Mehmood Qadri Haseeb, Dar Saad Abdullah, Bashir Raahim A, Khan Manal, Ali Salamat, Zahid Abdul Subhan, Ali Asim, Waheed Saba, Saeed Maha
Neurosurgery, Unit-I, Punjab Institute of Neurosciences, Lahore, PAK.
Surgery, Allama Iqbal Medical College, Lahore, PAK.
Cureus. 2023 Dec 21;15(12):e50923. doi: 10.7759/cureus.50923. eCollection 2023 Dec.
The human gastrointestinal tract (GIT) has a rich and pre-programmed microbiome. This microbiome is essential for physiological functions such as digestion, immunity, metabolism, and structural integrity, and of prime concern to us in conducting this study is the nervous system communication. This two-way communication between the GIT and central nervous system (CNS) is known as the gut-brain axis (GBA) and has implications for neurocritical disease. A change in any factor relating to this microbiome is known as gut dysbiosis; this can lead to aberrant communication through the GBA and in turn, can contribute to disease states. The primary objective of this study is to determine the cause-specific dysbiotic organisms in neuro-critically ill patients and their effects. We performed this study by searching published literature as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that defined gastrointestinal dysbiosis in neuro-critically ill patients were retrieved using Boolean search from 2000 to 2023 via PubMed and Google Scholar and narrowed the results down to five prospective case-control studies. We performed their quality assessment. The results concluded that in neurocritical illnesses such as encephalitis, brain tumors, intracerebral hemorrhage, and ischemic stroke, fluctuations in specific microbiota correlated with disease severity and prognosis. Moreover, the inhabiting population of dysbiotic organisms in neuro-critically ill patients were different in different diseases and there were no similarities in the composition of gut microbiota in these diseases. Taking stroke patients as an example; increased Enterobacteriaceae and lower Lachnospiraceae microbiome levels were found in patients with a higher stroke dysbiosis index (SDI). Those patients who developed stroke-associated pneumonia (SAP) displayed higher levels of Enterococcus species. In conclusion, dysbiosis has a major effect on neuro-critically ill patients' disease states and dysbiotic organisms can be used as a biomarker for disease. Further prospective studies on this topic are warranted for potential neurological and prognostic correlations.
人类胃肠道（GIT）拥有丰富且预先设定好的微生物群。这种微生物群对于诸如消化、免疫、代谢和结构完整性等生理功能至关重要，而在我们进行这项研究时，最关注的是神经系统通讯。胃肠道与中枢神经系统（CNS）之间的这种双向通讯被称为肠脑轴（GBA），并且与神经重症疾病有关。与这种微生物群相关的任何因素发生变化都被称为肠道菌群失调；这可能导致通过肠脑轴的异常通讯，进而可能促成疾病状态。本研究的主要目的是确定神经重症患者中特定病因的失调微生物及其影响。我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南，通过检索已发表的文献来开展这项研究。使用布尔检索法，通过PubMed和谷歌学术搜索2000年至2023年期间定义神经重症患者胃肠道菌群失调的研究，并将结果缩小至五项前瞻性病例对照研究。我们对这些研究进行了质量评估。结果得出，在诸如脑炎、脑肿瘤、脑出血和缺血性中风等神经重症疾病中，特定微生物群的波动与疾病严重程度和预后相关。此外，神经重症患者中失调微生物的寄居群体在不同疾病中有所不同，这些疾病的肠道微生物群组成没有相似之处。以中风患者为例；中风失调指数（SDI）较高的患者中发现肠杆菌科增加，而毛螺菌科微生物群水平较低。那些发生中风相关性肺炎（SAP）的患者显示肠球菌属水平较高。总之，菌群失调对神经重症患者的疾病状态有重大影响，失调微生物可作为疾病的生物标志物。关于这一主题的进一步前瞻性研究对于潜在的神经学和预后相关性是必要的。
