性腹泻(ADD)在临床越来越常见,常影响到原发病的治疗效果.笔者选择合适的肠内营养制剂联合肠道益生菌金双岐治疗老年患者ADD.现将应用效果报告如下.     

益生菌对小儿抗生素相关性腹泻的影响分析

目的探讨益生菌对小儿抗生素相关性腹泻的疗效评价及预防作用。方法将93例应用抗生素治疗的支气管肺炎患儿随机分成对照组(46例)和治疗组(47例),对照组患儿给予常规对症补液及思密达治疗;治疗组患儿是在对照组基础上给予口服枯草杆菌肠球菌二联活菌颗粒(妈咪爱)治疗。3d治疗后观察记录两组患儿的腹泻情况并进行疗效比较。结果治疗组患儿大便性状改变时间和大便次数恢复时间分别是(3.08±1.25)d和(3.24±0.79)d,明显低于对照组的(4.27±1.87)d和(4.68±1.28)d,差异有统计学意义(P0.05);治疗组有效率为91.49%,明显高于对照组的63.05%,差异有统计学意义。两组均无相关药物不良反应。结论益生菌不仅对小儿抗生素相关腹泻治疗有确切疗效,还对小儿抗生素相关腹泻发生有较好的预防作用。     

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。     

基于医嘱数据的肺炎住院儿童肠道微生态制剂应用的疗效分析

目的描述因肺炎住院儿童使用肠道微生态制剂的相关特征,评估肠道微生态制剂的临床应用效果。方法以上海市儿童医院2012年度因肺炎住院儿童的用药医嘱记录为研究对象,描述性统计药物人群暴露量以及抗菌药物、肠道微生态制剂使用率与治疗开始时间,比较肠道微生态制剂治疗前后使用的抗菌药物品种数量、肠道微生态制剂合用及未合用的住院时间、止泻药治疗比例与时间等。结果 2 974人次用药医嘱纳入分析,接受抗感染药物治疗者2 948人次（99.1%）、肠道微生态制剂治疗者1 252人次（42.1%）、合并抗菌药物以及肠道微生态制剂治疗者1 246人次（41.9%）。肠道微生态制剂起始治疗时间中位数为住院的第2天、众数为第1天。合并抗感染及菌群调节治疗者中,使用肠道微生态制剂前抗菌治疗时间中位数为3 d,众数为1 d。肠道微生态制剂使用后抗菌治疗中位数为5 d,众数为4 d;肠道微生态制剂菌群调节治疗时间的中位数、众数均为4 d。肺炎住院儿童中使用止泻药者626人次（21.0%）,主要集中在新生儿组和婴儿组。抗菌治疗合用肠道微生态制剂、未合用肠道微生态制剂的儿童分别有585人次（47.0%）、34人次（2.0%）接受止泻治疗,有显著性差异（P〈0.05）。合用肠道微生态制剂接受止泻治疗时间中位数为4 d,众数为3 d,四分位数Q1、Q3分别为2 d、6 d;未合用肠道微生态制剂接受止泻治疗时间中位数为3 d,众数为1 d,四分位数Q1、Q3分别为1 d、6 d,两组接受止泻治疗的时间没有显著性差异。抗菌治疗合用肠道微生态制剂的住院时间的中位数为7 d,众数为6 d,四分位数Q1、Q3分别为6 d、9 d;未合用肠道微生态制剂的住院时间的中位数、众数均为7 d,四分位数Q1、Q3分别为6 d、9 d,两组住院时间没有显著性差异。结论因肺炎住院儿童首次使用肠道微生态制剂主要在入院第2天,以预?     

Antibacterial activity of cephem antibiotics against isolates from clinical specimens at the Yokohama City University Hospital

Minimum inhibitory concentrations (MICs) of cephem antibiotics against 405 strains belonging to 17 species of clinical isolates were investigated using the standard method of the Japanese Congress of Chemotherapy. The results obtained are summarized below. Cephem antibiotics showed weak antibacterial activities against Enterococcus sp., B. fragilis and S. marcescens. S. pneumoniae, S. agalactiae, E. coli, K. pneumoniae and P. mirabilis were susceptible to cephem antibiotics. Cephem antibiotics of the 1st and the 2nd generations showed weak antibacterial activity against Citrobacter sp. and E. cloacae, while cephem antibiotics of 3rd generation had a good antibacterial activity against these species. Cephem antibiotics of the 2nd and the 3rd generations showed high antibacterial activity against H. influenzae and indole positive Proteus group. Cefoperazone showed high antibacterial activity against P. aeruginosa. Resistance to latamoxef, ceftizoxime and cefoxitin was observed among Staphylococcus sp., while the MICs of other antibiotics against Staphylococcus sp. were fairly low. Number of strains resistant to the 3rd cephem antibiotics seems to be increasing because the 3rd generation of cephem antibiotics have been used frequently. Further investigation will be required on resistant organism to these antibiotics including beta-lactamase producing strains.     

肽抗生素及其应用开发现状

作为宿主天然免疫的重要组成部分,肽抗生素具有抗菌、抗肿瘤、增强传统抗生素对耐药菌的活性、促进创伤愈合等多项生物学功能.它具有抗菌活性强、抗菌谱广、细菌不易产生耐受性等特点,预示其在医药、食品防腐、保健品及化妆品等领域具有广阔的应用前景.现对肽抗生素的应用开发现状进行综述.     

Estimation of antibacterial activity of various antibiotics against Pseudomonas aeruginosa by score method]

Antibacterial activity of various antibiotics against Pseudomonas aeruginosa isolated from each hospitals depends on the variety or amount of antibiotics used in each hospital. The antibiotic, which is effective to P. aeruginosa in a certain hospital is not always effective to that in other hospital. The excellent antibiotics in antibacterial activity have low MIC and hard to progress in resistance, and such antibiotics may be effective against P. aeruginosa isolated from any hospitals. Therefore we thought that the antibiotic, which was progress to resistance, would show a great difference in MIC among hospitals, and we investigated MIC and difference of MIC of various antibiotics against P. aeruginosa isolated from six hospitals. Furthermore, we converted the data of MICs and difference of MIC among six hospitals into the score, and tried to estimate antibacterial activity of various antibiotics by using those scores. From the results of analysis in this report, we think the antibiotics actually surpass in antibacterial activity may be imipenem, cefozopran, cefsulodin and amikacin. New analytical method proposed in this report will become one of potential methods to estimate antibacterial activity of antibiotics against bacteria isolated from inpatient with bacterial infections.     

Polycyclic peptide and glycopeptide antibiotics and their derivatives as inhibitors of HIV entry

Antiviral activity and other biological properties of two groups of polycyclic peptides are discussed. Antibiotics of the complestatin-kistamycin group have a structural motif similar to that of the peptide core of antibacterial antibiotics of the vancomycin-teicoplanin group though no amino acid component in the chloropeptin-kistamicin antibiotics is identical to an amino acid incorporated in the peptide core of the antibiotics of the vancomycin-teicoplanin group. Chloropeptins and the hydrophobic several derivatives of antibacterial antibiotics are inhibitors of HIV and some other viruses. They interfere with the viral (i.e. HIV) entry process. Chemical modifications of natural glycopeptide antibiotics led to the compounds with antiviral properties whereas antibacterial properties were lost. These glycopeptide aglycons derivatives can be envisaged as potential lead compounds for application as microbicides against sexual HIV transmission.     

Meta‐analysis: targeting the intestinal microbiota in prophylaxis for post‐operative Crohn’s disease

Aliment Pharmacol Ther 31 , 802–809

Summary

Background Enteric bacteria play an important early role in the pathogenesis of Crohn’s disease. Aim To perform a meta‐analysis of trials testing antibiotics or probiotics for prevention of post‐operative recurrence of Crohn’s disease. Methods Review of all randomized controlled trials comparing antibiotics or probiotics with placebo in prevention of endoscopic or clinical recurrence of Crohn’s disease after surgical resection. Fixed‐effect meta‐analysis was performed with dichotomous data summarized using relative risk with 95% confidence intervals, where appropriate. Results Seven studies were identified as suitable for inclusion (two comparing antibiotics with placebo, five comparing probiotics with placebo). The use of nitroimidazole antibiotics (metronidazole, ornidazole) reduced the risk of clinical (RR 0.23; 95% CI 0.09–0.57, NNT = 4) and endoscopic (RR 0.44; 95% CI 0.26–0.74, NNT = 4) recurrence relative to placebo. However, these agents were associated with higher risk of adverse events (RR 2.39, 95% CI 1.5–3.7) and patient withdrawal. Probiotic administration was not associated with any significant difference in risk of recurrence compared with placebo. Conclusions Nitroimidazole antibiotics are effective in the prevention of post‐operative Crohn’s disease recurrence, but their side‐effects limit acceptability. Probiotics have failed to show efficacy for post‐operative prophylaxis, but may merit further study.     

Cell free preparations of probiotics exerted antibacterial and antibiofilm activities against multidrug resistant E. coli

The sharp increase in antibiotic resistance imposes a global threat to human health and the discovery of effective antimicrobial alternatives is needed. The use of probiotics to combat bacterial pathogens has gained a rising interest. Pathogenic Escherichia coli is causative of multiple clinical syndromes such as diarrheal diseases, meningitis and urinary tract infections. In this work, we evaluated the efficacy of probiotics to control multidrug-resistant E. coli and reduce their ability to form biofilms. Six E. coli resistant to at least five antibiotics (Ceftazidime, Ampicillin, Clarithromycin, Amoxicillin?+?Clavulanic Acid and Ceftriaxone) were isolated in this work. Preparations of cell-free spent media (CFSM) of six probiotics belonging to the genus Bifidobacterium and Lactobacillus which were grown in Man-Rogosa-Sharpe (MRS) broth exhibited strong antibacterial activity (inhibition zones of 11.77–23.10?mm) against all E. coli isolates. Two E. coli isolates, namely E. coli WW1 and IC2, which were most resistant to all antibiotics were subjected to antibiofilm experiments. Interestingly, the CFSM of MRS fermented by all probiotics resulted in inhibition of biofilm formation while B. longum caused highest inhibition (57.94%) in case of E. coli IC2 biofilms and L. plantarum was responsible for 64.57% reduction of E. coli WW1 biofilms. On the other hand, CFSM of skim milk fermented by L. helveticus and L. rhamnosus exhibited a slight inhibitory activity against IC2 isolate (inhibition percentage of 31.52 and 17. 68, respectively) while WW1 isolate biofilms was reduced by CFSM of milk fermented by B. longum and L. helveticus (70.81 and 69.49 reduction percentage, respectively). These results support the effective use of probiotics as antimicrobial alternatives and to eradicate biofilms formed by multidrug-resistant E. coli.     

培南类抗菌药质量控制方法的研究进展

培南类抗菌药具有抗菌谱广、抗菌活性强等特点,用于多重耐药菌及重症感染的治疗.为了加强药物的安全性和有效性,本文主要综述了培南类抗菌药质量研究方面的进展,介绍了培南类抗菌药的结构特点,以及含量、有关物质、聚合物杂质和金属杂质等的检测方法,为培南类抗菌药的质量控制提供参考与借鉴.     

抗生素和益生菌制剂治疗腹泻型肠易激综合征（IBS-D）的临床研究

目的探讨抗生素和益生菌制剂治疗腹泻型肠易激综合征的临床效果。方法选取本院2011年10月～2013年10月诊治的腹泻型肠易激综合征患者128例,根据治疗方案分为两组,64例患者采用益生菌制剂治疗为对照组,64例患者采用抗生素和益生菌制剂治疗为观察组,疗程8周,在治疗前后不同时间点给予患者症状评分,比较两组患者的治疗效果。结果观察组患者在治疗2周、4周、6周、8周时症状评分均明显低于对照组,观察组患者总有效率（98．44％）明显高于对照组（87．50％）,差异均有统计学意义（P〈0．05）。结论抗生素和益生菌制剂是治疗腹泻型肠易激综合征的有效药物,可明显改善患者的临床病症,显著提高疾病的治疗效果。     

Systematic review: are probiotics useful in controlling gastric colonization by Helicobacter pylori?

Helicobacter pylori is a highly prevalent pathogen considered as an aetiological factor for gastroduodenal ulcers, and a risk factor for gastric adenocarcinoma and lymphoma in humans. Most subjects colonized by this micro-organism are asymptomatic and remain untreated. In symptomatic patients, the antibiotic treatment has a high cost and is not 100% effective because of resistance to antibiotics and to moderate patient compliance. This review discusses the role of probiotics as alternative solutions to assist in the control of H. pylori colonization in at-risk populations. The evidence that some strains of Lactobacillus and Bifidobacterium are able to inhibit H. pylori growth through the release of bacteriocins or organic acids, and may also decrease its adhesion to epithelial cells, is reviewed. In addition, probiotics have a possible role in the stabilization of the gastric barrier function and the decrease of mucosal inflammation. Other aspects that are considered are the contribution of probiotics to the healing of the gastric mucosa linked to their antioxidant and anti-inflammatory properties. Clinical trials in colonized adults and children are reviewed, and suggest that probiotics do not eradicate H. pylori but maintain lower levels of this pathogen in the stomach; in combination with antibiotics, probiotics may increase eradication rate and/or decrease adverse effects. Papers suggesting similar effects on H. pylori by foodstuffs such as berry juice and some milk proteins are quoted. Regular intake of these and other dietary products might constitute a low-cost, large-scale alternative solution applicable for populations at-risk for H. pylori colonization.