Effect of oral probiotics on intestinal microecology in patients with chronic heart failure
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摘要:目的
探讨益生菌在慢性心力衰竭(CHF)患者中的应用效果及对肠道微生态的影响。
方法选取112例CHF患者作为研究对象, 随机分为研究组和对照组, 每组56例。对照组采用血管紧张素转化酶抑制剂(ACEI)联合血管紧张素Ⅱ受体阻滞剂(ARB)治疗, 研究组在对照组的基础上联用双歧杆菌活菌胶囊治疗。检测2组患者心肌纤维化指标[Ⅰ型胶原前体C前肽(PⅠCP)、Ⅲ型胶原前体N前肽(PⅢNP)、PⅠCP/PⅢNP、Ⅰ型胶原羧基端肽(ⅠCTP)]水平、心功能指标[左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左心室收缩末期容积(LVESV)]、肠道菌群丰度、血浆氧化三甲胺(TMAO)水平和血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平。观察2组患者的治疗效果、用药安全性及出院后3个月内再入院率、病死率。
结果研究组总有效率为71.43 %, 高于对照组的51.79 %, 差异有统计学意义(P < 0.05); 治疗后, 研究组LVEF高于对照组, LVEDD、LVESD、LVESV小于对照组, 差异有统计学意义(P < 0.05); 治疗后, 研究组PⅠCP/PⅢNP高于对照组, ⅠCTP低于对照组, 差异有统计学意义(P < 0.05); 治疗后, 研究组变形菌门、放线菌门、厚壁菌门、梭杆菌门丰度均低于对照组, 拟杆菌门丰度高于对照组, 差异有统计学意义(P < 0.05); 治疗后, 研究组TMAO、TNF-α、IL-1β水平低于对照组, 差异有统计学意义(P < 0.05); 用药后, 2组患者均未发生严重不良反应; 出院3个月内, 研究组再入院率为12.50 %, 低于对照组的30.36 %, 差异有统计学意义(P < 0.05), 研究组、对照组患者病死率分别为1.79 %、7.14 %, 差异无统计学意义(P>0.05)。
结论益生菌联合ACEI和ARB治疗方案能有效减轻CHF患者心肌纤维化, 并改善肠道微生态及预后。
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关键词:
- 益生菌 /
- 血管紧张素转化酶抑制剂 /
- 血管紧张素Ⅱ受体阻滞剂 /
- 慢性心力衰竭 /
- 心肌纤维化
Abstract:ObjectiveTo investigate the effect of probiotics in patients with chronic heart failure (CHF) and its impact on intestinal microecology.
MethodsA total of 112 patients with CHF were selected as research subjects and randomly divided into study group and control group, with 56 patients in each group. The control group received angiotensin-converting enzyme inhibitors (ACEI) combined with angiotensin Ⅱ receptor blockers (ARB) for treatment, while the study group received bifidobacterium viable capsules on the basis of treatment in the control group. The levels of myocardial fibrosis markers[type Ⅰ collagen precursor C-propeptide (PⅠCP), type Ⅲ collagen precursor N-propeptide (PⅢNP), PⅠCP/PⅢNP, type Ⅰ collagen carboxyl-terminal peptide (ⅠCTP)], cardiac function indicators[leftventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-systolic volume (LVESV)], intestinal flora abundance, plasma trimethylamine oxide (TMAO) levels, and serum tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) levels were measured in both groups. The therapeutic effects, drug safety, re-hospitalization rate, and mortality rate within 3 months after discharge were observed in both groups.
ResultsThe total effective rate in the study group was 71.43 %, which was higher than 51.79 % in the control group (P < 0.05). After treatment, the LVEF in the study group was higher than that in the control group, while LVEDD, LVESD, and LVESV were lower than those in the control group (P < 0.05). After treatment, the PⅠCP/PⅢNP in the study group was higher than that in the control group, while the ⅠCTP level was lower than that in the control group (P < 0.05). After treatment, the abundances of Proteobacteria, Actinobacteria, Firmicutes, and Fusobacteria in the study group were lower than those in the control group, while the abundance of Bacteroidetes was higher than that in the control group (P < 0.05). After treatment, the levels of TMAO, TNF-α, and IL-1β in the study group were lower than those in the control group (P < 0.05). No serious adverse reactions occurred in either group after treatment. Within 3 months after discharge, the re-hospitalization rate in the study group was 12.50 %, which was lower than 30.36 %in the control group (P < 0.05). The mortality rates in the study group and the control group were 1.79 % and 7.14 %, respectively, but no statistically significant difference was observed(P>0.05).
ConclusionThe combination of probiotics with ACEI and ARB can effectively reduce myocardial fibrosis in patients with CHF and improve intestinal microecology and prognosis.
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表 1 2组患者治疗效果比较[n(%)]
组别 n 显效 有效 无效 总有效 对照组 56 12(21.43) 17(30.36) 27(48.21) 29(51.79) 研究组 56 18(32.14) 22(39.29) 16(28.57) 40(71.43)* 与对照组比较, * P < 0.05。 
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表 2 2组患者心功能指标比较(x±s)
组别 n LVEF/% LVEDD/mm LVESD/mm LVESV/mL 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 56 44.02±5.05 48.44±6.22* 65.05±4.88 44.02±4.05* 53.11±4.05 40.15±3.81* 54.28±4.28 40.45±3.64* 研究组 56 44.25±5.12 53.12±5.18*# 64.18±6.02 50.25±5.18*# 53.29±3.84 35.61±3.42*# 53.28±5.11 34.18±3.55*# LVEF: 左心室射血分数; LVEDD: 左室舒张末期内径; LVESD: 左室收缩末期内径; LVESV: 左心室收缩末期容积。
与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 3 2组患者心肌纤维化指标比较(x±s)
组别 n PⅠCP/(pg/mL) PⅢNP/(pg/mL) PⅠCP/PⅢNP ⅠCTP/(ng/mL) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 56 2 715.84±478.62 1 218.55±426.82* 6 145.92±502.61 2 212.52±175.61* 0.49±0.11 0.53±0.18 621.55±60.08 384.29±48.56* 研究组 56 2 842.51±448.72 1 154.61±648.52* 6 255.82±513.41 2 184.55±148.62* 0.47±0.08 0.63±0.21*# 631.45±60.22 205.15±40.28*# PⅠCP: Ⅰ型胶原前体C前肽; PⅢNP: Ⅲ型胶原前体N前肽; ⅠCTP: Ⅰ型胶原羧基端肽。与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
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表 4 2组患者肠道菌群丰度比较(x±s)
% 组别 n 变形菌门 放线菌门 厚壁菌门 拟杆菌门 梭杆菌门 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 56 8.62±1.09 7.45±0.84* 14.62±3.15 10.59±2.16* 63.08±5.67 48.67±5.22* 28.08±4.12 31.18±4.62* 0.92±0.15 0.85±0.12* 研究组 56 8.45±1.28 6.52±1.03*# 14.65±2.38 5.78±2.02*# 63.55±6.22 27.85±4.26*# 28.16±4.15 55.64±5.22*# 0.91±0.22 0.72±0.13*# 与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
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表 5 2组TMAO、TNF-α、IL-1β水平比较(x±s)
组别 n TMAO/(mg/L) TNF-α/(μg/L) IL-1β/(μg/L) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 56 0.65±0.04 0.52±0.06* 12.46±2.16 9.22±1.15* 21.68±3.55 16.42±2.18* 研究组 56 0.66±0.08 0.44±0.05*# 12.15±2.55 6.02±1.08*# 21.18±4.15 10.55±1.84*# TMAO氧化三甲胺; TNF-α: 肿瘤坏死因子-α; IL-1β: 白细胞介素-1β。与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
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