益生菌对维持性血液透析的慢性便秘患者肠道菌群及生存质量的影响

The effect of probiotics on intestinal microbiota and quality of life in MHD patients with chronic constipation

目的探究益生菌对维持性血液透析(maintenance hemodialysis,MHD)治疗的慢性便秘(chronic constipation,CC)患者肠道菌群及生存质量(patient assessment of constipation quality of life questionnair,PAC-QOL)的影响研究。方法选90例患者,随机分为观察组与对照组,各45例,检测并分析治疗前及治疗1月PAC-QOL及肠道菌群、血清炎性因子、肾功能指标。结果①2组患者Scr、BUN、UA治疗后较治疗前均下降(对照组t=7.933、13.190、4.176,均P<0.001;观察组t=7.721、12.722、5.948,均P<0.001),治疗后观察组BUN低于对照组(t=3.217,P=0.002),2组间Scr、UA无统计学意义(t=0.003、0.258,P=0.997、0.776)。②2组患者治疗后肠道双歧杆菌、乳杆菌数量均增加,大肠埃希菌、肠球菌数量均下降,且观察组改善明显(t=-9.367、-22.573、35.796、6.124,均P<0.001);同组比较,对照组患者肠道双歧杆菌数量治疗后无统计学意义(t=1.984,P=0.054),同组治疗后于治疗前比较均有改善(对照组t=-4.239、6.633、7.466,均P<0.001,观察组t=-10.759、-30.592、37.157、9.010,均P<0.001)。③2组患者治疗后IL-6、CRP治疗后明显下降(t=122.371、3.489,均P<0.001)。④2组治疗后观察组PAC-QOL躯体不适、心理社会不适、担心与焦虑、满意度评分及总分数改善更明显(t=6.342、7.146、6.261、10.575、13.159,均P<0.001)。结论益生菌能改善MHD的CC患者肠道菌群失衡,对微炎症状态有改善作用,对肾功能无明显改善作用。益生菌能使MHD的CC患者PAC-QOL评分降低,能改善CC症状,提高生活质量。

Objective To explore the effects of probiotics to treat chronic constipation on intestinal microbiota and quality of life in maintenance hemodialysis(MHD)patients.Methods Ninety patients were randomly divided into probiotic group(n=45)and control group(n=45).The patient assessment of constipation quality of life questionnaire(PAC-QOL),intestinal microbiota,serum inflammatory factors and renal function indicators were detected and analyzed before the treatment and after the treatment for one month.Results①After the treatment,Scr,BUN,and UA decreased in both groups(control group:t=7.933,13.190 and 4.176 respectively,P<0.001;probiotic group:t=7.721,12.722 and 5.948 respectively,P<0.001);BUN was lower in probiotic group than in control group(t=3.217,P=0.002),but Scr and UA had no statistical significances between the two groups(t=0.003 and 0.258,P=0.997 and 0.776).②After the treatment,the numbers of intestinal bifidobacteria and lactobacilli increased and E.coli and enterococci decreased in both groups,with the changes more prominent in probiotic group than in control group(t=-9.367,-22.573,35.796,and 6.124 respectively,P<0.001).In control group after the treatment,the number of bifidobacteria had no significant change(t=1.984,P=0.054),but intestinal lactobacilli increased and E.coli and enterococci decreased(t=-4.239,6.633 and 7.466 respectively,P<0.001);In probiotic group after the treatment,the increase of intestinal bifidobacteria and lactobacilli and decrease of E.coli and enterococci were statistically significant(t=-10.759,-30.592,37.157 and 9.010 respectively,P<0.001).③Serum IL-6 and CRP decreased after the treatment in both groups(t=122.371 and 3.489,P<0.001),with the decrease more in probiotic group.④After the treatment PAC-QOL improved in the domains of body discomfort,psychological and social inadaptation,worrying and anxiety,satisfaction score,and total score in both groups(t=24.216,13.26,34.175,49.925 and 34.553 respectively,P<0.001),with the improvements more in probiotic group.Conclusion Probiotics can be beneficial in improving the intestinal microbiota imbalance and the micro-inflammatory state but had no obvious effect on renal function in MHD patients with chronic constipation.Probiotics can also reduce the PAC-QOL score and improve the chronic constipation symptoms in these patients.