| Citation: |
HUANG Yanping. Application and potential mechanism of probiotics combined with high-dose vitamin C in severe acute pancreatitis[J]. Journal of Clinical Medicine in Practice, 2024, 28(17): 56-61. DOI: 10.7619/jcmp.20241137
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To investigate the effects of probiotics combined with high-dose vitamin C on immune function, intestinal mucosal function, and prognosis in patients with severe acute pancreatitis (SAP).
A total of 108 SAP patients were selected as study subjects and divided into control group (treated with high-dose vitamin C as adjuvant therapy, n=53) and observation group (treated with probiotics combined with high-dose vitamin C as adjuvant therapy, n=55) based on different treatment regimens. The efficacy, prognosis, and changes in inflammatory markers [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6)], immune function indicators (CD3+, CD4+, CD4+/CD8+), intestinal flora, intestinal mucosal function indicators [diamine oxidase (DAO), D-lactic acid, endotoxin], and monocyte p38MAPK/nuclear factor-κB (NF-κB) signaling pathway were observed before and after treatment in both groups.
The total effective rate in the observation group was 89.09%, which was significantly higher than the 69.81% in the control group (P < 0.05). After 3 and 7 days of treatment, the levels of IL-6, TNF-α, and CRP in the observation group were lower, while the levels of CD3+, CD4+, and CD4+/CD8+ were higher than those in the control group(P < 0.05). The levels of Enterococcus and Escherichia coli in the observation group were lower, while the levels of Lactobacillus and Bifidobacterium were higher than those in the control group (P < 0.05). Additionally, the levels of DAO, D-lactic acid, and endotoxin were lower in the observation group, and the relative expression levels of p38MAPK and p-p38MAPK proteins were also lower (P < 0.05). The length of hospital stay and ICU stay in the observation group were shorter compared to the control group (P < 0.05). There was no statistically significant difference in the incidence of voluntary discharge and death between the two groups (P>0.05).
The combination of probiotics and high-dose vitamin C has a definite therapeutic effect in SAP patients, effectively reducing inflammatory response, regulating immune function, promoting intestinal mucosal function repair, and facilitating early recovery. The achievement of above efficacy may be related to its inhibition of the p38MAPK/NF-κB signaling pathway.
| [1] |
刘真真, 胡辉歌, 申高飞, 等. 早期肠内营养支持联合益生菌治疗对SAP患者肠道菌群及胃肠功能的影响[J]. 医学临床研究, 2021, 38(11): 1663-1666. doi: 10.3969/j.issn.1671-7171.2021.11.017
|
| [2] |
TRIKUDANATHAN G, WOLBRINK D R J, VAN SANTVOORT H C, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach[J]. Gastroenterology, 2019, 156(7): 1994-2007. e3. doi: 10.1053/j.gastro.2019.01.269
|
| [3] |
LEE P J, PAPACHRISTOU G I. New insights into acute pancreatitis[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(8): 479-496. doi: 10.1038/s41575-019-0158-2
|
| [4] |
张王军, 成龙, 王刚, 等. 大剂量维生素C治疗重症急性胰腺炎的临床研究[J]. 中华肝胆外科杂志, 2021, 27(7): 540-542. doi: 10.3760/cma.j.cn113884-20200718-00378
|
| [5] |
孙永刚, 李海山, 徐礼友, 等. 维生素C辅助奥曲肽治疗对急性胰腺炎患者肠黏膜屏障功能和外周血T淋巴细胞亚群的影响[J]. 现代生物医学进展, 2023, 23(13): 2546-2549.
|
| [6] |
SOBOCKI B K, KAZMIERCZAK-SIEDLECKA K, FOLWARSKI M, et al. Pancreatic cancer and gut microbiome-related aspects: a comprehensive review and dietary recommendations[J]. Nutrients, 2021, 13(12): 4425. doi: 10.3390/nu13124425
|
| [7] |
LI H, XIE J Y, GUO X L, et al. Bifidobacterium spp. and their metabolite lactate protect against acute pancreatitis via inhibition of pancreatic and systemic inflammatory responses[J]. Gut Microbes, 2022, 14(1): 2127456. doi: 10.1080/19490976.2022.2127456
|
| [8] |
中华医学会外科学分会胰腺外科学组. 急性胰腺炎诊治指南(2014)[J]. 中华外科杂志, 2015, 53(1): 50-53. doi: 10.3760/cma.j.issn.0529-5815.2015.01.012
|
| [9] |
何俊娜, 申素芳, 陈洪. 血清载脂蛋白B与载脂蛋白A比值对重症急性胰腺炎患者预后的预测价值[J]. 中国临床医生杂志, 2023, 51(9): 1029-1032. doi: 10.3969/j.issn.2095-8552.2023.09.008
|
| [10] |
李谨, 张西京, 方宗平, 等. 布托啡诺联合右美托咪定在重症急性胰腺炎患者中的应用[J]. 空军军医大学学报, 2024, 45(1): 89-92.
|
| [11] |
柴薪, 张西京, 方宗平. 厚朴排气合剂联合早期肠内营养治疗重症急性胰腺炎的疗效观察[J]. 空军军医大学学报, 2024, 45(6): 695-698.
|
| [12] |
WALLER A, LONG B, KOYFMAN A, et al. Acute pancreatitis: updates for emergency clinicians[J]. J Emerg Med, 2018, 55(6): 769-779. doi: 10.1016/j.jemermed.2018.08.009
|
| [13] |
HABTEZION A, GUKOVSKAYA A S, PANDOL S J. Acute pancreatitis: a multifaceted set of organelle and CellularInteractions[J]. Gastroenterology, 2019, 156(7): 1941-1950. doi: 10.1053/j.gastro.2018.11.082
|
| [14] |
尹余平, 王霞, 陈恳, 等. 血清同型半胱氨酸、可溶性白介素2受体水平与急性胰腺炎患者病情严重程度的关系[J]. 实用临床医药杂志, 2022, 26(20): 85-88. doi: 10.7619/jcmp.20221507
|
| [15] |
陆卫华, 邬明, 方庆, 等. 早期低维生素C水平对急性胰腺炎病人免疫功能和临床预后的影响[J]. 肠外与肠内营养, 2020, 27(6): 330-334.
|
| [16] |
AZEEZ O M, AMID S A, ABDULKADIR Z S, et al. Maintenance impact of large dose of vitamin C on proinflammatory cytokines, insulin, and electrocardiographic parameters of wistar rats following partial pancreatectomy[J]. J Interferon Cytokine Res, 2021, 41(5): 187-194. doi: 10.1089/jir.2020.0261
|
| [17] |
XU L L, ZHAO B, SUN S L, et al. High-dose vitamin C alleviates pancreatic injury via the NRF2/NQO1/HO-1 pathway in a rat model of severe acute pancreatitis[J]. Ann Transl Med, 2020, 8(14): 852. doi: 10.21037/atm-19-4552
|
| [18] |
LI X Y, HE C, ZHU Y, et al. Role of gut microbiota on intestinal barrier function in acute pancreatitis[J]. World J Gastroenterol, 2020, 26(18): 2187-2193. doi: 10.3748/wjg.v26.i18.2187
|
| [19] |
HORVÁTH I L, BUNDUC S, FEHÉRVÁRI P, et al. The combination of ulinastatin and somatostatin reduces complication rates in acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials[J]. Sci Rep, 2022, 12(1): 17979. doi: 10.1038/s41598-022-22341-7
|
| [20] |
MINAGA K, WATANABE T, KUDO M. Probiotic-derived polyphosphate prevents pancreatitis[J]. Dig Dis Sci, 2021, 66(11): 3665-3667. doi: 10.1007/s10620-020-06809-y
|
| [21] |
YU C, ZHANG Y L, YANG Q, et al. An updated systematic review with meta-analysis: efficacy of prebiotic, probiotic, and synbiotic treatment of patients with severe acute pancreatitis[J]. Pancreas, 2021, 50(2): 160-166. doi: 10.1097/MPA.0000000000001734
|
| [22] |
WANG X Z, ZHANG P, ZHANG X. Probiotics regulate gut microbiota: an effective method to improve immunity[J]. Molecules, 2021, 26(19): 6076. doi: 10.3390/molecules26196076
|
| [23] |
岳鹏, 李国栋, 陈元清. 血必净联合生长抑素在重症急性胰腺炎患者中的疗效观察及对T淋巴细胞水平的影响研究[J]. 中国免疫学杂志, 2019, 35(9): 1116-1121. doi: 10.3969/j.issn.1000-484X.2019.09.018
|
| [24] |
李海涛, 张晓兰, 陈晓燕, 等. p38丝裂原活化蛋白激酶通路在重症急性胰腺炎中的作用[J]. 中华胰腺病杂志, 2020, 20(1): 57-60. doi: 10.3760/cma.j.issn.1674-1935.2020.01.011
|
| [25] |
倪斌, 易成, 张理科. 基于抗炎及抗氧化作用探讨微生态制剂在非酒精性脂肪肝模型大鼠中的应用价值[J]. 中国微生态学杂志, 2020, 32(5): 533-536.
|
| [26] |
杨涛. 益生菌联合早期肠内营养对重症急性胰腺炎的疗效观察[D]. 郑州: 郑州大学, 2019.
|
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