急性胰腺炎患者肠道菌群变化及益生菌的应用

吕彦青; 李嘉杰; 刘坤禹; 郭汝华; 季慧范

doi:10.3969/j.issn.1001-5256.2023.12.033

急性胰腺炎患者肠道菌群变化及益生菌的应用

DOI: 10.3969/j.issn.1001-5256.2023.12.033

吉林大学白求恩第一医院肝胆胰内科，长春 130021

基金项目:

吉林市人口与健康发展研究 (371170143428)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：吕彦青负责选题，分析资料，撰写文章；李嘉杰、刘坤禹、郭汝华参与选题，收集资料；季慧范拟定写作思路，指导撰写文章并最终定稿。

详细信息

通信作者:
季慧范， Jihf@jlu.edu.cn （ORCID： 0000-0001-8816-1906）

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出版历程
- 收稿日期: 2023-03-27
- 录用日期: 2023-05-05
- 出版日期: 2023-12-12

Changes in intestinal microbiota and application of probiotics in patients with acute pancreatitis

Department of Hepatobiliary and Pancreatic Medicine，The First Hospital of Jilin University，Changchun 130021，China

Research funding:

Research on Population and Health Development of Jilin City (371170143428)

More Information

Corresponding author: JI Huifan， Jihf@jlu.edu.cn （ORCID： 0000-0001-8816-1906）

摘要

摘要: 肠道菌群是人体中最复杂和最重要的微生态系统，肠道菌群失调与急性胰腺炎的发生、发展密切相关，近年来靶向调控肠道微生态辅助治疗急性胰腺炎逐步被人们重视。本文详细叙述了急性胰腺炎患者肠道菌群变化情况及机制，总结了益生菌应用的研究现状，指出益生菌辅助治疗方案的研究方向，并提出了预测急性胰腺炎患者优势菌群的新方法，以期为急性胰腺炎的治疗带来新思路。
- 胰腺炎，急性坏死性 /
- 胃肠道微生物组 /
- 鼠李糖乳杆菌
Abstract: Intestinal microbiota is the most complex and important microecosystem in the human body， and gut microbiota dysbiosis is closely associated with the development and progression of acute pancreatitis. Targeted regulation of intestinal microecology in assisting the treatment of acute pancreatitis has attracted more attention in recent years. This article describes the changes in intestinal microbiota and related mechanisms in patients with acute pancreatitis， summarizes the current research status of the use of probiotics， points out the research direction of probiotics as the adjuvant treatment regime， and proposes a new method for predicting the dominant flora in patients with acute pancreatitis， in order to bring new ideas for the treatment of acute pancreatitis.
- Pancreatitis， Acute Necrotizing /
- Gastrointestinal Microbiome /
- Lactobacillus Rhamnosus

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表 1 AP患者应用微生态制剂的RCT研究

Table 1. RCT studies on the application of microecological preparations in patients with acute pancreatitits

第一作者	年份	国家	疾病	结论
Oláh A^［40］	2002	匈牙利	AP	通过补充活植物乳杆菌299可以减少胰腺手术数量和败血症的发生
Kecskés G^［45］	2003	匈牙利	AP	补充植物乳杆菌299是预防胰腺炎败血症，减少手术次数和住院时间的有效方法
Besselink MGH^［46］	2004	荷兰	SAP	在SAP中早期肠内使用多物种益生菌可减少感染相关并发症
Karakan T^［47］	2007	土耳其	SAP	与标准肠内营养治疗相比，SAP经鼻空肠营养管补充益生元纤维，可改善住院时间、营养治疗持续时间、急性期反应和整体并发症
Oláh A^［48］	2007	匈牙利	SAP	早期鼻空肠喂养合生元可以预防SAP的器官功能障碍
Besselink MG^［42］	2008	荷兰	SAP	益生菌不能降低SAP患者的感染性并发症的风险，甚至与增高的死亡风险相关
Qin HL^［49］	2008	中国	AP	AP患者经肠内营养予以植物乳杆菌可以降低疾病严重性，同时获得更好的临床结局
Besselink MG^［50］	2009	荷兰	SAP	使用益生菌菌株的特定组合进行预防可减少细菌易位；但对于存在器官衰竭的患者，细菌易位和肠细胞损伤会增加
Lata J^［51］	2010	捷克	AP	根据当前研究，益生菌禁用于该适应证。尽管如此，内毒素水平的降低表明益生菌对细菌移位有积极影响，其重要性应在未来进行评估
Sharma B^［52］	2011	印度	AP	益生菌对AP肠道通透性或内毒素血症没有显著影响。然而，由于研究过早终止，该研究的把握度不足
Cui LH^［53］	2013	中国	SAP	早期肠内营养添加益生菌（双歧杆菌）可显著降低促炎细胞因子水平，早期恢复胃肠道功能，减少感染等并发症，并缩短SAP患者的住院时间
Zhu YM^［54］	2014	中国	SAP	使用益生菌不会减少SAP患者的感染并发症、缩短重症监护的持续时间或降低经皮引流率，但会增加肠缺血和坏死的发生率
Wu P^［55］	2017	中国	SAP	益生菌在治疗SAP中可能发挥有益作用，联合治疗可以促进治疗效果
Wan YD^［56］	2021	中国	MAP	予以MAP益生菌胶囊可缩短患者的住院时间
Rohith G^［57］	2022	印度	MSAP、SAP	合生元没有显著减少MSAP、SAP的脓毒性并发症和死亡率；然而，它们显著降低了住院时间
Wang JY^［58］	2023	中国	MSAP	乳果糖不仅可以恢复肠道功能，还可以调节肠道菌群，促进SCFA的产生

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