肠道菌群与过敏性哮喘

近年来随着过敏性哮喘发病率的持续升高,人们开始注意到环境、生活方式的改变可能会影响过敏性哮喘的发生。流行病学调查显示,过敏性哮喘的发生和发展与生命早期肠道菌群的紊乱密切相关。本研究主要综述近年来肠道菌群对过敏性哮喘发生的影响及机制,探讨影响肠道菌群定植的主要因素,以及微生态调节剂在过敏性哮喘等变应性疾病中的预防和治疗作用。     

真菌过敏性哮喘的治疗研究进展

真菌过敏性哮喘是由环境中真菌致敏原暴露诱导的一种呼吸道慢性炎症性疾病。真菌过敏哮喘患者肺部炎症细胞、结构细胞及细胞组分间有复杂的相互作用,使得患者气道壁重塑并伴渐进性肺功能障碍,表现为喘息、胸闷、呼吸困难等症状,对患者的工作和生活造成严重影响,而目前糖皮质激素及抗菌药物等传统疗法对其治疗效果欠佳。近年来,很多研究开始致力于对真菌过敏性哮喘新的治疗方法进行积极探索,使得真菌过敏性哮喘的治疗除应用糖皮质激素等传统方法外,在抗真菌感染及其免疫学治疗控制真菌过敏性哮喘方面取得一定新进展。     

婴儿早期维生素D补充水平对生长发育和肠道菌群的影响

目的：探讨和研究婴儿早期补充维生素D水平对其生长发育和肠道菌群的影响。方法：选取2016年1月—2018年1月在黑龙江中医药大学附属第一医院出生的健康婴儿235例为研究对象,根据维生素D补充情况分为观察组（维生素补充充足组）134例和对照组（维生素缺乏组）101例为研究对象,统计婴儿出生时和6月龄时的身长、体重和体质指数（BMI）变化情况,检测6月龄时肠道内主要菌群含量,对两组指标进行比较。 结果：出生时两组婴儿身长、体重和BMI等指标无明显变化（P＞0.05）,6月龄时观察组体重和BMI明显低于对照组（P＜0.05或P＜0.01）,观察组乳酸杆菌、双歧杆菌、肠球菌含量明显低于对照组（P＜0.05或P＜0.01）。结论：婴儿早期维生素D补充不足能够导致体重增加和BMI升高,并能引起肠道菌群数量增加,影响婴儿的生长,应引起足够重视。     

1,25—二羟基维生素D3的免疫调节机能

1,25-二羟基维生素D_3是人们熟悉的调节钙磷代谢的重要激素,它可抑制淋巴细胞增殖和抗体生成,诱导巨噬细胞的分化及细胞表面主要组织相容性抗原的表达,是一种新的免疫调节激素。     

维生素D及其受体在帕金森病中的作用

帕金森病(Parkinson's disease,PD)是一种常见的中枢神经系统退行性疾病,引起帕金森病的发病机制至今尚未明确。帕金森病患者及老年人普遍存在维生素D缺乏,这可能是帕金森病的重要发病机制之一。由于维生素D具有免疫调节,抗氧化,调节神经营养因子,降低神经毒性的功能,能同时针对几种导致神经退行性病变因素发挥作用,特别是老年人纠正维生素D缺乏可能会阻止神经元的损失和PD相关的认知功能下降。因此补充维生素D可能成为治疗PD的方法。近年来研究发现,维生素D受体基因多态性与帕金森病的发病有相关性。该文就维生素D及其受体在帕金森病中可能发生的保护作用及其机制作一综述。     

肺部菌群对过敏性哮喘的影响CSCD

过敏性哮喘是一种常见的过敏性疾病,其发病机制尚未完全清楚,但共生微生物与宿主免疫稳态的建立及维持关系密切。近年来的研究发现肠道菌群在过敏性哮喘的发生发展中起主要作用,“肺-肠轴”概念的提出阐释了肺部菌群与肠道菌群之间的串扰关系。研究证实肺部菌群与过敏性哮喘密切相关,并通过肺-肠轴直接或间接影响过敏性哮喘的发生发展。本文分析肺部菌群与过敏性哮喘的相关性及可能的机制,深入了解肺部菌群在过敏性哮喘中的作用及意义,以期为过敏性哮喘的临床预防及诊疗拓宽思路。     

维生素D受体最新研究进展

维生素D受体(vitamin D receptor,VDR)是一种核转录因子,通过与配体特异结合,调控多种基因的表达,从而调节多种生命活动的进行.本文总结了近年来VDR的研究进展,主要包括VDR的作用机制、VDR行使功能所需共激活子及共抑制子、VDR在生长分化、免疫调节和抑制肿瘤等方面的作用及VDR配体类似物在药物开发研究领域的最新进展.     

维生素A、D治疗毛细支气管炎和儿童支气管哮喘的临床效果研究

目的:探讨维生素A、D治疗毛细支气管炎和儿童支气管哮喘的临床效果。方法:选取2016年1月-2018年1月本院住院治疗的毛细支气管炎患儿120例、门诊就诊的支气管哮喘患儿120例、儿童保健门诊查体的健康患儿40例(近1年均无服用维生素AD史)作为研究对象。将毛细支气管炎组、哮喘组分别随机分为治疗组40例(常规治疗+口服维生素AD组)和对照组40例(常规治疗组)。治疗组补充口服维生素AD1粒qd,疗程共6个月。分别比较三组血清维生素A、D水平,随访6个月、1年内喘息的控制情况(喘息发作次数、持续时间、咳嗽程度、有无夜间症状或夜间憋醒、有无活动受限)及肺功能(第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC),哮喘组≥4岁患儿进行儿童哮喘控制测试(C-ACT)评分评价哮喘的控制情况。结果:观察组与对照组患儿血清维生素A、D水平无显著性差异(P0.05);观察组、对照组患者维生素A、D水平显著低于健康组患儿(P0.05);观察组患儿喘息发作次数、喘息发作时间、夜间症状、夜间憋醒、活动受限发生情况均显著低于对照组(P0.05)。治疗后,两组各肺功能指标较治疗前均显著升高(P0.05),观察组FEV1、FVC、FEV1/FVC水平及C-ACT评分均明显高于对照组(P0.05),观察组进展支气管哮喘的发生率明显低于对照组(P0.05)。结论:维生素A、D治疗毛细支气管炎和儿童支气管哮喘的临床效果显著。     

过敏性鼻炎患儿肠道菌群变化 及双歧杆菌三联活菌散对其辅助治疗效果

摘要：目的 观察过敏性鼻炎患儿肠道菌群变化及双歧杆菌三联活菌散对其辅助治疗的效果。方法 选取我院就诊的过敏性鼻炎患儿60例,从中随机抽取10例为疾病组,并以10例体检的健康儿童为健康对照组,采集两组对象粪便标本,用高通量测序法对比过敏性鼻炎患儿与健康对照组肠道菌结构的差异。另一方面,将入选的60例过敏性鼻炎患儿分为对照组（30例,采用常规治疗）和治疗组（30例,常规治疗联合双歧杆菌三联活菌治疗）。两组患儿连续治疗8周后,观察其治疗前后临床症状评分及血清IL-4、IL-12、IgE水平变化。结果 过敏性鼻炎患儿肠道菌群多样性低于健康对照组。患儿肠道菌群以拟杆菌门为主,健康对照组以厚壁菌门为主（P＜0.05)。患儿肠道双歧杆菌属数量低于健康对照组,而毛螺菌属,瘤胃菌属,红蝽菌属和普雷沃菌属有所增多（均P＜0.05)。治疗8周后,治疗组患儿临床症状评分明显降低,治疗的总有效率高于对照组（P<0.05）。治疗组患儿血清IL-4、IgE水平明显降低,IL-12水平明显升高,且治疗组患儿以上指标的改善程度均优于对照组（均P<0.05）。结论 过敏性鼻炎患儿与健康儿童相比肠道菌群存在差异,肠道菌群失衡可能是促进过敏性鼻炎发生发展的一个因素。双歧杆菌三联活菌散对过敏性鼻炎有辅助治疗的作用,能显著改善患儿临床症状,调节机体的免疫能力,具有一定临床应用价值。     

益生菌在腹型过敏性紫癜中临床应用的研究进展

过敏性紫癜(HSP)是儿童最常见的自身免疫性疾病之一,临床表现除皮疹外以消化道症状最为常见,严重影响患儿的生活质量。临床上治疗腹型HSP主要以糖皮质激素和抗组胺药物为主,但只能缓解病情,不能达到根治的目的,同时还存在一定的副作用。最近有学者对腹型HSP患者中肠道微生物区系中的细菌数量进行精确测量,发现腹型HSP可能与肠道菌群失调有关。益生菌是一类在适当摄入数量会对宿主机体带来益处的活的微生物,是调节机体微生态平衡的有效途径,可通过多种途径来增强肠道屏障功能、提高机体自身免疫力和降低变态反应性,从而使其在腹型HSP中具有治疗潜力。本文对益生菌在腹型HSP中的临床应用作一综述。     

Vitamin D in foods and as supplements

Numerous studies have shown that the vitamin D status is far from optimal in many countries all over the world. The main reason for this is lack of sunshine. Only a limited number of foods naturally contain vitamin D. Good sources of vitamin D(3) are fish (not only fatty fish), egg yolk, and offal such as liver. Some foods such as milk are fortified with vitamin D in some countries. Dietary vitamin D intake is low in many countries, especially as the dietary sources are limited. The use of supplements is important and seems to be high in some countries. Current dietary intake recommendations are too low to preserve/reach optimal S-25-OHD concentrations, when UVB radiation is not available. We suggest that the recommendations should be increased to at least 10 microg per day in all age groups when solar UVB is scarce. The elderly may need a daily vitamin D intake of 25 microg. If dietary intake of vitamin D is to be increased, food habits will have to change. From a public health point of view it is better to increase the potential sources of vitamin D by fortifying specific products that are consumed commonly in a whole population, or if necessary by especially vulnerable groups. Supplement use is probably the right alternative for vulnerable groups such as infants and inactive elderly in whom this is more easily implemented.     

微生态制剂辅助普米克令舒提高过敏性哮喘患儿免疫功能

目的 探讨微生态制剂辅助普米克令舒是否能提高过敏性哮喘患儿免疫功能。 方法 选择2018年1月至2019年12月在我院确诊并进行治疗的过敏性哮喘患儿150例,根据数字表法随机分为观察组与对照组,每组各75例。对照组患儿给予普米克令舒雾化吸入及常规综合治疗,观察组在对照组基础上辅助微生态制剂双歧四联活菌片进行治疗。对两组患儿治疗效果、治疗前后肠道菌群变化、免疫功能和用药期间不良反应发生率等指标进行比较分析。 结果 两组患儿治疗后观察组有效率为92.0%,显著高于对照组的77.3%(P0.05)。与治疗前比较,观察组患儿治疗后乳酸菌、双歧杆菌数量明显增多,肠球菌、肠杆菌数量明显减少(P+、CD4+水平、CD4+/CD8+比值均升高,CD8+水平下降(P结论 在过敏性哮喘患儿的治疗中,普米克令舒辅助微生态制剂可有效提高治疗效果,提高免疫功能,疗效确切且安全。     

胰腺疾病的肠道微生物群研究进展

肠道微生物群是指存在于人体消化道内的微生物组成的复杂群落。随着16S rRNA基因测序和宏基因组测序等高通量测序技术的发展,肠道微生物群已被证明与多种疾病息息相关。三大胰腺疾病与肠道微生物群密切相关,急性胰腺炎（acute pancreatitis,AP）、慢性胰腺炎（chronic pancreatitis,CP）和胰腺癌患者肠道微生物群的构成和丰度均与健康人群不同。反之,肠道微生物群的改变会减慢或加速胰腺疾病的发生发展。益生菌和抗菌药物的使用及粪菌移植等可减轻胰腺炎症反应,缓解胃肠道症状,影响胰腺癌化疗和免疫治疗的效果,因此可为胰腺疾病的诊疗提供新策略。本文总结了AP、CP和胰腺癌的肠道微生物群研究,阐述了疾病发生时肠道微生物群的变化、与胰腺相互作用的机制以及目前的主要研究技术,探讨了肠道微生物群在胰腺疾病诊疗中的研究进展。

     

肠道菌群失调与高尿酸血症关系的研究进展

高尿酸血症（hyperuricemia,HUA）是一种涉及肝、肾、肠等多个器官的代谢性疾病,因尿酸代谢异常而引起代谢障碍。尿酸在肝脏和肾脏中的代谢途径目前已经被阐明,但在肠道内的代谢途径尚未完全清晰。肠道菌群在人体肠道中定植,与宿主存在互惠共生的关系,在宿主的代谢和免疫调节中起着至关重要的作用。肠道菌群结构的变化可能引起代谢紊乱,肠道菌群参与嘌呤代谢酶的合成和炎症因子的释放,与HUA的发生发展密切相关。肠道菌群作为探讨HUA发病机制的切入点,已成为新的研究热点。本综述主要阐述HUA与肠道菌群之间的关系,探讨肠道菌群抗HUA的机制,如肠道菌群促进嘌呤和尿酸分解代谢,影响尿酸排泄,以及HUA引起的肠道炎症反应等,以期为通过调节肠道菌群来治疗HUA提供一定的依据。

     

Vitamin D: its role in cancer prevention and treatment

Vitamin D, the sunshine vitamin, has been recognized for almost 100 years as being essential for bone health. Vitamin D provides an adequate amount of calcium and phosphorus for the normal development and mineralization of a healthy skeleton. Vitamin D made in the skin or ingested in the diet, however, is biologically inactive and requires obligate hydroxylations first in the liver to 25-hydroxyvitamin D, and then in the kidney to 1,25-dihydroxyvitamin D. 25-Hydroxyvitamin D is the major circulating form of vitamin D that is the best indicator of vitamin D status. 1,25-dihydroxyvitamin D is the biologically active form of vitamin D. This lipid-soluble hormone interacts with its specific nuclear receptor in the intestine and bone to regulate calcium metabolism. It is now recognized that the vitamin D receptor is also present in most tissues and cells in the body. 1,25-dihydroxyvitamin D, by interacting with its receptor in non-calcemic tissues, is able to elicit a wide variety of biologic responses. 1,25-dihydroxyvitamin D regulates cellular growth and influences the modulation of the immune system. There is compelling epidemiologic observations that suggest that living at higher latitudes is associated with increased risk of many common deadly cancers. Both prospective and retrospective studies help support the concept that it is vitamin D deficiency that is the driving force for increased risk of common cancers in people living at higher latitudes. Most tissues and cells not only have a vitamin D receptor, but also have the ability to make 1,25-dihydroxyvitamin D. It has been suggested that increasing vitamin D intake or sun exposure increases circulating concentrations of 25-hydroxyvitamin D, which in turn, is metabolized to 1,25-dihydroxyvitamin D(3) in prostate, colon, breast, etc. The local cellular production of 1,25-dihydroxyvitamin D acts in an autocrine fashion to regulate cell growth and decrease the risk of the cells becoming malignant. Therefore, measurement of 25-hydroxyvitamin D is important not only to monitor vitamin D status for bone health, but also for cancer prevention.     

Vitamin D status and nutrition in Europe and Asia

Vitamin D status is highly different in various countries of Europe, the Middle East and Asia. For this review, vitamin D deficiency is defined as serum 25-hydroxyvitamin D (25(OH)D) <25 nmol/l. Within European countries, serum 25(OH)D is <25 nmol/l in 2–30% of adults, increasing in the elderly and institutionalized to more than 80% in some studies. A north-south gradient was observed for serum 25(OH)D in the Euronut and MORE studies with higher levels in Scandinavia and lower levels in Italy and Spain and some Eastern European countries. This points to other determinants than sunshine, e.g. nutrition, food fortification and supplement use. Mean vitamin D intake in Scandinavia is 200–400 IU/d, twice that in other European countries. Very low serum 25(OH)D levels have been reported in the Middle East, e.g. Turkey, Lebanon, Jordan and Iran. In these countries serum 25(OH)D was lower in women than in men and associated with clothing habits. In a Lebanese survey, vitamin D deficiency was observed in the majority and occurred mainly in veiled women. In India, vitamin D deficiency was observed in more than 30%, vitamin D status being poor in school children, pregnant women and large cities. Vitamin D status was much better in Malaysia and Singapore, but lower serum 25(OH)D was observed in Japan and China. Rickets and osteomalacia appear quite common in India, but precise data are lacking. Immigrants in Europe from the Middle East and Asia carry a high risk for vitamin D deficiency, pregnant women being especially at risk. Comparison of vitamin D status between countries is hampered by interlaboratory variation of serum 25(OH)D measurement. In addition, there is a need of population-based data. In conclusion, vitamin D deficiency is common in Southern Europe, the Middle East, India, China and Japan. It is less common in Northern Europe and Southeast Asia. Risk groups are young children, the elderly, pregnant women and non-western immigrants in Europe. Important determinants are skin type, sex, clothing, nutrition, food fortification, supplement use, BMI and degree of urbanization.     

Early life antibiotic-driven changes in microbiota enhance susceptibility to allergic asthma

Allergic asthma rates have increased steadily in developed countries, arguing for an environmental aetiology. To assess the influence of gut microbiota on experimental murine allergic asthma, we treated neonatal mice with clinical doses of two widely used antibiotics--streptomycin and vancomycin--and evaluated resulting shifts in resident flora and subsequent susceptibility to allergic asthma. Streptomycin treatment had little effect on the microbiota and on disease, whereas vancomycin reduced microbial diversity, shifted the composition of the bacterial population and enhanced disease severity. Neither antibiotic had a significant effect when administered to adult mice. Consistent with the 'hygiene hypothesis', our data support a neonatal, microbiota-driven, specific increase in susceptibility to experimental murine allergic asthma.