Department of Nephrology Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Ann Palliat Med. 2021 Feb;10(2):1180-1190. doi: 10.21037/apm-20-202. Epub 2020 Sep 21.
Gut microbiota play an important role in the inflammation. This study aimed to investigate whether exogenous probiotics could improve the intestinal barrier function effect via attenuating inflammation and immunomodulation to improve the clinical outcomes in critically ill patients.
A single-blind, randomized controlled trial was performed in a respiratory intensive care unit (RICUs). Patients assigned to the intervention group received probiotics Clostridium butyricum until death or discharge. Stool and blood samples were collected on the 1st day and 15th day of administration. Primary clinical outcomes and clinical manifestations were recorded during the follow-up period.
There were 61 patients in this study, with 28 patients receiving probiotics. There were no differences in the mortality and hospital stay between intervention group and control group. In addition, the duration of fever (% of hospital stays) was significantly shorter in the intervention group as compared to control group (4.85% vs. 12.94%, P=0.00). The incidence of constipation significantly reduced in the intervention group (17.86% vs. 42.42%, P=0.04). The overall ratio of gastrointestinal adverse effects was comparable between them. Bactericides significantly decreased after probiotic intervention (Δm=-0.69, P=0.048), while Escherichia coli and Enterococcus tended to decrease in the intervention group (Δm=-0.65, P=0.08; Δm=-0.52, P=0.22) on the day 15. No fluctuation was observed in the Bifidobacterium and Lactobacillus after probiotic intervention.
Our study fails to show the beneficial effects of probiotics on the primary clinical outcomes in critically ill patients. The intestinal barrier is damaged, and probiotics may reduce the burden of Gm-bacteria from the gut.
肠道微生物群在炎症中起着重要作用。本研究旨在探讨外源性益生菌是否可以通过减轻炎症和免疫调节来改善肠道屏障功能，从而改善危重症患者的临床结局。
在呼吸重症监护病房（RICUs）进行了一项单盲、随机对照试验。干预组患者接受酪酸梭菌益生菌治疗，直至死亡或出院。在给药的第 1 天和第 15 天采集粪便和血液样本。在随访期间记录主要临床结局和临床表现。
本研究共纳入 61 例患者，其中 28 例接受益生菌治疗。干预组和对照组的死亡率和住院时间无差异。此外，与对照组相比，干预组发热持续时间（占住院时间的百分比）明显缩短（4.85%比 12.94%，P=0.00）。干预组便秘的发生率显著降低（17.86%比 42.42%，P=0.04）。两组胃肠道不良反应的总发生率相当。益生菌干预后杀菌剂显著减少（Δm=-0.69，P=0.048），而干预组大肠杆菌和肠球菌的数量有减少的趋势（Δm=-0.65，P=0.08；Δm=-0.52，P=0.22）在第 15 天。益生菌干预后双歧杆菌和乳酸杆菌数量没有波动。
本研究未能显示益生菌对危重症患者主要临床结局的有益作用。肠道屏障受损，益生菌可能减少肠道内 Gm 细菌的负担。
