Clinical characteristics and risk factors of post-operative intestinal flora disorder following laparoscopic colonic surgery:A propensityscore-matching analysis

BACKGROUND Intestinal flora disorder(IFD)poses a significant challenge after laparoscopic colonic surgery,and no standard criteria exists for its diagnosis and treatment.AIM To analyze the clinical features and risk factors of IFD.METHODS Patients with colon cancer receiving laparoscopic surgery were included using propensity-score-matching(PSM)methods.Based on the occurrence of IFD,patients were categorized into IFD and non-IFD groups.The clinical characteristics and treatment approaches for patients with IFD were analyzed.Multivariate regression analysis was performed to identify the risk factors of IFD.RESULTS The IFD incidence after laparoscopic surgery was 9.0%(97 of 1073 patients).After PSM,97 and 194 patients were identified in the IFD and non-IFD groups,respectively.The most common symptoms of IFD were diarrhea and abdominal,typically occurring on post-operative days 3 and 4.All patients were managed conservatively,including modulation of the intestinal flora(90.7%),oral/intravenous application of vancomycin(74.2%),and insertion of a gastric/ileus tube for decompression(23.7%).Multivariate regression analysis identified that preoperative intestinal obstruction[odds ratio(OR)=2.79,95%CI:1.04–7.47,P=0.041]and post-operative antibiotics(OR=8.57,95%CI:3.31–23.49,P<0.001)were independent risk factors for IFD,whereas pre-operative parenteral nutrition(OR=0.12,95%CI:0.06–0.26,P<0.001)emerged as a protective factor.CONCLUSION A stepwise approach of probiotics,vancomycin,and decompression could be an alternative treatment for IFD.Special attention is warranted post-operatively for patients with pre-operative obstruction or early use of antibiotics.

Intestinal flora and depressive disorders:exploration and prospect of microbial-gut-brain axis

This paper examines the correlation between depressive disorders and intestinal flora.Depression is a common affective disorder characterized by low mood,loss of interest,anhedonia,high incidence,high recurrence rate,high disability rate,and high medical costs.The incidence and harmfulness of depressive disorder are gradually increasing,and its etiology is complex and diverse,among which the abnormal intestinal flora is considered to be one of the causes of depressive disorder.This article reviews the results of several studies that found intestinal flora imbalance in depressed patients,including changes in the type and quantity of flora and changes in metabolic pathways.In addition,antibiotic and probiotic treatments have also been shown to be effective in alleviating depressive symptoms,further indicating the importance of intestinal flora disturbances in the pathogenesis of depression.We also explored the relationship between intestinal flora and the pathogenesis of depressive disorders.Through neuro-immuno-endo-crine-metabolic pathways,intestinal flora can affect the function of the central nervous system,cause changes in the host’s mental behavior,and lead to or aggravate depressive symptoms.Overall,this study not only found differences in the intestinal flora of patients with depressive disorders but also revealed the potential role of intestinal flora in the pathogenesis.Importantly,this provides a new theoretical basis for further clarifying the pathogenesis of depressive disorders and formulating diagnosis and treatment strategies.

Relationship of intestinal flora disorder with TLR/NK-kB and inflammatory mediator expression in patients with ulcerative colitis

Objective:To study the relationship of intestinal flora disorder with TLR/NK-kB and inflammatory mediator expression in patients with ulcerative colitis (UC).Methods: Patients who were diagnosed with UC in Yan'an People's Hospital between May 2015 and February 2017 were selected, patients with active UC and patients with remission UC were included in the AUC and RUC group;patients who were diagnosed with colonic polyps in Yan'an People's Hospital through physical examination during the same period were selected as the control group. Feces was collected to test the flora number, mucosa lesion was collected to determine the expression of TLR/NK-kB and inflammatory mediators, and serum was collected to detect the levels of inflammatory mediators.Results: Bifidobacterium, lactobacillus acidophilus and bacteroides number in feces of AUC group and RUC group were significantly lower than those of control group while escherichia coli and enterococcus number in feces, TLR2, TLR4, TLR5, TLR9, NK-kB, HMGB1, TNF-α, IL-6 and IL-17 mRNA expression in intestinal mucosa lesion as well as HMGB1, TNF-α, IL-6 and IL-17 levels in serum were significantly higher than those of control group;bifidobacterium, lactobacillus acidophilus and bacteroides number in feces of AUC group were significantly lower than those of RUC group while escherichia coli and enterococcus number in feces, TLR2, TLR4, TLR5, TLR9, NK-kB, HMGB1, TNF-α, IL-6 and IL-17 mRNA expression in intestinal mucosa lesion as well as HMGB1, TNF-α, IL-6 and IL-17 levels in serum were significantly higher than those of RUC group;TLR2, TLR4, TLR5, TLR9, NK-kB, HMGB1, TNF-α, IL-6 and IL-17 mRNA expression in intestinal mucosa lesion as well as HMGB1, TNF-α, IL-6 and IL-17 levels in serum were negatively correlated with bifidobacteria, lactobacillus acidophilus and bacteroides number, and positively correlated with escherichia coli and enterococcus number.Conclusion:The intestinal flora disorder in patients with ulcerative colitis can increase the expression of inflammatory mediators by activating the TLR/NK-kB pathway.

Study on mechanism and genetic analysis of lipid metabolism disorder in pregnant rats

Objective: To analyze the characteristics and possible mechanism of lipid metabolism in pregnant rats with intestinal flora imbalance. Methods: A total of 129 sexually mature female SD rats were divided into three groups: non-pregnant group (untreated healthy rats), healthy pregnant group (natural insemination pregnant rats), and pregnant microflora disorder group (pregnant rats were given mixed antibiotics by gavage to build the modeling), with 43 rats in each group. The contents of TG, LDL, HDL and TC were detected by automatic biochemical analyzer, and the contents of SCD1, PGC-1 alpha, PEPCK, ApoE and MTTP genes were detected by fluorescence quantitative PCR technology. Regression analysis was used to explore the comprehensive influence of each gene on total cholesterol expression in rats. Principal component analysis was used to explore the internal mechanism of lipid metabolism in pregnant rats with intestinal flora disorder. Results: The contents of TG, TC, LDL and HDL were compared among the three groups of rats and the differences were statistically significant (P<0.05) . The expression levels of related genes (SCD1, PGC-1, PEPCK, ApoE, MTTP) in the three groups were statistically significant (P<0.05) . SCD1 content in the non-pregnant group, healthy pregnancy group, and disordered pregnancy group was (0.92±0.12) μg/mL, (1.20±0.15)μg/mL, and (1.53±0.20) μg/mL, respectively. PGC-1 alpha content in the non-pregnant group, healthy pregnancy group, and disordered pregnancy group was (1.34±0.21) μg/mL, (0.93±0.12) micron /mL, and (0.41±0.08) μg/mL, respectively. PEPCK content in the non-pregnant group, healthy pregnancy group, and disordered pregnancy group was (0.48±0.06) μg/mL, (0.35±0.09)μg/mL, and (0.22±0.05) μg/mL, and the differences were statistically significant (P<0.05) . Multivariate linear regression analysis showed that the influence of gene content on The effect of each gene content on TC content was in order from large to small: SCD1 (OR=4.572) , PGC-1 (OR=3.387) , PEPCK (OR=3.935) , ApoE (OR=3.597) , MTTP (OR=3.096) . The principal component analysis showed that three principal components could be extracted from five related genes of lipid metabolism in pregnant rats with intestinal dysbiosis: SCD1/PEPCK pathway (contribution rate: 36.28%) , PGC-1 /ApoE pathway (contribution rate: 30.42%) , and MTTP pathway (contribution rate: 15.37%) . Conclusion: After pregnancy, blood lipids in rats are significantly increased while the imbalance of intestinal flora will lead to decreased blood lipids. The disorder of lipid metabolism in pregnant rats with intestinal flora imbalance is mainly related to the disorder of gene expression, which further affects the functions of SCD1/PEPCK, PGC-1 /ApoE and MTTP pathways.

基于“胃不和则卧不安”理论探讨肠道菌群对失眠的作用机制

《素问·逆调论》中记载“胃不和则卧不安”。然而由饮食不节引起的失眠,此病症的发病机制尚不清楚。现代研究发现,肠道菌群作为肠和脑的中间纽带,将胃肠道系统与中枢神经系统联系起来,这与中医论述的“胃不和则卧不安”的观点不谋而合。本文以肠道菌群为出发点,探讨胃肠不舒与失眠发生的内在联系,将现代发病机制与中医理论结合起来,以明确“胃不和则卧不安”的发病机制,为治疗失眠提供新思路。

结直肠癌患者肠道菌群及粪便SDC2基因甲基化检测意义及其关系研究

目的探讨粪便Syndecan-2(SDC2)甲基化与肠道菌群失调在结直肠癌(CRC)中的意义。方法将70例CRC患者(CRC组)、65例结直肠腺瘤性息肉(CAP)患者(CAP组)及50例健康志愿者(对照组)作为研究对象,检测其粪便DNA SDC2甲基化与肠道菌群失调情况,实时荧光定量PCR法定量分析粪便菌群,Spearman相关系数分析CRC患者粪便SDC2甲基化与其定量分析结果之间的相关性。结果实时荧光定量PCR法在分析粪便菌群中的稳定性及特异性良好,CRC组粪便SDC2甲基化阳性率及肠道菌群失调率均高于对照组与CAP组(P<0.05);与对照组相比,CRC组及CAP组有益菌定量分析水平降低,CRC组肠道菌群中有害菌水平上升(P<0.05)。CRC患者粪便SDC2甲基化与肠道乳酸杆菌、双歧杆菌定量水平呈负相关(P<0.05),与大肠杆菌、粪肠球菌以及脆弱拟杆菌定量分析水平呈正相关(P<0.05)。结论CRC患者存在明显的肠道菌群紊乱表现及高水平SDC2甲基化阳性率,肠道菌群可能通过影响SDC2甲基化参与CRC发生与发展。

儿童抽动障碍与肠道菌群及炎症反应、免疫指标相关性研究

目的探究儿童抽动障碍与肠道菌群及炎症反应、免疫指标相关性研究。方法选取连云港市第二人民医院2022年1月至2023年6月收治的69例儿童抽动障碍病儿作为试验组,并选取69例同期在该院体检的健康儿童作为对照组。对比两组小儿肠道菌群及炎症反应[白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)]、免疫指标[分化抗原(CD)3^(+)、CD4^(+)、CD8^(+)],同时分析试验组病儿美国耶鲁综合抽动严重程度量表(YGTSS)评分与肠道菌群、炎症反应和免疫指标的相关性。结果试验组病儿双歧杆菌水平低于对照组[(7.15±0.98)IgCFU/g比(9.24±0.85)IgCFU/g],大肠埃希菌水平高于对照组[(7.19±0.77)IgCFU/g比(6.29±0.81)IgCFU/g](均P<0.05);试验组病儿血清IL-6[(3.45±0.39)ng/L比(1.44±0.31)ng/L]和TNF-α[(10.24±1.31)ng/L比(5.43±1.29)ng/L]水平显著高于对照组(均P<0.05);试验组病儿CD3^(+)[(57.99±1.32)%比(62.08±1.27)%]和CD4^(+)[(41.87±1.23)%比(48.25±1.18)%]水平低于对照组,CD8^(+)[(36.77±1.39)%比(31.85±1.27)%]水平高于对照组(P<0.05);Pearson分析结果显示双歧杆菌水平、CD3^(+)和CD4^(+)水平与YGTSS评分呈负相关(r=−0.57、−0.66、−0.67,均P<0.05),大肠埃希菌水平、IL-6、TNF-α和CD8^(+)水平与YGTSS评分呈正相关(r=0.68、0.68、0.62、0.59,均P<0.05)。结论儿童抽动障碍病儿存在明显的肠道菌群及炎症反应、免疫指标异常,其病情程度与肠道菌群及炎症反应、免疫指标存在明显的相关性。

孤独症谱系障碍与肠道菌群的相关性的研究进展

孤独症谱系障碍(ASD)是一组具有高度遗传异质性的神经发育障碍性疾病。除了神经症状,许多ASD儿童常合并胃肠道症状。越来越多的证据表明,ASD儿童肠道菌群的组成发生显著变化,异常的肠道菌群可能通过微生物-肠-脑轴参与ASD的发生和发展。目前,尚无有效的药物改善ASD的核心症状。本文针对肠道微生态菌群及其代谢产物与ASD之间的潜在关系,以及微生态疗法(益生菌、益生元、粪菌移植)在ASD中的应用价值展开综述,旨在为改善ASD儿童核心症状提供更多的参考。

肠道菌群干预在日间腹腔镜胆囊切除术加速康复外科中的临床研究

目的探讨肠道菌群干预在日间腹腔镜胆囊切除术(day-care laparo-scopic cholecystectomy,DCLC)加速康复外科(enhanced recovery affer surgery,ERAS)中的临床疗效。方法选取2020年1月至2022年12月在九江市第一人民医院肝胆胰外科接受DCLC的60例患者作为研究对象,按照随机数字表法分为对照组、研究A组与研究B组,每组20例。所有患者均行DCLC,对照组采用常规的ERAS围手术期治疗,研究A组在对照组基础上联合肠道菌群,研究B组在研究A组基础上联合口服维生素D3。比较3组临床指标(腹泻发生率、胃肠道紊乱发生率、延迟出院率、再入院率),治疗前后血清D-乳酸、胃泌素水平及不良反应发生率。结果研究A组与研究B组腹泻发生率、胃肠道紊乱发生率、延迟出院率、再入院率均低于对照组,差异有统计学意义(P<0.05)。治疗后,3组血清D-乳酸及研究A组胃泌素水平均低于治疗前,研究A组、研究B组血清D-乳酸水平均低于对照组,且研究B组低于研究A组,差异有统计学意义(P<0.05)。3组并发症发生率比较差异无统计意义。结论肠道菌群干预能提高行DCLC ERAS患者的胃肠功能恢复,可减少腹泻、胃肠道紊乱的发生,降低延迟出院率和再入院率,有利于患者快速康复。

益生元在2型糖尿病肾病Ⅳ期患者中的应用效果

目的探讨益生元在2型糖尿病肾病Ⅳ期患者中的应用效果。方法选择2020年6月至2022年6月九江市第一人民医院肾内科收治的80例2型糖尿病肾病Ⅳ期患者为研究对象,按照随机数字表法将其分为观察组和对照组,每组40例。对照组给予常规治疗,观察组在对照组方法的基础上另给予混合型菊粉。比较两组患者治疗前后的血清白蛋白(ALB)、血红蛋白(Hb)、肾功能指标及炎症指标等实验室指标,比较两组患者的急性胃肠损伤(AGI)评分、并发症发生率、二次住院率等预后指标。结果治疗前,两组患者的各实验室指标比较,差异无统计学意义(P>0.05)。观察组治疗后的血清白蛋白(HbA1c)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血肌酐(SCr)、血尿素氮(BUN)指标均低于治疗前,ALB、Hb、估算肾小球滤过率(eGFR)均高于治疗前,差异有统计学意义(P<0.05)。对照组治疗后的CRP低于治疗前,差异有统计学意义(P<0.05);对照组治疗前后的ALB、HbA1c、Hb、CRP、IL-6、TNF-α、SCr、BUN、eGFR指标比较,差异无统计学意义(P>0.05)。治疗后,观察组的ALB、eGFR均高于对照组,HbA1c、CRP、IL-6、TNF-α、SCr、BUN均低于对照组,差异有统计学意义(P<0.05)。观察组的AGI评分、并发症发生率、二次住院率均低于对照组,胃肠道恢复时间短于对照组,差异有统计学意义(P<0.05)。结论益生元能有效改善2型糖尿病肾病患者的肠道菌群紊乱,减少毒素蓄积,延缓肾功能恶化。

饮食干预治疗抑郁相关症状的研究进展

抑郁症是一种常见的精神疾病,目前全球有近16%的人群受到抑郁相关症状的影响,而在中国抑郁症患者的诊治率仅有9.5%。抑郁症具有高发病率和低治愈率的特点,如何有效提高其治疗效果是近年来研究的热点。抗抑郁药作为抑郁症的主要治疗方式,存在药物不良反应多和起效慢等缺点,促使人们开始重视抑郁症的非药物治疗。饮食干预是一种改变饮食结构和节律的非药物治疗方式;目前关于饮食干预在精神医学的应用非常广泛,对治疗抑郁症也有一定的效果。近年来的研究证据表明,饮食干预可以通过脑-肠轴相关的进食机制来治疗和改善抑郁症的相关症状。该文综述饮食干预在抑郁症治疗中的多维度探索,包括饮食结构干预、饮食节律干预、肠道菌群的作用等方面,详细介绍饮食干预的方式和涉及的相关机制,希冀为饮食干预治疗抑郁相关症状提供参考。

基于肠道菌群紊乱与炎症反应从“脾虚失运、痰瘀阻滞”论治糖尿病前期

糖尿病前期又称糖调节受损,是向糖尿病发生发展的重要病理过程,严重危害人民的身心健康,因此积极治疗糖尿病前期,延缓或防止其进展为糖尿病期至关重要。糖尿病前期归属于中医学“脾瘅”范畴,文章通过梳理古代经典医家典籍理论及现代医家临床经验总结等,分析探讨糖尿病前期的病机演变过程,将其总结概括为“脾虚失运,痰瘀阻滞”。结合现代临床与基础研究,发现肠道菌群的平衡稳定状态是脾主运化功能正常发挥的重要体现,脾虚可影响肠道菌群稳态。脾虚日久,引发水饮与血液的停聚,痰瘀互结,会进一步加重脾虚。研究表明,糖尿病前期患者体内存在轻微的炎症反应,且在病理、病机等方面痰瘀互结又与炎症反应存在着紧密联系。故基于以上理论,归纳出脾虚失运-肠道菌群紊乱为致病之本,痰瘀阻滞-炎症浸润为疾病迁延之由。在此病机基础上总结出健脾气助运化,化痰祛瘀并用的治法,以期为糖尿病前期的中医临床诊断与治疗提供新的方向与思考。

抑郁障碍患者肠道菌群相对丰度与认知功能的相关性

目的:探讨抑郁障碍患者肠道菌群相对丰度和认知功能的特点及两者的相关性。方法:选取2021年12月至2022年6月间来自宁波市第一医院心身医学科的78例抑郁障碍患者为病例组,60名健康志愿者为对照组,使用Thinc-it工具[包括数字符号替代测试(digit symbol substitution test,DSST)、选择反应时间任务(choice reaction time task,CRT)、连线测验(trail making test,TMT)-B、1-back记忆任务(1-back Memory task,1-BACK)和抑郁症认知损害5项问卷(perceived deficits questionnaire-5,PDQ-5-D)]评估认知功能,应用16SrDNA测序技术获得组间肠道菌群的相对丰度特征。采用Pearson相关性分析抑郁障碍患者肠道菌群相对丰度与认知功能的相关性。结果:与对照组相比,病例组PDQ-5-D评分、TMT-B耗时数明显升高,CRT、1-BACK、DSST计数均显著下降(P均<0.01);病例组变形菌门、肠杆菌科、埃希氏-志贺氏菌属的相对丰度较对照组升高,拟杆菌门、放线菌门、双歧杆菌科、双歧杆菌属的相对丰度均较对照组降低(P均<0.05)。变形菌门的相对丰度与PDQ-5-D评分、TMT-B耗时数均呈负相关(P均<0.05);肠杆菌科的相对丰度与PDQ-5-D评分、TMT-B耗时数呈负相关,与DSST计数呈正相关(P均<0.05);埃希氏-志贺氏菌属的相对丰度与TMT-B耗时数呈负相关,与DSST计数呈正相关(P均<0.05)。结论:抑郁障碍患者存在认知功能损害及肠道菌群相对丰度的变化,两者具有相关性。

基于肠道菌群和代谢组学探讨“脑肠共治”电针对孤独症大鼠的作用机制

目的观察“脑肠共治”电针对孤独症大鼠的社交能力及对肠道菌群、代谢产物的影响。方法采用丙戊酸钠腹腔注射法制备孤独症大鼠模型,选取造模成功的大鼠随机分为4组,每组10只,分别为模型组、基础电针组、针药结合组、脑肠共治电针组。另外选取10只正常大鼠为对照组。基础电针组予以电针百会、神庭、心俞;针药结合组在基础电针组的基础上再予以益生菌灌胃治疗;脑肠共治电针组在基础电针组基础上再结合电针足三里、曲池。均每日1次,连续4周。采用三箱社交实验评估行为学改变,16S rDNA测序分析肠道菌群分布情况,超高效液相色谱串联质谱分析血浆中的差异代谢组分,并结合Spearman相关性分析进行肠道菌群与代谢组学之间的关联分析。结果与对照组相比,模型组大鼠社交能力和社交新颖性均减弱(P<0.01);与模型组相比,基础电针组、针药结合组、脑肠共治电针组的社交新颖性增强(P<0.01);与基础电针组比较,针药结合组、脑肠共治电针组社交新颖性增强(P<0.01)。肠道菌群研究发现,与对照组比较,模型组的弯曲菌门相对丰度上调,嗜黏蛋白阿克曼菌相对丰度下调;而与模型组相比,针药结合组、脑肠共治电针组的弯曲菌门相对丰度下调,嗜黏蛋白阿克曼菌相对丰度上调。LEfSe分析发现,脑肠共治电针组与模型组共筛选出嗜黏蛋白阿克曼菌等21个关键菌,如与模型组比较,脑肠共治电针组可上调嗜黏蛋白阿克曼菌、卷曲乳杆菌,同时下调梭状芽胞杆菌等。代谢组学分析共筛选出12个差异代谢物,通路分析显示,其主要与氨基酸代谢、磷酸盐代谢、嘌呤代谢、花生四烯酸代谢等通路相关。结论电针百会、神庭、心俞、足三里、曲池对孤独症大鼠社交能力有明显的改善作用,调控肠道菌群如嗜黏蛋白阿克曼菌等菌属丰度,同时影响代谢物水平,且部分代谢物的改变与肠道菌群存在复杂相关性,可能与氨基酸代谢、磷酸盐代谢、嘌呤代谢、花生四烯酸代谢等通路相关。

应用16S rDNA高通量测序分析孤独症谱系障碍患儿肠道菌群的变化

目的 基于16S rDNA高通量测序分析孤独症谱系障碍(ASD)患儿肠道菌群的变化。方法 收集25例ASD患儿(ASD组)和22例健康儿童(对照组)的新鲜粪便样本,提取两组样本DNA,通过16S rDNA高通量测序和生物信息分析评估两组研究对象肠道菌群的变化情况。结果 在门水平上,两组的优势菌门均为厚壁菌门、拟杆菌门、变形菌门、放线菌门、脱硫菌门;在属水平上,ASD组的优势菌属为拟杆菌属、双歧杆菌属、志贺-大肠杆菌属、普氏菌属、链球菌属、克雷伯氏菌属、副拟杆菌属、肠杆菌属、小杆菌属、考拉杆菌属。两组研究对象肠道菌群的α多样性及β多样性无明显差异。ASD组中疣微菌门、疣微菌纲、疣微菌目、阿克曼菌科、阿克曼菌属显著富集。ASD组的婴儿双歧杆菌、长双歧杆菌的相对丰度低于对照组(P<0.05)。结论 与正常儿童相比,ASD患儿存在肠道菌群失调,疣微菌门、阿克曼菌属相对丰度增加,婴儿双歧杆菌、长双歧杆菌相对丰度减少,但目前对于ASD患儿肠道菌群的改变未有统一结论,仍需进一步深入研究。

乳铁蛋白调节高脂饮食小鼠糖脂代谢的机制

目的:探究乳铁蛋白(LF)调节高脂饮食引起的小鼠糖脂代谢紊乱的机制。方法:选取30只SPF级雄性C57BL/6小鼠随机分为对照组(K组,正常饮食)、模型组(M组,高脂饲料+饮纯水)、乳铁蛋白治疗组(Y2组,高脂饲料+饮2%乳铁蛋白水),连续喂养12周。每周记录小鼠体质量变化。在第12周取附睾周围腹腔脂肪组织,测定内脏脂肪率。使用商业酶分析试剂盒测血糖、血脂水平,酶联免疫吸附法测定胰岛素水平,16S rRNA测序法检测小鼠的肠道菌群,气相色谱质谱法检测短链脂肪酸含量。结果:乳铁蛋白干预12周后,Y2组小鼠相比于M组小鼠内脏脂肪率下降31.05%,血糖(5.92 mmol/L)、胰岛素(19.60 mmol/L)、总胆固醇(3.17 mmol/L)、甘油三酯(0.28 mmol/L)和低密度脂蛋白水平(1.84 mmol/L)与M组相比均下降且差异显著(P<0.05),高密度脂蛋白水平(1.88 mmol/L)与M组相比显著上升(P<0.05)。乳铁蛋白干预降低了厚壁菌门和拟杆菌门的比值,增加了拟杆菌门的相对丰度,降低了颤螺旋菌、大肠埃希菌、脱铁杆菌的相对丰度,调节了短链脂肪酸的代谢异常,控制了脂肪的积累。结论:乳铁蛋白通过调节肠道菌群结构来调控脂肪积累,改善高脂饮食小鼠的糖脂代谢紊乱。

从肠道微生态探讨“敦土制水”辨治慢性肾脏病的思路

探讨中医“脾”功能失调与慢性肾脏病肠道微生态失调的内在关系,阐述“脾”影响肠道菌群的组成和功能,机体代谢、免疫功能,从而参与慢性肾脏病的发生发展过程,为中医药“敦土制水”法治疗慢性肾脏病提供现代理论依据。“敦土制水”是我国中西医结合肾脏病奠基人之一陈以平“斡旋三焦”治肾理论体系的重要组成部分。肠道微生物构成的微生态系统在各方面深刻影响着慢性肾脏病的进展与其相关并发症的发生。“脾肾失调”是CKD的病因之本,而脾居中焦,具有“升清”“运化”和“卫”的功能,与肠道菌群的组成和功能及其对机体代谢、免疫等作用相似,肠道菌群的组成平衡和功能稳定可视为“脾主升清”的正常状态。慢性肾脏病患者脾肾亏虚,脾不升清、土不制水,则肠道微生态平衡失调,肠道菌群失去自我稳定状态,组成和功能发生改变,引起CKD的发生发展。“敦土制水”法重在强健脾运,可调节肠道菌群,治疗慢性肾脏病有良好临床疗效。

气体信号分子硫化氢防治骨质疏松的作用与机制

作为一种气体信号分子,近年来硫化氢(H_(2)S)防治骨质疏松的作用得到证实,其病理生理机制也陆续被阐明。H_(2)S能通过拮抗氧化应激和炎症反应、促进血管生成、调节肠道菌群和钙磷代谢,促进骨形成、抑制骨吸收,进而防治多种类型的骨质疏松,如绝经后骨质疏松、糖皮质激素或高同型半胱氨酸引发的骨质疏松。本文对现有研究进行总结,为进一步探索骨质疏松症的发病机制和治疗方案提供新思路。

肠道菌群紊乱与围术期神经认知功能障碍的研究进展

围术期神经认知障碍(PND)是老年手术患者术后最常见的并发症之一,也是麻醉、精神、老年等专科共同关注的热点问题。目前,大量研究证实肠道菌群与大脑之间存在着重要的交互关联,称为肠-脑轴。肠道菌群在肠-脑轴中发挥核心作用,其稳态对神经认知功能具有重要的影响。本文基于国内外研究进展,就肠道菌群紊乱与PND的密切关系、手术和麻醉过程对肠道菌群稳态的破坏、以及通过调节肠道菌群对PND的干预作用等方面进行综述,以期为临床工作和科学研究提供参考。

归脾汤联合艾司西酞普兰治疗抑郁症的临床疗效及对肠道菌群的影响

目的 探讨归脾汤联合艾司西酞普兰治疗抑郁症的疗效及对肠道菌群的影响。方法 选取2021年12月至2022年7月宁波大学附属第一医院收治的78例心脾两虚型抑郁症患者,按随机数字表法分为3组,归脾汤联合抗抑郁药组使用归脾汤联合草酸艾司西酞普兰治疗,益生菌联合抗抑郁药组使用双歧三联杆菌活菌胶囊联合草酸艾司西酞普兰治疗,单用抗抑郁药组使用草酸艾司西酞普兰治疗,每组各26例,疗程8周。评估治疗前及治疗第1、2、4、8周汉密尔顿抑郁量表(HAMD-17)评分和汉密尔顿焦虑量表(HAMA)评分,并行16S rDNA肠道菌群检测。另以本院30名体检健康者为对照组。结果 归脾汤联合抗抑郁药组在第2、4、8周时疗效均优于单用抗抑郁药组(均P<0.05)。治疗第2、4、8周,归脾汤联合抗抑郁药组HAMD-17评分显著低于单用抗抑郁药组,HAMA评分显著低于益生菌联合抗抑郁药组及单用抗抑郁药组(均P<0.05)。Alpha多样性分析显示,治疗8周后归脾汤联合抗抑郁药组Chao1指数和物种丰富度指数均显著高于治疗前(均P<0.05)。Beta多样性分析显示,对照组肠道菌群物种多样性均显著大于3个病例组(均P<0.05);治疗后3组肠道菌群物种多样性均显著大于治疗前(均P<0.05)。3组变形杆菌门、肠杆菌科、埃希-志贺菌属、克雷伯菌属等菌群丰度均显著高于对照组,拟杆菌门、梭菌属等丰度均显著低于对照组(均P<0.05)。相比治疗前,归脾汤联合抗抑郁药组治疗后厚壁菌门、颤螺菌科、瘤胃球菌科、梭菌属等菌群丰度均显著升高,变形杆菌门、肠杆菌科、克雷伯菌属、埃希-志贺菌属等丰度均显著降低(均P<0.05);单用抗抑郁药组治疗后丁酸球菌科、粪球菌属、颤螺菌属等丰度均显著升高,丹毒丝菌科丰度显著降低(均P<0.05);益生菌联合抗抑郁药组治疗后普雷沃菌属、粪球菌属、梭菌属等丰度均显著升高,艾克曼菌科、肠杆菌属等丰度均显著降低(均P<0.05)。结论 归脾汤联合艾司西酞普兰治疗可增加抑郁症患者肠道菌群的丰富性和多样性,促进有益菌的增殖,减少有害菌,提高临床疗效,加快起效时间,优于单用西药治疗。