溃疡性结肠炎的微生态学改变及双歧杆菌的治疗作用研究  

Micro-ecological Changes of Ulcerative Colitis and Effect of Bacillus Bifidus on It

作　　者：邱春雷[1] 严红[2] 吴雄健[3] 刘洪荣[4] 

机构地区：[1]井冈山大学附属医院消化内科,江西省吉安市343000 [2]井冈山大学临床医学院内科系 [3]赣南医学院第一附属医院内科 [4]赣南医学院第一附属医院消化科

出　　处：《中国全科医学》2014年第26期3077-3082,共6页Chinese General Practice

摘　　要：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(Apo-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、Apo-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,Apo-2.7含量低于AUC1组(P<0.05);RUC2组sIgA含量高于RUC1组,Apo-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�Objective To detect fecal flora of patients with active ulcerative colitis（ AUC） and remitting ulcerative colitis（ RUC） to observe its micro- ecological changes and the effect of bacillus bifidus on ulcerative colitis（ UC）. Methods Fresh faeces were collected in 64 AUC patients（ AUC group）,71 RUC patients（ RUC group）,30 healthy subjects（ control group） from May 2011 to March 2013 in the Affiliated Hospital of Jinggangshan University. Primer Premier 5. 0 was used to design 16 SrDNA gene- specific PCR premier to analyze the changes of fecal flora. AUC group were subdivided randomly into groups AUC1（ n = 32）,AUC2（ n = 32）; RUC group into groups RUC1（ n = 36）,RUC2（ n = 35）. Groups AUC1,RUC1 had oral norfloxacin,3 capsules /time,2 times /d; groups AUC2,RUC2 had oral bifidobacterium capsules,2 capsules /time,3 times /d. The course lasted 1 month and 4 subgroups had oral sulfasalazine in the meantime,1. 0 g /time,4 times /d. The contents of secretory immunoglobulin A（ sIgA） and mitochondrial membrane protein（ Apo- 2. 7） were determined. Results As compared with control group,groups AUC,RUC had decreased bacillus bifidus,lactobacillus,bacteroides,spherical clostridium,clostridium leptum,oprah winfrey clostridium,total bacterial colony（ P 〈 0. 05）,and increased Escherichia coli,enterococcus colony（ P 〈 0. 05）; as compared with RUC group,AUC group had reduced bacillus bifidus,lactobacillus（ P 〈0. 05）,and increased Escherichia coli（ P 〈 0. 05）. Four subgroups had no obvious adverse reactions during treatment. The clinical therapeutic and histological effects were better in groups AUC2,RUC2 than in groups AUC1,RUC1（ P 〈 0. 05）,and bacillus bifidus,lactobacillus were more,Escherichia coli fewer in groups AUC2,RUC2 than in groups AUC1,RUC1 after treatment（ P 〈 0. 05）. There was significant difference in contents of sIgA,Apo- 2. 7 between control group and groups AUC1,RUC1（ P 〈 0. 05）,sIgA content higher,Apo- 2. 7 content lower in group AU

关 键 词：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 

分 类 号：R37[医药卫生—病原生物学] R574.621[医药卫生—基础医学]