鼠李糖乳杆菌GG治疗急性胃肠炎儿童的免疫反应和肠道通透性：一项随机、双盲、安慰剂对照试验
Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial.
作者信息
Sindhu Kulandaipalayam N C, Sowmyanarayanan Thuppal V, Paul Anu, Babji Sudhir, Ajjampur Sitara S R, Priyadarshini Sophia, Sarkar Rajiv, Balasubramanian K A, Wanke Christine A, Ward Honorine D, Kang Gagandeep
机构信息
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
出版信息
Clin Infect Dis. 2014 Apr;58(8):1107-15. doi: 10.1093/cid/ciu065. Epub 2014 Feb 5.
BACKGROUND
Probiotics have a possible role in the treatment of pediatric acute gastroenteritis. We report the effect of the probiotic Lactobacillus rhamnosus GG (LGG) on intestinal function, immune response, and clinical outcomes in Indian children with cryptosporidial or rotavirus diarrhea.
METHODS
Children with gastroenteritis aged 6 months to 5 years, testing positive for either rotavirus or Cryptosporidium species in stool (coinfections were excluded), were randomized to LGG (ATCC 53103) or placebo, once daily for 4 weeks. Baseline demographic and clinical details were obtained. Sera were tested for immunoglobulin G (IgG) and immunoglobulin A (IgA) antibodies to Cryptosporidium and rotavirus, and the lactulose to mannitol ratio for intestinal permeability was determined at baseline and at the end of follow-up.
RESULTS
Of the 124 children enrolled, 82 and 42 had rotavirus and cryptosporidial diarrhea, respectively. Median diarrheal duration was 4 days; one-third of the children had severe diarrhea. Baseline and clinical parameters were comparable between children receiving LGG and placebo. At the end of follow-up, fewer children with rotavirus diarrhea on LGG had repeated diarrheal episodes (25% vs 46%; P = .048) and impaired intestinal function (48% vs 72%; P = .027). Significant increase in IgG levels postintervention (456 vs 2215 EU; P = .003) was observed in children with rotavirus diarrhea receiving LGG. Among children with cryptosporidial diarrhea, those receiving LGG showed significant improvement in intestinal permeability.
CONCLUSIONS
LGG has a positive immunomodulatory effect and may be useful in decreasing repeated episodes of rotavirus diarrhea. Improvement in intestinal function in children with rotavirus and cryptosporidial gastroenteritis emphasizes the role of probiotics in treating intestinal impairment after infection.
CLINICAL TRIALS REGISTRATION
CTRI/2010/091/000339.
背景
益生菌在小儿急性胃肠炎的治疗中可能发挥作用。我们报告了益生菌鼠李糖乳杆菌GG（LGG）对患有隐孢子虫或轮状病毒腹泻的印度儿童肠道功能、免疫反应及临床结局的影响。
方法
年龄在6个月至5岁的胃肠炎患儿，粪便中轮状病毒或隐孢子虫属检测呈阳性（排除合并感染），被随机分为LGG组（ATCC 53103）或安慰剂组，每日一次，共4周。记录基线人口统计学和临床详细信息。检测血清中针对隐孢子虫和轮状病毒的免疫球蛋白G（IgG）和免疫球蛋白A（IgA）抗体，并在基线和随访结束时测定乳果糖与甘露醇比值以评估肠道通透性。
结果
124名入组儿童中，82名和42名分别患有轮状病毒和隐孢子虫腹泻。腹泻持续时间中位数为4天；三分之一的儿童有严重腹泻。接受LGG和安慰剂的儿童基线和临床参数具有可比性。随访结束时，接受LGG的轮状病毒腹泻患儿反复腹泻发作的较少（25%对46%；P = 0.048），肠道功能受损的也较少（48%对72%；P = 0.027）。接受LGG的轮状病毒腹泻患儿干预后IgG水平显著升高（456对2215 EU；P = 0.003）。在隐孢子虫腹泻患儿中，接受LGG的患儿肠道通透性有显著改善。
结论
LGG具有积极的免疫调节作用，可能有助于减少轮状病毒腹泻的反复发生。轮状病毒和隐孢子虫性胃肠炎患儿肠道功能的改善强调了益生菌在治疗感染后肠道损伤中的作用。
临床试验注册
CTRI/2010/091/000339。
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