益生菌对维持性血液透析慢性肾脏病患者肠道菌群失调的影响

Effect of probiotics on intestinal flora dysbiosis in patients with chronic kidney disease on maintenance hemodialysis

目的探究益生菌对维持性血液透析慢性肾脏病患者肠道菌群失调的影响,为此类患者的治疗提供参考。方法选取2017年4月到2019年4月我院收治的78例维持性血液透析慢性肾病患者,按照随机数字法分为观察组和对照组各39例。对照组患者给予常规治疗,观察组患者给予常规治疗联合益生菌。检测两组患者肠道菌群变化,同时检测血清炎性因子(IL-6、TNF-α、CRP)、肠道屏障功能(D-乳酸、内毒素)及肾功能指标[肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)]水平。结果治疗后两组患者Scr、BUN水平均下降(均P<0.05),观察组与对照组比较有减少趋势,但差异无统计学意义(均P>0.05)。治疗后两组患者肠道双歧杆菌、乳杆菌数量均增加,大肠埃希菌、肠球菌数量均下降,且观察组患者改善情况优于对照组,差异有统计学意义(t=4.226、9.634、6.157、2.739,P<0.001、<0.001、<0.001、=0.008)。治疗后两组患者D-乳酸、内毒素水平均降低,且观察组低于对照组,差异有统计学意义(t=2.856、3.125,P=0.007、0.003)。治疗后两组患者血清IL-6、TNF-α、CRP水平均下降,且观察组下降幅度更大,差异具有统计学意义(t=3.124、4.025、8.024,P=0.007、<0.001、<0.001)。结论益生菌对维持性血液透析慢性肾脏病患者肠道菌群失衡、肠道屏障功能和微炎症状态均具有改善作用,可为该类患者临床治疗提供一定参考。

Objective To observe the effects of probiotics on intestinal flora dysbiosis in patients with chronic kidney disease(CKD)on maintenance hemodialysis,and provide a reference for clinical treatment in such patients.Methods A total of 78 patients with CKD on maintenance hemodialysis admitted to our hospital from Apr 2017 to Apr 2019 were divided into the observation group or the control group randomly,39 cases in each group.The control group received conventional treatment while the observation group received conventional treatment combined with probiotics granules.The changes of intestinal flora,serum inflammatory factors(IL-6,TNF-α,CRP),intestinal barrier function(D-lactic acid and endotoxin)and renal function indicators(Scr,BUN)were detected in the 2 groups.Results The levels of Scr and BUN in both groups decreased after treatment(P<0.05);there was a decreasing trend in the observation group compared with the control group(P>0.05).After treatment,the numbers of Bifidobacteria and Lactobacillus in both groups were increased after treatment,while the numbers of Escherichia coli and Enterococci were decreased,and the improvement in observation group was better than in the control group(t=4.226,9.634,6.157,2.739;P<0.001,<0.001,<0.001,=0.008).The levels of D-lactic acid and endotoxin decreased in both groups after treatment,which were lower in observation group than in the control group(t=2.856,3.125;P=0.007,0.003).The levels of IL-6,TNF-αand CRP in both groups decreased,and the reduction in the observation group was more obvious(t=3.124,4.025,8.024;P=0.007,<0.001,<0.001).Conclusion Probiotics can improve intestinal flora dysbiosis,intestinal barrier function and micro-inflammatory status in patients with chronic kidney disease on maintenance hemodialysis,which can provide a reference for clinical treatment.