益生菌治疗炎症性肠病的研究进展

炎症性肠病（inflammatory bowel disease,IBD）主要包括溃疡性结肠炎（ulcerative olitis,UC）和Crohn＇s病（Crohn＇s disease,CD）,近年来随着人们生活水平的提高以及饮食结构的变化,该病在我国的发病率逐年上升.目前研究认为IBD是由基因的易感性,环境因素激发和肠道免疫系统失调等多种因素交互作用引起的消化系统自身免疫性慢性炎症疾病.应用免疫抑制剂作为临床上治疗该病的主要手段已经有了很大的发展,却仍然存在着价格昂贵,毒副作用强,而且并不是对所有患者都有效等问题.长期使用抗生素则因容易引起肠道细菌耐药而导致菌群失调,往往使得IBD的病情更加复杂.临床研究表明IBD患者肠道内存在着严重的菌群失调,通过给予益生菌对局部的微生态环境进行调节,可使病情缓解.本文从炎症性肠病的病因学出发,对目前应用益生菌治疗IBD及其治疗机制的研究进展进行综述.     

益生菌在儿童炎症性肠病中的应用

炎症性肠病（inflammatory bowel disease,IBD）是一种原因不明的慢性非特异性肠道炎性疾病,主要包括溃疡性结肠炎（ulcerative colitis,UC）、克罗恩病（Crohn's disease,CD）和未定型的炎症性肠病（IBD-unclassified,IBDU）。随着对肠道微生物与IBD关系认识的不断加深,许多研究发现肠道菌群的生态失调在IBD的发病中起着重要作用。益生菌在儿童IBD治疗中具有良好前景,但仍缺乏有效的证据来确证益生菌疗效,并指导临床对益生菌的种类和剂量等进行选择。现有研究表明,益生菌对儿童IBD的治疗具有特异性,在诱导和维持UC缓解效果明显,但在诱导CD缓解、维持CD缓解和预防术后并发症及复发方面效果并不理想。     

益生菌在炎症性肠病治疗中的研究进展

益生菌（Probiotics）是一类能够促进肠道微生物菌群平衡,对宿主健康或生理功能产生有益作用的活性微生物。目前广泛应用于生命健康领域、科学研究、生物工程、工农业以及食品安全。大量国内外研究表明益生菌在降血压、降血糖、降血脂、抗过敏、抗炎、调节免疫、维持肠道菌群平衡等方面具有积极作用。炎症性肠病的病因和发病机制尚未完全明确,现多认为与遗传、环境、感染、免疫以及肠道微生物多因素相互作用有关。益生菌通过多种机制介导,在临床治疗炎症性肠病中扮演着重要角色。     

益生菌在炎症性肠病中的治疗作用

炎症性肠病(inflammatory bowel disease,IBD)包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)。随着对肠道微生物群在IBD发病机制中作用的认识不断深入,近年来益生菌广泛应用于IBD治疗。大量临床试验结果表明,益生菌治疗IBD的疗效主要体现在对UC和贮袋炎的治疗,对CD的疗效不明确。益生菌治疗IBD可能通过促进肠道微生物群平衡、改善肠道屏障功能、调节肠道黏膜免疫及营养物质代谢等途径。     

布拉酵母对炎症性肠病的治疗作用

炎症性肠病包括溃疡性结肠炎和克罗恩病, 其病因与发病机制尚未完全明确。大量研究表明, 肠道微生物在炎症性肠病的发生、发展中发挥重要作用。布拉酵母是一种有益于人体健康的肠道微生物, 研究发现能有效改善炎症性肠病症状, 可能与其抑制肠道致病菌、增强肠屏障功能、调节肠道黏膜免疫反应等有关。     

肠内营养支持治疗对炎症性肠病患者肠黏膜屏障功能及炎症反应的影响

目的 探讨早期肠内营养（EN）支持治疗对炎症性肠病（IBD）患者肠黏膜屏障功能及炎症反应的影响。方法 将80例IBD患者按营养支持治疗途径分为EN组（48例）和肠外营养（PN）组（32例）,在常规治疗的基础上分别给予早期EN、PN支持治疗。比较治疗前后2组患者营养学相关指标[白蛋白（ALB）、前白蛋白（PA）、转铁蛋白（TF）]、肠黏膜屏障功能指标（内毒素、D-乳酸）及炎症相关指标[C-反应蛋白（CRP）、降钙素原（PCT）、粪便钙卫蛋白（FCP）]水平。结果 治疗前,2组患者各观察指标水平差异无统计学意义（P>0.05）;治疗后,与治疗前相比,2组患者血清ALB、PA及TF水平均显著升高（P0.05）。结论 在常规治疗的基础上,早期EN支持治疗对IBD患者肠黏膜屏障功能的改善及炎症缓解作用优于PN支持治疗。     

炎症性肠病患者的自主神经功能研究

目的:探讨炎症性肠病患者的自主神经功能状态。方法:选取炎症性肠病(IBD)患者60例作为观察组,包括活动期溃疡性结肠炎(UC)37例,活动期克罗恩病(CD)23例,同期健康体检者50例作为对照组。交感神经功能采用握力试验以及卧立位血压差的方式进行检查;迷走神经功能则采用卧立位心率变化和Valsalva动作反应指数检查方法。结果:(1)观察组卧立位心率变化均值明显低于对照组,其中溃疡性结肠炎和克罗恩病心率变化均值均明显低于对照组,差异有统计学意义(P0.05);溃疡性结肠炎与克罗恩病心率变化均值差异无统计学意义(P0.05);溃疡性结肠炎和克罗恩病Valsalva动作反应指数与对照组相比差异无统计学意义(F=1.06,P0.05)。(2)观察组卧立位血压差均值明显高于对照组,握力试验的血压反应均值明显低于对照组,溃疡性结肠炎和克罗恩病卧立位血压差均值均明显低于对照组,握力试验的血压反应均值均明显低于对照组差异有统计学意义(P0.05);而溃疡性结肠炎和克罗恩病卧立位血压差均值及血压反应均值比较均无统计学差异。结论:炎症性肠病患者存在自主神经功能紊乱,交感神经功能增强而迷走神经功能相对减弱。     

益生菌对炎症性肠病幼鼠Th17细胞的调节作用

目的 观察鼠李糖乳杆菌（LGG）对炎症性肠病（IBD）幼鼠结肠白细胞介素-17A（IL-17A）水平的影响,探讨益生菌对Th17细胞的调节作用。方法 36只健康雄性SD幼鼠随机分4组：空白对照组、LGG对照组各8只,IBD组、IBD-LGG组各10只。利用2,4,6-三硝基苯磺酸（TNBS）诱导幼鼠IBD模型,观察一般状况、IBD疾病活动指数评分。第8天处死所有幼鼠,留取结肠标本,观察病理改变并采用免疫组织化学法测定结肠组织IL-17A的表达。结果 相比两对照组,IBD组、IBD-LGG组幼鼠一般状态差,IBD-LGG组便性状及隐血较IBD组缓解;IBD组、IBD-LGG组幼鼠结肠组织均见炎症改变,但IBD-LGG组较轻。IBD-LGG组DAI评分、IL-17A水平均低于IBD组,差异有统计学意义（P＜0.05）。结论 益生菌可减轻IBD幼鼠肠道炎症,其机制可能与益生菌调节Th17细胞进而调控IL-17A表达有关。     

英夫利西单抗联合复合益生菌对炎症性肠病患者肠黏膜屏障、炎症因子、细胞免疫功能及骨代谢指标的影响

摘要 目的：探讨英夫利西单抗联合复合益生菌对炎症性肠病（IBD）患者肠黏膜屏障、细胞免疫功能及骨代谢指标的影响。方法：研究对象选取2017年3月~2019年12月期间来我院诊治的290例IBD患者,信封抽签法分为对照组和研究组,各145例。研究组采用英夫利西单抗联合复合益生菌治疗,对照组采用英夫利西单抗治疗,比较两组患者疗效、肠黏膜屏障功能、T细胞亚群、骨代谢指标及炎症因子水平,并记录两组治疗期间不良反应情况。结果：对照组治疗2疗程后的临床总有效率为71.72%（104/145）,低于研究组的86.21%（125/145）（P<0.05）。治疗1疗程后、治疗2疗程后,两组患者的C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、骨钙素（BGP）、Ｉ-型胶原Ｃ末端肽（CTX）、CD8⁺及尿乳果糖/甘露醇比值均较治疗前降低,治疗2疗程后上述指标水平低于治疗1疗程后,且研究组低于对照组（P<0.05）。治疗1疗程后、治疗2疗程后,两组的CD4⁺、CD4⁺/ CD8⁺较治疗前升高,治疗2疗程后上述指标水平高于治疗1疗程后,且研究组高于对照组（P<0.05）。两组不良反应发生率对比无统计学差异（P>0.05）。结论：英夫利西单抗联合复合益生菌治疗IBD患者,可减轻患者的炎症反应,提高患者的免疫功能,改善其肠黏膜屏障和骨代谢指标,且安全性较好。     

粪菌移植和益生菌在复发性艰难梭菌感染和炎症性肠病中的应用进展

聚集在人体肠道的菌群对维持机体正常的生理功能具有重要作用,肠道菌群的失调会导致复发性艰难梭菌感染及炎症性肠病等疾病。粪菌移植是将健康供者肠道内的功能菌群转移到患病个体的肠道内,重建患者的肠道微生态环境,从而达到治疗的目的。研究发现,粪菌移植在治疗复发性艰难梭菌感染方面表现出较高的治愈率,同时对炎症性肠病有积极的疗效。益生菌是一类能发挥健康作用的活性微生物,当机体摄入足够数量的益生菌,益生菌能在宿主肠道内定植,可以恢复并维持宿主肠道菌群的平衡。益生菌可作为预防复发性艰难梭菌感染的辅助治疗,同时在缓解炎症性肠病方面也有较好的效果。     

Neuropharmacology of stress-induced mucosal inflammation: implications for inflammatory bowel disease and irritable bowel syndrome

Inflammatory bowel disease (IBD) and the irritable bowel syndrome (IBS) are common causes of medical consultation and the most frequent diagnosis raised by gastroenterologists. Recent years have witnessed considerable advances in the understanding of the mechanisms involved in the initiation and perpetuation of these chronic and recurrent disorders. However, particularly in IBS, the success of the "bench-to the-bedside medicine" has been rather poor since many affected individuals still experience significant bother and negative impact in their quality of life despite growing investigative and sanitary costs. Besides IBD, several subgroups of IBS patients have been lately identified as carriers of mucosal inflammation throughout the gut. Although multifactorial, life stress has emerged as a critical factor for mucosal inflammation in these conditions. Due to the clinical and biological heterogeneity of IBD and IBS patients, the simplistic hypothesis of a stress-related stepwise progression of gut inflammation may be useful to gain operative knowledge and render better and specific diagnostic markers and improved therapeutic options. Therefore, in this review, we have consciously admitted the possibility of linear evolution of gut inflammation, from the mucosa to the serosa, and assumed a bidirectional progression, from physiological to pathological inflammation. Thus, we have outlined the stress neurocircuitry implicated in the regulation of gut inflammation and the participating pathways (mechanisms, receptors and molecules) and provided with both, evidence and a theoretical-based approach to present and potential drugs that, alone or in combination, might help to prevent, control or regress the stress-induced inflammatory process at different stages.     

Enhanced platelet adhesion induces angiogenesis in intestinal inflammation and inflammatory bowel disease microvasculature

Although angiogenesis is viewed as a fundamental component of inflammatory bowel disease (IBD) pathogenesis, we presently lack a thorough knowledge of the cell type(s) involved in its induction and maintenance in the inflamed intestinal mucosa. This study aimed to determine whether platelet (PLT) adhesion to inflamed intestinal endothelial cells of human origin may favour angiogenesis. Unstimulated or thrombin‐activated human PLT were overlaid on resting or tumour necrosis factor (TNF)‐α‐treated human intestinal microvascular endothelial cells (HIMEC), in the presence or absence of blocking antibodies to either vascular cell adhesion molecule (VCAM)‐1, intercellular adhesion molecule (ICAM)‐1, integrin α_vβ₃, tissue factor (TF) or fractalkine (FKN). PLT adhesion to HIMEC was evaluated by fluorescence microscopy, and release of angiogenic factors (VEGF and soluble CD40L) was measured by ELISA. A matrigel tubule formation assay was used to estimate PLT capacity to induce angiogenesis after co‐culturing with HIMEC. TNF‐α up‐regulated ICAM‐1, α_vβ₃ and FKN expression on HIMEC. When thrombin‐activated PLT were co‐cultured with unstimulated HIMEC, PLT adhesion increased significantly, and this response was further enhanced by HIMEC activation with TNF‐α. PLT adhesion to HIMEC was VCAM‐1 and TF independent but ICAM‐1, FKN and integrin α_vβ₃ dependent. VEGF and sCD40L were undetectable in HIMEC cultures either before or after TNF‐α stimulation. By contrast, VEGF and sCD40L release significantly increased when resting or activated PLT were co‐cultured with TNF‐α‐pre‐treated HIMEC. These effects were much more pronounced when PLT were derived from IBD patients. Importantly, thrombin‐activated PLT promoted tubule formation in HIMEC, a functional estimate of their angiogenic potential. In conclusion, PLT adhesion to TNF‐α‐pre‐treated HIMEC is mediated by ICAM‐1, FKN and α_vβ₃, and is associated with VEGF and sCD40L release. These findings suggest that inflamed HIMEC may recruit PLT which, upon release of pro‐angiogenic factors, actively contribute to inflammation‐induced angiogenesis.     

不同途径下MIMP对炎症性肠病小鼠的肠屏障及炎症因子的改善作用

目的通过葡聚糖硫酸钠(DSS)诱导小鼠炎症性肠病(inflammatory bowel disease,IBD)模型并观察不同途经下乳酸杆菌微小膜蛋白(MIMP)对炎症性肠病小鼠的肠炎的影响。方法 C57BL/6小鼠40只根据DSS和MIMP不同的干预组合将其分为4组:诱导肠炎+MIMP腹腔注射组(n=10)、诱导肠炎+MIMP灌胃组(n=10)、单纯诱导肠炎组(n=10)、空白对照组(n=10),DSS干预浓度为2.5%。干预期间,观察小鼠体重变化情况,腹泻、血便、死亡等发生率,各组小鼠活体肠道通透性差异,比较肠道长度及肠上皮组织病理学改变,应用荧光定量PCR反应观察各组小鼠肠道中的炎症因子的表达,应用免疫组织化学染色观察各组小鼠肠道上皮中IL-23的表达。结果 MIMP腹腔注射组以及灌胃组小鼠整体情况较好,体重减轻程度轻,腹泻、便血及死亡发生率低;MIMP干预可显著改善肠道通透性(P0.05),并降低肠道萎缩程度,同时降低小鼠肠道病理评分及组织学评分,可显著降低小鼠肠道中促炎性细胞因子(IL-23p19、IL-17A、IL-12p40)的表达(P0.05),并提高抑炎性细胞因子(IL-10)的表达(P0.05),免疫组化显示MIMP可显著降低小鼠肠上皮细胞中IL-23的表达水平。结论 MIMP腹腔注射及灌胃对IBD小鼠的炎症状态及肠道屏障功能有显著的改善作用,并可显著降低促炎性细胞因子的表达,提高抑炎性细胞因子的表达。     

Depleted mucosal antioxidant defences in inflammatory bowel disease

Experimental approaches designed to define the role of reactive oxygen and nitrogen species generated by inflammatory cells in the tissue injury seen in inflammatory bowel disease rarely consider the chemical antioxidant defences against such increased oxidant stress in the mucosa. In this investigation, we have analysed components of the aqueous and lipid phase antioxidant mucosal defences by measuring the total peroxyl radical scavenging capacity and the levels of urate, glutathione, -tocopherol, and ubiquinol-10 in paired noninflamed and inflamed mucosal biopsies from inflammatory bowel disease patients. Compared to paired noninflamed mucosa, decreases were observed in inflamed mucosa for total peroxyl radical scavenging capacity (55%, p = 0.0031), urate [Crohn's disease (CD), 62.2%, p = 0.066; ulcerative colitis (UC), 47.3%, p = 0.031], glutathione (UC, 59%, 7/8 patients, ns), total glutathione (UC 65.2%, 6/8 patients, ns), ubiquinol-10 (CD, 75.7%, p = 0.03; UC, 90.5%, p = 0.005). The mean -tocopherol content was unchanged. These observations support our earlier findings of decreased reduced and total ascorbic acid in inflamed IBD mucosa and demonstrate that the loss of chemical antioxidant defences affects almost all the major components. The decreased antioxidant defences may severely compromise the inflamed mucosa, rendering it more susceptible to oxidative tissue damage, hindering recovery of the mucosa and return of epithelial cell layer integrity. The loss of chemical antioxidant components provides a strong rationale for developing novel antioxidant therapies for the treatment of inflammatory bowel disease.     

肠道微生物群落与炎症性肠病关系研究进展

目的炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC）,以持续性肠道非特异性炎症为特征,通常反复发作、迁延不愈,临床上仍无特效性的治疗手段。IBD确切的发病机制尚不清楚,涉及免疫、环境及遗传等因素,这些因素共同诱导肠道炎症、黏膜损伤和修复。肠道微生物群落及其代谢产物、宿主基因易感性及肠道黏膜免疫三方面共同参与了IBD的发病机制。本文从消化道微生态角度出发,对目前IBD相关的肠道微生物群落研究现状、宿主-微生物间免疫应答及益生菌治疗等内容进行探讨。     

Differential protein expression profile in the intestinal epithelium from patients with inflammatory bowel disease

The loss of intestinal epithelial cell (IEC) function is a critical component in the initiation and perpetuation of chronic intestinal inflammation in the genetically susceptible host. We applied proteome analysis (PA) to characterize changes in the protein expression profile of primary IEC from patients with Crohn's disease (CD) and ulcerative colitis (UC). Surgical specimens from 18 patients with active CD (N = 6), UC (N = 6), and colonic cancer (N = 6) were used to purify primary IEC from ileal and colonic tissues. Changes in protein expression were identified using 2D-gel electrophoreses (2D SDS-PAGE) and peptide mass fingerprinting via MALDI-TOF mass spectrometry (MS) as well as Western blot analysis. PA of primary IEC from inflamed ileal tissue of CD patients and colonic tissue of UC patients identified 21 protein spots with at least 2-fold changes in steady-state expression levels compared to the noninflamed tissue of control patients. Statistical significance was achieved for 9 proteins including the Rho-GDP dissociation inhibitor alpha that was up-regulated in CD and UC patients. Additionally, 40 proteins with significantly altered expression levels were identified in IEC from inflamed compared to noninflamed tissue regions of single UC (N = 2) patients. The most significant change was detected for programmed cell death protein 8 (7.4-fold increase) and annexin 2A (7.7-fold increase). PA in primary IEC from IBD patients revealed significant expression changes of proteins that are associated with signal transduction, stress response as well as energy metabolism. The induction of Rho GDI alpha expression may be associated with the destruction of IEC homeostasis under condition of chronic intestinal inflammation.     

炎症性肠病与肠道微生态的研究进展

炎症性肠病(inflammatoryboweldisease,IBD)是一种肠道慢性炎症性疾病,其发病机制尚不清楚。然而,IBD的发病率不断上升给患者及其家属带来了巨大的经济负担,需要找到积极有效的治疗方法来帮助患者。最新的观点认为,宿主和肠道微生物之间的平衡被打破会触发遗传易感个体的免疫炎症反应。肠道菌群失调在炎症性肠病的发病及发展过程中起着重要的作用。临床研究发现,IBD患者肠道菌群失调程度不同,而联合应用益生菌可以改善这些患者的症状。越来越多的研究者密切关注肠道菌群与IBD的关系,并进行了深入的基础和临床研究。本文从肠道菌群对IBD的生理影响以及益生菌和粪便细菌移植等方面进行综述。     

The insulin-like growth factor system and markers of inflammation in adult patients with inflammatory bowel disease

BACKGROUND AND OBJECTIVES: Catabolism and growth impairment are well-known complications of inflammatory bowel disease (IBD). Recent studies have demonstrated significant changes in the IGF system in IBD patients. The aim of the present study was to investigate correlations between the IGF system and markers of inflammation in IBD. METHODS: A cross-sectional study comprising 99 IBD patients (Crohn's disease (CD, n = 50) and ulcerative colitis (UC, n = 49)). Correlations between markers of inflammation and IGF-I, IGF-II and IGFBP-3 were examined in CD and UC patients in remission and relapse. The patients were clinically scored using Crohn's Disease Activity Index (CDAI) for CD patients and Activity Index (AI) for UC patients. RESULTS: In the UC group we found correlations between IGF-I and CRP (r(s) = Spearman's rho) (r(s) = -0.40, p < 0.01) and albumin (r(s) = 0.46, p < 0.001), IGFBP-3 and albumin (r(s) = 0.36, p < 0.01) and AI score (r(s) = -0.31, p < 0.05). IGF-II correlated with CRP (r(s) = -0.42, p < 0.01), IL-6 (r(s) = -0.65, p < 0.001), albumin (r(s) = 0.41, p < 0.01), AI score (r(s) = -0.30, p < 0.05) and orosomucoid (r(s) = -0.47, p < 0.001). In the CD group we found correlations between IGF-I and CRP (r(s) = -0.40, p < 0.05), and albumin (r(s) = -0.46, p < 0.01), IGFBP-3 and albumin (r = 0.36, p < 0.01). IGF-II correlated with IL-6 (r(s) = -0.65, p < 0.001), albumin (r(s) = 0.41, p < 0.01), CDAI score (r(s) = -0.30, p < 0.05) and orosomucoid (r(s) = -0.47, p < 0.001). CONCLUSIONS: IGF-I, IGF-II and IGFBP-3 are correlated to albumin and IGF-I and IGF-II are correlated to CRP in IBD patients. Further, IGF-II is correlated to IL-6 in IBD patients. This may suggest a correlation between inflammation and the IGF system with involvement in muscle and bone catabolism in IBD.