基于肠道菌群探讨益生菌对慢性心衰患者的影响研究

To explore the effects of probiotics on patients with chronic heart failure based on intestinal flora

目的:探讨益生菌对慢性心衰患者肠道菌群代谢产物氧化三甲胺、血清炎性指标、心功能及日常生活的影响。方法:随机选取本院2019年1~12月就诊100例慢性心衰(CHF)患者,利用随机数字表分为对照组和治疗组,每组各50例,对照组采用常规西医治疗(强心、利尿、扩血管),治疗组采用常规西医联合益生菌治疗,观察治疗后12周CHF患者心功能左室射血分数(LVEF)、心脏容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI);肠道菌群代谢产物氧化三甲胺(TMAO);血清炎症指标肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP);生活质量评分(ADL)、6 min步行实验(6 MWT)等指标与治疗前变化情况。结果:两组治疗后心功能指标(LVEDVI、LVESVI、LVEF)、血浆TMAO、TNF-α、CRP、日常生活质量评分、6 min步行实验均较治疗前明显改善(P<0.05)。治疗组TMAO、TNF-α、CRP较对照组表达水平明显下降,差异有统计学意义(P<0.05),同时ADL评分、6 MWT较对照组指标明显提升,差异有统计学意义(P<0.05)。治疗组在改善心功能(LVEDVI、LVESVI、LVEF)方面与对照组相比无明显差别,差异无统计学意义(P>0.05)。结论:益生菌能纠正肠道菌群紊乱,从而控制TMAO的分泌,抑制炎症反应,同时能有效改善患者的生活质量,但不能修复已受损的心肌细胞和心功能。

Objective:To investigate the effects of probiotics on trimethylamine oxide,serum inflammatory markers,cardiac function and daily life in patients with chronic heart failure.Methods:Randomly selected 100 cases of chronic heart failure(CHF)from Mianyang Central Hospital from January to December,2019,by using random Numbers table who then were divided into control group and treatment group with 50 cases each.Control group received conventional western medicine therapy(strong heart,diuresis and expand blood vessels),while treatment group received a combination(conventional western medicine treatment+probiotics).chronic heart failure(CHF)in patients with cardiac function in left ventricular ejection fraction(LVEF)and cardiac volume index(LVEDVI),left ventricular end systolic volume index(LVESVI);Intestinal flora metabolite TMAO;Serum inflammatory markers were tumor necrosis factor-α(TNF-α)and c-reactive protein(CRP).Quality of life score(ADL),indexes of 6min walking experiment and changes before treatment were observed 12 weeks after treatment.Results:After treatment,cardiac function(LVEDVI,LVESVI,LVEF)in both groups was higher than that before treatment.Plasma TMAO,serum inflammatory indicators TNF-α,CRP,daily life quality score,and 6 min walking test were significantly improved(P<0.05).The expression levels of TMAO,TNF-α,and CRP in the treatment group were significantly lower than those in the control group,with statistically significant differences(P<0.05),while the ADL score and 6MWT were significantly higher than those in the control group,with statistically significant differences(P<0.05).There was no significant difference between the treatment group and the control group in improving cardiac function(LVEDVI,LVESVI,LVEF)(P>0.05).Conclusion:Probiotics can correct intestinal flora disorder,control TMAO secretion,inhibit inflammatory response,and effectively improve the quality of life of patients.But it cannot repair damaged cardiomyocytes and heart function.