中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
26期
3077-3082
,共6页
邱春雷%严红%吴雄健%刘洪荣
邱春雷%嚴紅%吳雄健%劉洪榮
구춘뢰%엄홍%오웅건%류홍영
结肠炎,溃疡性%双歧杆菌%免疫球蛋白A,分泌%线粒体膜转运蛋白类%微生态学
結腸炎,潰瘍性%雙歧桿菌%免疫毬蛋白A,分泌%線粒體膜轉運蛋白類%微生態學
결장염,궤양성%쌍기간균%면역구단백A,분비%선립체막전운단백류%미생태학
Colitis,ulcerative%Bifidobacterium%Immunoglobulin A,secretory%Mitochondrial oroteins%Micro-ecology
目的:检测活动期溃疡性结肠炎( AUC)和缓解期溃疡性结肠炎( RUC)患者粪便菌群,观察其微生态学改变及双歧杆菌对溃疡性结肠炎( UC)的治疗作用,探讨UC的发病机制。方法选择2011年5月-2013年3月在井冈山大学附属医院门诊就诊或住院AUC患者64例( AUC组)和RUC患者71例( RUC组),另选择同期在本院体检健康者30例(对照组),收集其新鲜粪便,利用引物设计软件Primer Premier 5.0设计肠道菌群16SrDNA基因特异性PCR引物,分析肠道菌群变化。按照随机数字表法,将AUC组患者分为AUC1组32例和AUC2组32例,RUC组分为RUC1组36例和RUC2组35例;AUC1组和RUC1组患者口服诺氟沙星胶囊(氟哌酸胶囊),3粒/次,2次/d;AUC2组和RUC2组口服双歧杆菌活菌胶囊(丽珠肠乐胶囊),2粒/次,3次/d。4个亚组治疗疗程均为1个月,同时口服柳氮磺胺吡啶片,1.0 g/次,4次/d。检测各组受试者分泌型免疫球蛋白 A ( sIgA )含量和线粒体膜蛋白(Aoo-2.7)含量。结果与对照组相比,AUC组和RUC组双歧杆菌、乳酸杆菌、拟杆菌、球形梭菌、柔嫩梭菌、普拉梭菌及总细菌菌落数减少(P<0.05),大肠埃希菌、肠球菌菌落数增加(P<0.05);与RUC组相比,AUC组双歧杆菌、乳酸杆菌菌落数减少(P<0.05),大肠埃希菌菌落数增加(P<0.05)。4个亚组患者在治疗过程中均未出现明显不良反应。AUC2组、RUC2组临床疗效和组织学疗效分别优于AUC1组、RUC1组(P<0.05);且治疗后AUC2组、RUC2组双歧杆菌、乳酸杆菌菌落数分别较AUC1组、RUC1组增加,大肠埃希菌菌落数分别较AUC1组、RUC1组减少(P<0.05)。对照组与AUC1组、RUC1组sIgA、Aoo-2.7含量比较,差异均有统计学意义(P<0.05);AUC2组sIgA含量高于AUC1组,Aoo-2.7含量低于AUC1组(P<0.05);RUC2组sIgA含量高于RUC1组,Aoo-2.7含量低于RUC1组(P<0.05)。结论 UC患者肠道共生菌数量减少,条件致病菌数量增加,双歧杆菌活菌制剂治疗UC疗效显著,UC发病可能与机体菌群失调、肠道免疫功能破坏及结肠黏膜上皮细胞过度凋亡有关。
目的:檢測活動期潰瘍性結腸炎( AUC)和緩解期潰瘍性結腸炎( RUC)患者糞便菌群,觀察其微生態學改變及雙歧桿菌對潰瘍性結腸炎( UC)的治療作用,探討UC的髮病機製。方法選擇2011年5月-2013年3月在井岡山大學附屬醫院門診就診或住院AUC患者64例( AUC組)和RUC患者71例( RUC組),另選擇同期在本院體檢健康者30例(對照組),收集其新鮮糞便,利用引物設計軟件Primer Premier 5.0設計腸道菌群16SrDNA基因特異性PCR引物,分析腸道菌群變化。按照隨機數字錶法,將AUC組患者分為AUC1組32例和AUC2組32例,RUC組分為RUC1組36例和RUC2組35例;AUC1組和RUC1組患者口服諾氟沙星膠囊(氟哌痠膠囊),3粒/次,2次/d;AUC2組和RUC2組口服雙歧桿菌活菌膠囊(麗珠腸樂膠囊),2粒/次,3次/d。4箇亞組治療療程均為1箇月,同時口服柳氮磺胺吡啶片,1.0 g/次,4次/d。檢測各組受試者分泌型免疫毬蛋白 A ( sIgA )含量和線粒體膜蛋白(Aoo-2.7)含量。結果與對照組相比,AUC組和RUC組雙歧桿菌、乳痠桿菌、擬桿菌、毬形梭菌、柔嫩梭菌、普拉梭菌及總細菌菌落數減少(P<0.05),大腸埃希菌、腸毬菌菌落數增加(P<0.05);與RUC組相比,AUC組雙歧桿菌、乳痠桿菌菌落數減少(P<0.05),大腸埃希菌菌落數增加(P<0.05)。4箇亞組患者在治療過程中均未齣現明顯不良反應。AUC2組、RUC2組臨床療效和組織學療效分彆優于AUC1組、RUC1組(P<0.05);且治療後AUC2組、RUC2組雙歧桿菌、乳痠桿菌菌落數分彆較AUC1組、RUC1組增加,大腸埃希菌菌落數分彆較AUC1組、RUC1組減少(P<0.05)。對照組與AUC1組、RUC1組sIgA、Aoo-2.7含量比較,差異均有統計學意義(P<0.05);AUC2組sIgA含量高于AUC1組,Aoo-2.7含量低于AUC1組(P<0.05);RUC2組sIgA含量高于RUC1組,Aoo-2.7含量低于RUC1組(P<0.05)。結論 UC患者腸道共生菌數量減少,條件緻病菌數量增加,雙歧桿菌活菌製劑治療UC療效顯著,UC髮病可能與機體菌群失調、腸道免疫功能破壞及結腸黏膜上皮細胞過度凋亡有關。
목적:검측활동기궤양성결장염( AUC)화완해기궤양성결장염( RUC)환자분편균군,관찰기미생태학개변급쌍기간균대궤양성결장염( UC)적치료작용,탐토UC적발병궤제。방법선택2011년5월-2013년3월재정강산대학부속의원문진취진혹주원AUC환자64례( AUC조)화RUC환자71례( RUC조),령선택동기재본원체검건강자30례(대조조),수집기신선분편,이용인물설계연건Primer Premier 5.0설계장도균군16SrDNA기인특이성PCR인물,분석장도균군변화。안조수궤수자표법,장AUC조환자분위AUC1조32례화AUC2조32례,RUC조분위RUC1조36례화RUC2조35례;AUC1조화RUC1조환자구복낙불사성효낭(불고산효낭),3립/차,2차/d;AUC2조화RUC2조구복쌍기간균활균효낭(려주장악효낭),2립/차,3차/d。4개아조치료료정균위1개월,동시구복류담광알필정편,1.0 g/차,4차/d。검측각조수시자분비형면역구단백 A ( sIgA )함량화선립체막단백(Aoo-2.7)함량。결과여대조조상비,AUC조화RUC조쌍기간균、유산간균、의간균、구형사균、유눈사균、보랍사균급총세균균락수감소(P<0.05),대장애희균、장구균균락수증가(P<0.05);여RUC조상비,AUC조쌍기간균、유산간균균락수감소(P<0.05),대장애희균균락수증가(P<0.05)。4개아조환자재치료과정중균미출현명현불량반응。AUC2조、RUC2조림상료효화조직학료효분별우우AUC1조、RUC1조(P<0.05);차치료후AUC2조、RUC2조쌍기간균、유산간균균락수분별교AUC1조、RUC1조증가,대장애희균균락수분별교AUC1조、RUC1조감소(P<0.05)。대조조여AUC1조、RUC1조sIgA、Aoo-2.7함량비교,차이균유통계학의의(P<0.05);AUC2조sIgA함량고우AUC1조,Aoo-2.7함량저우AUC1조(P<0.05);RUC2조sIgA함량고우RUC1조,Aoo-2.7함량저우RUC1조(P<0.05)。결론 UC환자장도공생균수량감소,조건치병균수량증가,쌍기간균활균제제치료UC료효현저,UC발병가능여궤체균군실조、장도면역공능파배급결장점막상피세포과도조망유관。
Objective Todetectfecalfloraofoatientswithactiveulcerativecolitis(AUC)andremittingulcerative colitis(RUC)to observe its micro-ecological changes and the effect of bacillus bifidus on ulcerative colitis(UC). Methods Freshfaeceswerecollectedin64AUCoatients(AUCgrouo),71RUCoatients(RUCgrouo),30healthysubjects(control grouo)from May 2011 to March 2013 in the Affiliated Hosoital of Jinggangshan University. Primer Premier 5. 0 was used to de-sign 16SrDNA gene -soecific PCR oremier to analyze the changes of fecal flora. AUC grouo were subdivided randomly into grouos AUC1(n=32),AUC2(n=32);RUC grouo into grouos RUC1(n=36),RUC2(n=35). Grouos AUC1,RUC1 had oral norfloxacin,3 caosules/time,2 times/d;grouos AUC2,RUC2 had oral bifidobacterium caosules,2 caosules/time, 3 times/d. The course lasted 1 month and 4 subgrouos had oral sulfasalazine in the meantime,1. 0 g/time,4 times/d. The contents of secretory immunoglobulin A(sIgA)and mitochondrial membrane orotein(Aoo-2. 7)were determined. Results Ascomoaredwithcontrolgrouo,grouosAUC,RUChaddecreasedbacillusbifidus,lactobacillus,bacteroides,sohericalclos-tridium,clostridium leotum,oorah winfrey clostridium,total bacterial colony(P <0. 05),and increased Escherichia coli, enterococcus colony(P<0. 05);as comoared with RUC grouo,AUC grouo had reduced bacillus bifidus,lactobacillus(P<0. 05),and increased Escherichia coli(P<0. 05). Four subgrouos had no obvious adverse reactions during treatment. Theclinical theraoeutic and histological effects were better in grouos AUC2,RUC2 than in grouos AUC1,RUC1(P<0. 05),and bacillus bifidus,lactobacillus were more,Escherichia coli fewer in grouos AUC2,RUC2 than in grouos AUC1,RUC1 after treatment(P<0. 05). There was significant difference in contents of sIgA,Aoo-2. 7 between control grouo and grouos AUC1, RUC1(P<0. 05),sIgA content higher,Aoo-2. 7 content lower in grouo AUC2 than in grouo AUC1(P<0. 05);sIgA con-tenthigher,Aoo-2.7loweringrouoRUC2thaningrouoRUC1(P<0.05).Conclusion Intestinalsymbioticstrainsde-crease,oooortunistic oathogens increase in UC oatients. Bifidobacteria viable oreoarations are of good theraoeutic effect. UC may be associated with dysbacteriosis,damaged intestinal immune function,excessive aoootosis of colonic eoithelial cells.