益生菌（培养的枯草芽孢杆菌/粪肠球菌）治疗酒精性肝炎的效果：随机对照多中心研究

Effects of probiotics (cultured Lactobacillus subtilis/Streptococcus faecium) in the treatment of alcoholic hepatitis: randomized-controlled multicenter study.

作者信息

Han Sang Hak, Suk Ki Tae, Kim Dong Joon, Kim Moon Young, Baik Soon Koo, Kim Young Don, Cheon Gab Jin, Choi Dae Hee, Ham Young Lim, Shin Dong Hoon, Kim Eun Ji

机构信息

aDepartment of Pathology bDepartment of Internal Medicine cDepartment of Laboratory Medicine, Hallym University College of Medicine dCenter for Efficacy Assessment and Development of Functional Foods and Drugs, Hallym University eDepartment of Internal Medicine, Kangwon University College of Medicine, Chuncheon fDepartment of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju gDepartment of Internal Medicine, Ulsan University College of Medicine, Gangneung hDepartment of Emergency Medical Technology, Daewon University College, Jecheon, South Korea.

出版信息

Eur J Gastroenterol Hepatol. 2015 Nov;27(11):1300-6. doi: 10.1097/MEG.0000000000000458.

DOI:10.1097/MEG.0000000000000458

PMID:26302024

Abstract

BACKGROUND

Probiotics might reduce gut-derived microbial lipopolysaccharide (LPS) by restoring bowel flora in patients with alcoholic hepatitis (AH). We evaluated the therapeutic effects of probiotics in patients with AH.

PATIENTS AND METHODS

Between September 2010 and April 2012, 117 patients (probiotics 60 and placebo 57) were prospectively randomized to receive the 7 days of cultured Lactobacillus subtilis/Streptococcus faecium (1500 mg/day) or placebo. All patients were hospitalized and were not permitted to consume alcohol for the 7 days of the study. Liver function test, proinflammatory cytokines, LPS, and colony-forming units by stool culture were examined and compared after therapy.

RESULTS

In both groups, the mean levels of aspartate aminotransferase/alanine aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, bilirubin, and prothrombin time were significantly improved after 7 days of abstinence. In the probiotics group (baseline and after), albumin (3.5 ± 0.7 and 3.7 ± 0.6 g/dl, P=0.038) and tumor necrosis factor-α (121 ± 244 and 71 ± 123 pg/ml, P=0.047) showed differences. In addition, the number of colony-forming units of Escherichia coli was significantly reduced (435 ± 287 and 168 ± 210, P=0.002). In the placebo group, the level of LPS (1.7 ± 2.8 and 2.0 ± 2.7 EU/ml) was significantly increased. In the intergroup comparison, significant differences in the levels of tumor necrosis factor-α (P=0.042) and LPS (P=0.028) were observed between the groups.

CONCLUSION

Immediate abstinence is the most important treatment for patients with AH. In addition, 7 days of oral supplementation with cultured L. subtilis/S. faecium was associated with restoration of bowel flora and improvement of LPS in patients with AH.

摘要

背景

益生菌可能通过恢复酒精性肝炎（AH）患者的肠道菌群来降低肠道源性微生物脂多糖（LPS）。我们评估了益生菌对AH患者的治疗效果。

患者与方法

在2010年9月至2012年4月期间，117例患者（益生菌组60例，安慰剂组57例）被前瞻性随机分组，接受为期7天的枯草芽孢杆菌/粪肠球菌培养物（1500毫克/天）或安慰剂治疗。所有患者均住院治疗，在研究的7天内禁止饮酒。治疗后检查并比较肝功能测试、促炎细胞因子、LPS以及粪便培养的菌落形成单位。

结果

两组患者在戒酒7天后，天冬氨酸转氨酶/丙氨酸转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶、胆红素和凝血酶原时间的平均水平均有显著改善。在益生菌组（基线和治疗后），白蛋白（3.5±0.7和3.7±0.6克/分升，P = 0.038）和肿瘤坏死因子-α（121±244和71±123皮克/毫升，P = 0.047）出现差异。此外，大肠杆菌的菌落形成单位数量显著减少（435±287和168±210，P = 0.002）。在安慰剂组，LPS水平（1.7±2.8和2.0±2.7 EU/毫升）显著升高。组间比较显示，两组之间肿瘤坏死因子-α水平（P = 0.042）和LPS水平（P = 0.028）存在显著差异。