益生菌与乳果糖协同作用对老年2型糖尿病肾病便秘患者胃肠动力、黏膜功能及疾病进展的影响

Effects of probiotics and lactulose synergistic action on gastrointestinal motility,mucosal function and disease progression in elderly patients with type 2 diabetes mellitus nephropathy constipation

目的观察益生菌与乳果糖协同作用对老年2型糖尿病(T2DM)肾病便秘患者胃肠动力、黏膜功能及疾病进展的影响。方法选取2021年5月至2023年3月该院收治的108例老年T2DM肾病便秘患者为研究对象,采用随机数字表法将患者分为观察组、对照1组、对照2组,每组36例。对照1组采用双歧杆菌四联活菌片治疗,对照2组采用乳果糖治疗,观察组采用双歧杆菌四联活菌片与乳果糖联合治疗。比较各组临床疗效,治疗前、治疗1、4周后便秘症状、胃肠动力、血清脑肠肽[P物质(SP)、一氧化氮(NO)、血管活性肠肽(VIP)]、肠黏膜屏障功能[D-乳酸(DLC)、二胺氧化酶(DAO)、脂多糖(LPS)]、肾功能[肌酐(Cr)、尿素氮(BUN)、肾小球滤过率(eGFR)]及Toll样受体4(TLR4)/核因子-κB(NF-κB)mRNA表达。结果治疗1、4周后,观察组总有效率、不同时点钡剂排出率均高于对照1、2组,直肠症状、腹部症状及粪便性状评分低于对照1、2组(P<0.05),对照1、2组比较差异无统计学意义(P>0.05);观察组血清NO、VIP水平低于对照1、2组(P<0.05),SP水平高于对照1、2组(P<0.05)。治疗4周后,观察组血清DLC、DAO、LPS水平低于对照1、2组(P<0.05);观察组和对照1组Cr、BUN、TLR4 mRNA表达、NF-κB mRNA表达较治疗前降低(P<0.05),eGFR水平较治疗前升高(P<0.05),但组间上述指标比较差异无统计学意义(P>0.05)。结论益生菌与乳果糖在老年T2DM肾病便秘患者治疗中可发挥协同作用,能减轻便秘症状,促进胃肠动力,恢复肠黏膜屏障功能,可能是通过抑制TLR4/NF-κB而达到抗炎、抗凋亡目的,以抑制糖尿病肾病进一步发展。

Objective To observe the effects of probiotics and lactulose synergistic action on gastrointestinal motility,mucosal function and disease progression in elderly patients with type 2 diabetes mellitus(T2DM)nephropathy constipation.Methods A total of 108 elderly patients with T2DM nephropathy constipation admitted and treated in this hospital from May 2021 to March 2023 were selected as the study subjects and divided into the observation group,control group 1 and control group 2 by the random number table method,36 cases in each group.The control group 1 was treated with bifidobacterium tetrad tablet,the control group 2 adopted the lactulose treatment,and the observation group was treated with bifidobacterium tetrad tablet combined with lactulose.The clinical efficacy,constipation symptoms before treatment and in 1,4 weeks after treatment,gastrointestinal motility,serum cerebrointestinal peptide[substance P(SP),nitric oxide(NO),vasoactive intestinal peptide(VIP)],intestinal mucosal barrier function[D-lactic acid(DLC),diamine oxidase(DAO),lipopolysaccharide(LPS)],renal function[creatinine(Cr),urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)]and Toll-like receptor 4(TLR4)/nuclear factorκB(NF-κB)mRNA expression were compared between the groups.Results After 1-,4-week treatment,the total effective rate,barium discharge rate at different time points in the observation group were higher than those in the control group 1 and control group 2,and the scores of rectal,abdominal and fecal traits in the observation group were lower than those in the control group 1 and control group 2(P<0.05),but there was no statistically significant difference between the control group 1 and control group 2(P>0.05).The serum NO and VIP levels in the observation group were lower than those in the control group 1 and control group 2(P<0.05),the SP level was higher than that in the control group 1 and control group 2(P<0.05).After 4-week treatment,the levels of serum DLC,DAO and LPS in the observation group were lower than those in the control group 1 and control group 2(P<0.05);the Cr and BUN levels,TLR mRNA expression and NF-κB mRNA expression in the observation group and control group 1 were decreased compared with before treatment(P<0.05),the eGFR level was increased compared with before treatment(P<0.05),but the above indexes had no statistically significant difference between these two groups(P>0.05).Conclusion Probiotics and lactulose in the treatment of elderly patients with T2DM nephropathy constipation could play a synergistic role,alleviate the constipation symptom,promote the gastrointestinal motility and restore the intestinal mucosal barrier function,which may be reach the anti-inflammation and anti-apoptosis goal by inhibiting TLR4/NF-κB,so as to inhibit the further development of diabetic nephropathy.