摘要
背景近年来,肠道菌群在肠易激综合征(irritable bowel syndrome,IBS)发生、进展中的作用逐渐被认可,而益生菌是IBS治疗的推荐药物,可促进肠道蠕动,纠正、维持菌群平衡,在治疗胃肠道疾病中的疗效已得到证实.目的探讨微生态制剂联合二甲双胍在2型糖尿病(type 2 diabetes mellitus,T2DM)伴IBS患者中的应用效果及对肠道菌群、Toll样受体4(Toll-like receptor,TLR4)/髓样分化因子88(myeloid differentiation factor,MyD88)/核因子-κB(nuclear factor-κb,NF-κB)信号通路的调节作用.方法选取2018-08/2022-08丽水市第二人民医院T2DM伴IBS患者200例,随机分为两组,每组100例,对照组采取二甲双胍治疗,观察组采取微生态制剂联合二甲双胍治疗.比较两组治疗前后肠道敏感度、肠道菌群(乳酸杆菌、双歧杆菌、大肠杆菌、粪肠球菌)、肠道菌群代谢产物短链脂肪酸(short chain fatty acids,SCFAs)、血糖水平[空腹血糖(fasting blood glucose,FPG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、餐后2 h血糖(2-hour postprandial blood glucose,2hPG)]及TLR4/MyD88/NF-κB信号通路相关蛋白,并统计不良反应发生情况.结果治疗4 wk、8 wk后观察组乳酸杆菌、双歧杆菌高于对照组,大肠杆菌、粪肠球菌数量、肠道敏感度及血清MyD88、TLR4、NF-κBp65水平低于对照组(P<0.05);治疗8 wk后,观察组丁酸、总SCFAs含量高于对照组,FPG、HbA1c、2hPG水平低于对照组(P<0.05);观察组不良反应发生率9.00%与对照组14.00%比较,无显著差异.结论双歧杆菌三联活菌胶囊联合二甲双胍能有效降低T2DM伴IBS患者肠道敏感度,减轻胃肠道症状,强化控糖效果,考虑可能与其可通过提高益生菌丰度而纠正菌群失调、调节肠道菌群代谢产物、调控TLR4/MyD88/NF-κB信号通路有关.
BACKGROUND In recent years,the role of intestinal flora in the occurrence and progression of irritable bowel syndrome(IBS)has been gradually recognized,and,as recommended agents for the treatment of IBS,probiotics,which can promote intestinal motility and correct and maintain the balance of flora,have been proven effective in the treatment of gastrointestinal diseases.AIM To investigate the therapeutic effects of microecological agents combined with metformin in patients with type 2 diabetes mellitus(T2DM)with IBS and their modulatory effect on the intestinal flora and the Toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD8)/nuclear factor-κB(NF-κB)signaling pathway.METHODS Two hundred patients with T2DM with IBS treated at our hospital from August 2018 to August 2022 were selected and randomly divided into either a control group or an observation group,with 100 cases in each group.The control group was treated with metformin alone,and the observation group was treated with microecological agents combined with metformin.Intestinal sensitivity,intestinal flora(Lactobacillus,Bifidobacterium,Escherichia coli,and Enterococcus faecalis),short-chain fatty acids(SCFAs),blood glucose levels[fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),and 2-hour postprandial glucose(2hPG)],and serum levels of TLR4/MyD88/NF-κB signaling pathway-related proteins were compared between the two groups before and after treatment.The incidence of adverse effects was recorded.RESULTS After 4 wk and 8 wk of treatment,the numbers of Lactobacillus and Bifidobacterium were higher,and the numbers of E.coli and Enterococcus faecalis,intestinal sensitivity,and serum MyD88,TLR4,and NF-κBp65 levels were lower in the observation group than in the control group(P<0.05).After 8 wk of treatment,the levels of butyric acid and total SCFAs were higher,and the levels of FPG,HbA1c,and 2hPG were lower in the observation group than in the control group(P<0.05).The incidence of adverse reactions did not differ significantly between the
作者
陈秀梅
雷旭伟
吴筱芬
Xiu-Mei Chen;Xu-Wei Lei;Xiao-Fen Wu(The Second People’s Hospital of Lishui,Lishui 323000,Zhejiang Province,China)
出处
《世界华人消化杂志》
CAS
2023年第8期326-333,共8页
World Chinese Journal of Digestology
关键词
微生态制剂
2型糖尿病
二甲双胍
肠易激综合征
肠道菌群
Microecological agents
Type 2 diabetes
Metformin
Irritable bowel syndrome
Intestinal flora