Marteau P, Sokol H, Dray X, Seksik P
AP-HP, Hôpital Lariboisière, Medicosurgical Department of Digestive Diseases, Laboratoire de Biologie EA 3199, CNAM & University Diderot-Paris 7, Paris, France.
Gastroenterol Clin Biol. 2009 Jun;33 Suppl 3:S228-34. doi: 10.1016/S0399-8320(09)73158-6.
Inflammatory bowel diseases are the result of an abnormal immune response to environmental factors including the intestinal microbiota. Epithelial and immune cells of the intestinal mucosa recognise specific bacterial molecules via Toll like and NOD like receptors and this interaction modulates the inflammatory response (activation of the NF-kappaB pathway). It is thus rational to try treatments which could modify the intestinal microbiota i.e. antibiotics, new substrates (prebiotics) or new micro-organisms (probiotics). We review the literature on existing evidence for the efficacy of probiotic strains or combinations in patients with pouchitis (good evidence), ulcerative colitis (fair evidence), and Crohn's disease (no evidence at the present time). We also discuss the mechanisms of action, the use of microbial agents as pharmacological vectors, the development of genetically modified probiotics (including a clinical pilot trial in patients with Crohn's disease), and safety issues.
炎症性肠病是对包括肠道微生物群在内的环境因素产生异常免疫反应的结果。肠道黏膜的上皮细胞和免疫细胞通过Toll样受体和NOD样受体识别特定的细菌分子，这种相互作用调节炎症反应（激活NF-κB途径）。因此，尝试使用能够改变肠道微生物群的治疗方法是合理的，即抗生素、新底物（益生元）或新微生物（益生菌）。我们回顾了关于益生菌菌株或组合对袋状结肠炎患者（充分证据）、溃疡性结肠炎患者（中等证据）和克罗恩病患者（目前尚无证据）疗效的现有证据的文献。我们还讨论了作用机制、将微生物制剂用作药理学载体、转基因益生菌的开发（包括针对克罗恩病患者的一项临床试点试验）以及安全性问题。
