Department of Nursing, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan, China.
Crit Care. 2011;15(6):R290. doi: 10.1186/cc10579. Epub 2011 Dec 2.
Traumatic brain injury (TBI) is associated with a profound immunological dysfunction manifested by a severe shift from T-helper type 1 (Th1) to T-helper type 2 (Th2) response. This predisposes patients to infections, sepsis, and adverse outcomes. Probiotic bacteria have been shown to balance the Th1/Th2 cytokines in allergic murine models and patients. For the present study, we hypothesized that the enteral administration of probiotics would adjust the Th1/Th2 imbalance and improve clinical outcomes in TBI patients.
We designed a prospective, randomized, single-blind study. Patients with severe TBI and Glasgow Coma Scale scores between 5 and 8 were included, resulting in 26 patients in the control group and 26 patients in the probiotic group. All patients received enteral nutrition via a nasogastric tube within 24 to 48 hours following admission. In addition, the probiotic group received 109 bacteria of viable probiotics per day for 21 days. The associated serum levels of Th1/Th2 cytokines, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, nosocomial infections, length of ICU stay, and 28-day mortality rate were studied.
The patients responded to viable probiotics, and showed a significantly higher increase in serum IL-12p70 and IFNγ levels while also experiencing a dramatic decrease in IL-4 and IL-10 concentrations. APACHE II and SOFA scores were not significantly affected by probiotic treatment. Patients in the probiotic group experienced a decreased incidence of nosocomial infections towards the end of the study. Shorter ICU stays were also observed among patients treated with probiotic therapy. However, the 28-day mortality rate was unaffected.
The present study showed that daily prophylactic administration of probiotics could attenuate the deviated Th1/Th2 response induced by severe TBI, and could result in a decreased nosocomial infection rate, especially in the late period.
ChiCTR-TRC-10000835.
创伤性脑损伤（TBI）与严重的免疫功能障碍有关，表现为从辅助性 T 细胞 1（Th1）向辅助性 T 细胞 2（Th2）反应的剧烈转变。这使患者容易感染、败血症和产生不良后果。益生菌已被证明可以平衡过敏小鼠模型和患者的 Th1/Th2 细胞因子。在本研究中，我们假设肠道给予益生菌将调整 Th1/Th2 失衡，并改善 TBI 患者的临床结局。
我们设计了一项前瞻性、随机、单盲研究。纳入格拉斯哥昏迷评分（GCS）为 5-8 分的严重 TBI 患者，对照组 26 例，益生菌组 26 例。所有患者均在入院后 24-48 小时内通过鼻胃管接受肠内营养。此外，益生菌组每天接受 109 个活益生菌。研究了相关的 Th1/Th2 细胞因子、急性生理学和慢性健康评估（APACHE）Ⅱ和序贯器官衰竭评估（SOFA）评分、医院感染、ICU 住院时间和 28 天死亡率。
患者对活益生菌有反应，血清 IL-12p70 和 IFNγ 水平显著升高，而 IL-4 和 IL-10 浓度显著降低。益生菌治疗对 APACHE II 和 SOFA 评分无显著影响。益生菌组患者在研究结束时医院感染的发生率降低。接受益生菌治疗的患者 ICU 住院时间也较短。然而，28 天死亡率没有受到影响。
本研究表明，每天预防性给予益生菌可减轻严重 TBI 引起的 Th1/Th2 反应偏差，并可降低医院感染率，尤其是在后期。
ChiCTR-TRC-10000835。
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