Venkatachalam Balaji, Abraham Babu Kuruvilla
Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.
Indian J Crit Care Med. 2020 Sep;24(Suppl 4):S211-S214. doi: 10.5005/jp-journals-10071-23627.
The gut that we took for granted in the critically ill, as just a conduit for food passage has over the decade or so shown us that it is an active endocrine and exocrine organ with over 40 trillion microorganisms living commensally within it. This cosmos of microorganisms that is called the gut microbiome comprises roughly 1,000 different species and put together is more DNA than the entire human genome. Under normal circumstances, in a healthy individual multiple elements of the gut viz intestinal epithelium, gut barrier function, the microbiomes, all put together offer protection against infection and this is crucial in maintenance of health. Any change to the norm, be it in the form of surgical interventions, the introduction of medications, or the pathophysiological effects of systemic disease leads to a 360° alteration in this finely construed ecosystem leading to devastating effects that go beyond the boundaries of the gut itself. Intestinal epithelium helps to absorb nutrients as well as acts as the coordinator of mucosal immunity (first line of immune defense). During ill health, gut epithelial apoptosis occurs, alterations happen in the tight epithelial junctions leading to loss of gut barrier function and loss of the mucosal immunity leading to mucosal damage and hyperpermeability. Lastly, the microbiome is transformed into a pathobiome, with resultant increase in pathogenic bacteria and induction of virulence in commensal gut bacteria. Multiple organ damage starts to set in, caused by toxins leaving the intestine via both portal blood flow and mesenteric lymph. This review article traces the gut microbiomic ecology in health and sickness, modern tools that are used to manipulate gut microbiome in the search for the prevention and treatment of critical illness and will explore if appropriate manipulation of gut microbiome can influence or modulate the course of critical illness. Venkatachalam B, Abraham BK. Should We Fiddle with Gut Microbiome in Critically Ill? Indian J Crit Care Med 2020;24(Suppl 4):S211-S214.
在重症患者中，我们曾认为理所当然只是食物通道的肠道，在过去十年左右的时间里向我们表明，它是一个活跃的内分泌和外分泌器官，有超过40万亿微生物共生其中。这个被称为肠道微生物群的微生物宇宙大约由1000个不同物种组成，其DNA总量比整个人类基因组还要多。在正常情况下，健康个体的肠道多个组成部分，即肠上皮、肠道屏障功能、微生物群，共同提供抗感染保护，这对维持健康至关重要。任何偏离正常状态的变化，无论是手术干预、药物引入，还是全身性疾病的病理生理影响，都会导致这个精心构建的生态系统发生360°改变，从而产生超出肠道本身范围的毁灭性影响。肠上皮有助于吸收营养，同时作为黏膜免疫（免疫防御的第一道防线）的协调者。在患病期间，肠道上皮细胞发生凋亡，紧密的上皮连接出现改变，导致肠道屏障功能丧失和黏膜免疫功能丧失，进而导致黏膜损伤和通透性增加。最后，微生物群转变为致病微生物群，导致病原菌增加，并使共生肠道细菌产生毒力。毒素通过门静脉血流和肠系膜淋巴离开肠道，引发多器官损伤。这篇综述文章追溯了健康和疾病状态下的肠道微生物生态、用于操纵肠道微生物群以寻求预防和治疗重症疾病的现代工具，并将探讨对肠道微生物群进行适当操纵是否能影响或调节重症疾病的进程。 文卡塔查拉姆·B，亚伯拉罕·BK。我们应该干预重症患者的肠道微生物群吗？《印度重症监护医学杂志》2020年；24（增刊4）：S211 - S214。
