乳果糖和枯草杆菌屎球菌二联活菌治疗轻微性肝性脑病疗效观察

目的:探讨乳果糖和枯草杆菌屎球菌二联活菌治疗肝硬化所致轻微性肝性脑病(MHE)的疗效。方法:将患有MHE的患者84例随机分为四组,对照组(A组,仅接受肝硬化综合治疗),乳果糖组(B组,在A组基础上加用乳果糖口服液),枯草杆菌屎球菌二联活菌组(C组,在A组基础上加用枯草杆菌屎球菌二联活菌胶囊),联合组(D组,在A组基础上联合应用乳果糖和枯草杆菌屎球菌二联活菌胶囊),每组均治疗4周。分别于治疗后第一周,第二周,第四周观察患者的数字连接实验(NCT)、数字符号实验(DST)结果,血氨变化及不良反应的发生情况。结果:B、C、D组NCT时间,DST分数及血氨均较A组改善明显,其中以D组最显著(P0.05),且随着治疗时间延长,B、C、D组以上各指标逐渐改善,其中D组以治疗后2周效果最明显(P0.05)。四组均无明显不良反应,其中D组不良反应率最低。结论:单用乳果糖与单用枯草杆菌二联活菌均可改善MHE患者的病情,但联合用药效果明显优于单药治疗,且随用药时间延长,疗效明显,安全性高,值得在临床推广。     

Gas chromatographic method for detection of urinary sucralose: application to the assessment of intestinal permeability

We developed a capillary column gas chromatography (CCGC) method for the measurement of urinary sucralose (S) and three other sugar probes including, sucrose, lactulose (L) and mannitol (M) for use in in vivo studies of intestinal permeability. We compared the capillary method with a packed column gas chromatography (PCGC) method. We also investigated a possible role for sucralose as a probe for the measurement of whole gut permeability. Sample preparation was rapid and simple. The above four sugars were detected precisely, without interference. We measured intestinal permeability using 5- and 24-h urine collections in 14 healthy volunteers. The metabolism of sugars was evaluated by incubating the intestinal bacteria with an iso-osmolar mixture of mannitol, lactulose and sucralose at 37 degrees C for 19 h. Sugar concentrations and the pH of the mixture were monitored. The use of the CCGC method improved the detection of sucralose as compared to PCGC. The average coefficient of variation decreased from 15% to 4%. It also increased the sensitivity of detection by 200-2000-fold. The GC assay was linear between sucralose concentrations of 0.2 and 40 g/l (r=1.000). Intestinal bacteria metabolized lactulose and acidified the media but did not metabolize sucralose or mannitol. The new method for the measurement of urinary sucralose permits the simultaneous quantitation of sucrose, mannitol and lactulose, and is rapid, simple, sensitive, accurate and reproducible. Because neither S nor M is metabolized by intestinal bacteria, and because only a tiny fraction of either sugar is absorbed, this pair of sugar probes appears to be available for absorption throughout the GI tract. Thus, the 24-h urinary concentrations of S and M, or the urinary S/M ratio following an oral dose of a sugar mixture, might be good markers for whole gut permeability.     

Effects of lactulose and lactitol on coliform bacteria and bacterial translocation in the caecum during 72-h starvation in rats

Lactulose and lactitol, non-absorbable disaccharides, prevent bacterial translocation (BT) arising from the gut. In contrast, lack of food into the gut leads to coliform bacterial overgrowth and even if it does not cause BT, can induce the risk from other stimuli for BT. In this study, we tested whether lactulose and lactitol affected populations of coliform bacteria in the caecum during starvation in Sprague-Dawley rats. Three groups of rats were starved for 72 h and given oral 2 ml undiluted lactulose (670 mg/ml), 2 ml undiluted lactitol (666 mg/ml) or 2 ml physiological saline, respectively, once a day. The caecum and mesenteric lymph nodes (MLNs) were removed for microbiological and histopathological analyses. The highest degree of coliform bacterial overgrowth, BT to MLNs and histopathological damage were observed in lactulose-treated rats, followed by the group treated with lactitol. As a result of this study, both drugs, especially lactulose augmented the proliferation and translocation tendency of coliform bacteria in the caecum during 72-h starvation in rats.     

乳果糖对肝癌TACE后肠黏膜损伤的保护作用研究

目的了解乳果糖对肝癌TACE后患者肠黏膜损伤的保护作用。方法将54例患者随机分为2组,治疗组按常规治疗加服乳果糖,对照组按常规治疗,服药后观察全身和肠道情况并检测二胺氧化酶(DAO)的内毒素水平。结果治疗组血二胺氧化酶水平与术前相比差异无显著性(P>0.05),未应用乳果糖组血内毒素水平比术前降低(P<0.05);治疗组血内毒素水平与术前相比差异无显著性(P>0.05),而未应用乳果糖组血内毒素水平比术前升高(P<0.05)。结论乳果糖增强了肠道黏膜的屏障作用,在避免肝癌TACE后的肠道细菌易位,内毒素血症起到积极作用。     

乳果糖联合美常安治疗成人功能性便秘的临床疗效观察

目的 观察乳果糖联合美常安(枯草杆菌肠球菌二联活菌)治疗成人功能性便秘的疗效及安全性.方法 采用随机分组、平行对照试验.按入选标准选择成人便秘患者64例,随机进入试验组和对照组,每组均为32例.试验组服用乳果糖15 mL bid和美常安500 mg tid;对照组服用乳果糖15 mL bid,疗程2周.观察排便次数、大便性状及便秘伴随症状的变化.结果 试验组48 h首次排便率(78.12％)明显高于对照组(53.33％)(P＜0.05);试验组平均每周排便次数明显高于对照组(P＜0.01);治疗后试验组和对照组大便恢复正常率分别为87.50％和60.00％(P＜0.05),试验组腹胀缓解率(84.00％)及排便困难缓解率(92.59％)均明显高于对照组(56.52％和65.38％)(均为P ＜0.05);试验组总有效率(93.75％)明显高于对照组(73.33％)(P＜0.05);两组均无严重不良反应发生.结论 乳果糖联合美常安治疗成人功能性便秘比单纯应用乳果糖治疗症状改善快、效果好、安全.     

双歧杆菌四联活菌片联合乳果糖对儿童功能性便秘患者排便频次及肠道菌群的影响

使用双歧杆菌四联活菌片联合乳果糖的治疗方案对儿童功能性便秘患者排便频次及肠道菌群的影响进行探究。

通过随机数表法将选取的150例于2021年5月至2022年12月来我院进行便秘治疗的儿童分为观察组（75例）和对照组（75例）,对照组患儿采用乳果糖进行治疗,观察组在对照组乳果糖治疗的基础上给予双歧杆菌四联活菌片,对两组患儿的临床疗效、排便频次、肠道菌群和不良反应以及复发率作对比。

观察组和对照组患儿经治疗后的临床总有效率对比,对照组（86.67%）显著低于观察组（97.33%）,差异有统计学意义（χ² = 4.438,P = 0.035）;治疗后两组患儿便秘频次和便秘困难程度评分与治疗前相比均有所降低,且对照组患儿的便秘频次和便秘困难程度评分降低幅度不及观察组显著（t = 8.880,P＜0.001）;两组患儿经治疗后双歧杆菌数量均有增多,葡萄球菌、酵母菌、肠杆菌数量均有减少,且对照组患儿无论是双歧杆菌数量的增多情况或是葡萄球菌、酵母菌、肠杆菌数量的减少情况均不及观察组显著（t = 7.823,P＜0.001）;观察组和对照组患儿中的不良反应发生率分别为9.33%和12.00%,差异无统计学意义（χ² = 0.280,P = 0.597）,复发率在观察组和对照组患儿中分别为2.67%和14.67%,差异有统计学意义（χ² = 5.390,P = 0.020）。

双歧杆菌四联活菌片联合乳果糖能够有效改善患儿的临床症状,增加患儿排便频次,平衡肠道菌群,提高患儿的生活质量。

     

乳果糖联合双歧杆菌三联活菌胶囊在轻微性肝性脑病患者中的应用效果

目的 探讨乳果糖联合双歧杆菌三联活菌胶囊在轻微性肝性脑病(MHE)患者中的应用效果。 方法 选择2015年1月至2019年4月在我院消化科住院就诊的94例MHE患者为研究对象,随机分为观察组和对照组各47例。两组患者均予基础治疗。观察组患者在基础治疗上加用双歧杆菌三联活菌胶囊(630 mg/次,2次/d,温开水送服)联合乳果糖口服液(20 mL/次,3次/d,口服)治疗,连用8周。对照组患者单用乳果糖口服液治疗,剂量、用法及疗程同观察组。观察两组患者治疗前后血氨、血清内毒素(ET)、数字连接试验(NCT)时间和数字符号实验(DST)评分及肠道菌群数量的变化,并比较肝性脑病(HE)的转变率。 结果 治疗8周后,两组患者血氨、ET和NCT时间均较治疗前明显下降,DST评分较治疗前明显上升,且观察组变化幅度大于对照组(均P2=3.89,P=0.049)。 结论 乳果糖联合双歧杆菌三联活菌胶囊能显著改善MHE患者智力测验结果,降低HE转化率,其作用机制可能与其能纠正患者肠道菌群紊乱,降低血氨水平,控制内毒素血症相关。     

双歧杆菌三联活菌联合乳果糖对儿童功能性便秘的疗效

目的 观察双歧杆菌三联活菌(金双歧)联合乳果糖口服液治疗儿童功能性便秘的临床疗效。探索临床治疗儿童功能性便秘的良好方法。 方法 选择我院2015年1月至2017年12月收治的110例功能性便秘患儿为研究对象,随机分为治疗组(58例)和对照组(52例)。两组患儿均予以基础治疗,对照组患儿给予乳果糖口服液治疗,治疗组患儿给予金双歧联合乳果糖口服液治疗,比较两组患儿疗效及不良反应。 结果 治疗组和对照组患儿治疗总有效率分别为91.4%和76.9%,差异有统计学意义(χ2=4.385 0,P=0.036 2)。治疗组患儿不良反应发生率为3.4%,对照组为11.5%,差异无统计学意义(χ2=5.153 0,P=0.272 0)。随访1年后,治疗组患儿远期复发率低于对照组。 结论 双歧杆菌三联活菌联合乳果糖口服液对儿童功能性便的疗效优于单用乳果糖口服液,患儿远期复发少,值得临床推广。     

双歧杆菌四联活菌片联合乳果糖对轻微型肝性脑病患者炎症性肠黏膜损伤的保护作用

目的探讨双歧杆菌四联活菌片联合乳果糖对轻微型肝性脑病(MHE)患者炎症性肠黏膜损伤的保护作用,为该类患者的治疗提供参考。方法选择2018年1月至2019年12月我院内科住院治疗的90例MHE患者,随机分为联用组和单用组各45例。两组患者给予低盐饮食、护肝降转氨酶、维持水电解质平衡及防治并发症等基础治疗。单用组患者给予乳果糖口服液20 mL/次,3次/d,口服。联用组患者在单用组基础上加用双歧杆菌四联活菌片1.5 g/次,3次/d,温开水送服。两组患者连用8周。观察两组患者治疗前后血清丙氨酸转氨酶(ALT)、数字连接试验(NCT)时间、血清炎症因子[白介素(IL) 6、肿瘤坏死因子(TNF) α]和肠黏膜损伤指标[血清肠脂肪酸结合蛋白(IFABP)、中晚期糖基化终末产物(AGEs)]水平变化,并比较临床型肝性脑病(HE)的进展率。结果治疗8周后,两组患者ALT、IL 6、TNF α、IFABP、AGEs水平和NCT时间均较治疗前明显下降,且联用组患者下降幅度大于单用组(均P<0.05)。联用组患者临床型HE的进展率为8.89%(4/45),明显低于单用组的24.44%(11/45),差异有统计学意义(χ²=3.920,P=0.047 1)。结论双歧杆菌四联活菌片联合乳果糖能改善MHE患者肝功能和智力测验结果,降低临床型HE的进展率,其作用机制可能与其能抑制IL 6、TNF α水平,保护肠黏膜相关。     

Comparison of batch and repeated batch operation of lactulose synthesis with cross-linked aggregates of Bacillus circulans β-galactosidase

Synthesis of lactulose with crosslinked aggregates of Bacillus circulans β-galactosidase (CLAGs) has been compared in batch and repeated-batch operation for the first time. The effect of the type of the precipitating agent and its concentration, the crosslinker concentration and the time of crosslinking were evaluated for their effect on the parameters: immobilization yield, specific activity and thermal stability of the biocatalysts. The type and concentration of the precipitating agent were the variables that produced a significant variation in the immobilization parameters of the biocatalyst. CLAGs were obtained with a specific activity of 7790 IU_H⋅g⁻¹ at an immobilization yield of 46.2 % using 50 % v/v of propanol as precipitating agent, 5.5 g_{glutarldehyde} g_protein⁻¹ for crosslinking and 1 h of crosslinking time. This biocatalyst was more stable than the free enzyme with a stabilization factor of 11.3 h at 50 °C. Highest yield of lactulose synthesis with CLAGs was 0.42 g g⁻¹ for a fructose/lactose molar ratio of 8. Repeated-batch operation allowed a significant increase in lactulose production per unit mass of biocatalyst and in cumulative productivity with respect to batch operation, yielding an efficiency of biocatalyst use of 2.43 kg_lactulose g_{biocatalyst protein}⁻¹.