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
Changes in intestinal microbiota and application of probiotics in patients with acute pancreatitis
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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。
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关键词:
- 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. -
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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DOI: 10.1056/nejmoa1910437. -
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