水溶性膳食纤维治疗慢传输型便秘的临床疗效

Clinical benefits after soluble dietary fiber supplementation：a randomized clinical trial in adults with slow-transit constipation

目的 观察果胶作为重要的水溶性膳食纤维治疗慢传输型便秘的临床疗效.方法 通过临床前瞻性随机对照研究,于201 1年6月至2013年12月期间在南京军区南京总医院选取慢传输型便秘患者80例,按随机数字表法分配至治疗组（40例,给予水溶性膳食纤维,含果胶8 g,每日3次）和对照组（给予安慰剂）,治疗4周.比较治疗前、后两组的结肠传输时间、便秘症状评分以及肠道菌群变化.结果 治疗后治疗组的结肠传输时间明显低于治疗前和对照组[（60.2±11.2）h比（80.3 ±9.5）h和（79.4±11.7）h,P＜0.01],治疗后治疗组的便秘症状评分也均低于治疗前和对照组（均P＜0.05）.经实时PCR方法检测,治疗后治疗组粪便中的梭菌属数量明显少于治疗前和对照组[lg拷贝数/样本湿重（g）：9.07 ±0.63比9.74 ±0.81和9.66±0.43,P＜0.05],双歧杆菌和乳酸杆菌数量明显多于治疗前和对照组[lg拷贝数/样本湿重（g）：8.26±0.83比6.42±1.07和6.48±0.82,6.83±0.77比5.85±0.64和5.91±0.73;均P＜0.05].两组患者均未出现任何副作用.结论 水溶性膳食纤维可安全有效地治疗慢传输型便秘,明显缩短结肠传输时间和改善便秘症状,并具有调节肠道菌群和维护肠道微生态的效果.

Objective To explore the effect of pectin,a kind of soluble dietary fiber,on colonic transit time （CTT）,clinical symptoms and gut microbiota in adults with slow-transit constipation.Methods A total of 80 patients with slow-transit constipation were selected between June 2011 and December 2013.For this randomized controlled trial,we evaluated the efficacy of pectin on intestinal transit time and other indices of constipation in adults with slow-transit constipation.They were randomized to receive either pectin or placebo.Treatment consisted of 4-week supplementation with 24 g/d pectin （fiber group） or maltodextrin （placebo group）.Before and after 4-week treatment,CTT,constipation symptoms and fecal bacterial population were compared between groups.Results CTT of the fiber group after treatment was lower than those of fiber group before treatment and those in the placebo group （（60.2 ± 11.2） h vs （80.3 ± 9.5）,（79.4 ± 11.7） h,P ＜ 0.01）.Constipation score of the fiber group after treatment also decreased than those of fiber group before treatment and those in the placebo group （both P ＜ 0.05）.Bifidobacterium sp.and Lactobacillus sp.evidently increased （lg copies/g：8.26 ± 0.83 vs 6.42 ± 1.07 and 6.48 ± 0.82,6.83 ± 0.77 vs 5.85 ± 0.64 and 5.91 ± 0.73 ; all P ＜ 0.05） and total Clostridium sp.significantly decreased（9.07 ± 0.63 vs 9.74 ± 0.81 and 9.66 ± 0.43,P ＜ 0.05） in the fiber group after treatment versus the placebo group.No significant adverse effects were reported.Conclusions Four-week soluble dietary fiber use accelerates colon transit time and alleviates clinical symptoms in patients with slow-transit constipation.Additionally,supplementary fiber offers protective effects on gut microbiota by increasing the population of healthy microflora.