肠内营养对缺血性脑卒中患者肠道菌群的影响

doi:10.3969/j.issn.1006-9771.2019.07.016

《中国康复理论与实践》 ›› 2019, Vol. 25 ›› Issue (7): 822-827.doi: 10.3969/j.issn.1006-9771.2019.07.016

肠内营养对缺血性脑卒中患者肠道菌群的影响

范春江¹, 刘庭玉², 李刚¹, 黄建¹, 曹扬¹, 党旖旎³

1.无锡市康复医院(无锡市残疾人康复中心)康复科，江苏无锡市 214043
2.复旦大学附属中山医院青浦分院消化内科，上海市 201799
3.南京医科大学第一附属医院(江苏省人民医院)消化内科，江苏南京市 210029

收稿日期:2019-02-11 修回日期:2019-04-19 出版日期:2019-07-25 发布日期:2019-07-23
通讯作者: 党旖旎 E-mail:yeani-hi@126.com
作者简介:范春江(1980-)，男，汉族，江苏启东市人，硕士，副主任医师，主要研究方向：康复医学、呼吸内科和消化内科。
基金资助:
无锡市卫计局面上项目(No. ME201504)

Effect of Enteral Nutrition on Intestinal Flora in Patients with Ischemic Stroke

FAN Chun-jiang¹, LIU Ting-yu², LI Gang¹, HUANG Jian¹, CAO Yang¹, DANG Yi-ni³

1.Department of Rehabilitation, Wuxi Rehabilitation Hospital (Wuxi Rehabilitation Center for the Disabled), Wuxi, Jiangsu 214043, China
2.Department of Gastroenterology, Qingpu Branch, Affiliated Zhongshan Hospital of Fudan University, Shanghai 201799, China
3.Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu 210029, China

Received:2019-02-11 Revised:2019-04-19 Published:2019-07-25 Online:2019-07-23
Contact: DANG Yi-ni E-mail:yeani-hi@126.com
Supported by:
Supported by Wuxi Health and Family Planning Bureau Project (General) (No. ME201504)

摘要/Abstract

摘要： 目的探讨肠内营养治疗对缺血性脑卒中患者肠道微生态的影响。方法 2017年3月至4月，121例恢复期缺血性脑卒中患者，在常规康复的基础上，予肠内营养治疗1周。入院时、干预后1周和1个月时分别留取新鲜粪便和血浆，记录患者营养状况。酶联免疫吸附试验检测肿瘤坏死因子-α (TNF-α)、白细胞介素(IL)-1α、IL-1β、IL-6和IL-8，选10例患者行16S rDNA基因序列检测。结果干预后1个月，患者营养风险筛查量表评分较入院时降低(P < 0.05)；血清IL-1β和IL-6水平较入院时升高(P < 0.05)，而血清IL-8水平较入院时下降(P < 0.05)。此外，肠内营养治疗可改变肠道的优势菌群，提高菌群多样性和丰度。结论肠内营养可通过改变缺血性脑卒中患者肠道菌群来调节炎症因子水平。

关键词: 缺血性脑卒中, 肠内营养, 肠道菌群

Abstract: Objective To explore the effect of enteral nutrition on gut microbiota for ischemic stroke. Methods From March to April, 2017, 121 patients with convalescent ischemic stroke were enrolled. The patients received routine rehabilitation combing with 1-week enteral nutrition. The patients' fresh feces and blood samples were obtained at admission, one week and one month after the enteral nutrition, while nutritional status was assessed with Nutrition Risk Screening (NRS2002). Cytokines, including tumor necrosis factor (TNF) -α, interleukin (IL)-1α, IL-1β, IL-6 and IL-8 were tested with ELISA. Ten patients were tested with 16S rDNA Illumina HiSeq/MiSeq for gut microbiota alterations. Results The scores of NRS2002 decreased (P < 0.05), the level of serum IL-1β and IL-6 raised, while the level of IL-8 dropped one month after enteral nutrition (P < 0.05). In addition, the enteral nutrition altered the dominant bacterial community, and alleviated the diversity and species richness of bacteria, while the difference was statistically significant one week after enteral nutrition. Conclusion Enteral nutrition can alter gut microbiota to facilitate to recover ischemic stroke.

Key words: ischemic stroke, enteral nutrition, intestinal flora

中图分类号:

R743.3

范春江, 刘庭玉, 李刚, 黄建, 曹扬, 党旖旎. 肠内营养对缺血性脑卒中患者肠道菌群的影响[J]. 《中国康复理论与实践》, 2019, 25(7): 822-827.

FAN Chun-jiang, LIU Ting-yu, LI Gang, HUANG Jian, CAO Yang, DANG Yi-ni. Effect of Enteral Nutrition on Intestinal Flora in Patients with Ischemic Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(7): 822-827.

参考文献

1 GoldsteinL B, BushnellC D, AdamsR J, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2011, 42(2): 517-584.
2 GreenA R. Pharmacological approaches to acute ischaemic stroke: reperfusion certainly, neuroprotection possibly [J]. Br J Pharmacol, 2018, 153(Suppl 1): S325-S338.
3 WangY， CuiL， JiX， et al. The China National Stroke Registry for patients with acute cerebrovascular events: design, rationale, and baseline patient characteristics [J]. Int J Stroke, 2011, 6(4): 355-361.
4 王少石,郑天衡,陈真理,等. 早期肠内营养治疗对急性组中近期预后的影响[J]. 中华内科杂志, 2007, 46(5): 366-369.
5 FujishimaI. Rehabilitation for swallowing disorders associated with stroke [M]. 2nd ed. Tokyo: Ishiyaku Publishers Inc., 1998.
6 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010[J]. 中华神经科杂志, 2010, 43(2): 146-153.
7 H P JrAdams, del ZoppoG, AlbertsM J, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists [J]. Circulation, 2007, 115(20): e478-e534.
8 BeamerN B, CoullB M, ClarkW M, et al. Interleukin-6 and interleukin-1 receptor antagonist in acute stroke [J]. Ann Neurol, 1995, 37(6): 800-805.
9 DávalosA, RicartW, Gonzalez-HuixF, et al. Effect of malnutrition after acute stroke on clinical outcome [J]. Stroke, 1996, 27(6): 1028-1032.
10 ClaessonM J, JefferyI B, CondeS, et al. Gut microbiota composition correlates with diet and health in the elderly [J]. Nature, 2012, 488(7410): 178-184.
11 GoyalM S, VenkateshS, MilbrandtJ, et al. Feeding the brain and nurturing the mind: Lingking nutrition and the gut microbiota to brain development [J]. Proc Natl Acad Sci U S A. 2015, 112(46): 14105-14112.
12 SinghV, RothS, LloveraG, et al. Microbiota dysbiosis controls the neuroinflammatory response after stroke [J]. J Neurosci, 2016, 36(28): 7428-7440.
13 KostulasN, Kivis?kkP, HuangY, et al. Ischemic stroke is associated with a systemic increase of blood mononuclear cells expressing interleukin-8 mRNA [J]. Stroke, 1998, 29(2): 462-466.
14 KimJ S. Cytokines and adhesion molecules in stroke and related diseases [J]. J Neurol Sci, 1996, 137(2): 69-78.
15 FassbenderK, RossolS, KammerT, et al. Proinflammatory cytokines in serum of patients with acute cerebral ischemia: kinetics of secretion and relation to the extent of brain damage and outcome of disease [J]. J Neurol Sci, 1994, 122(2): 135-139.

[1]	邓婷, 陈敬绵, 刘小蒙, 姚晓华, 刘芦姗, 何威, 张通, 芦海涛. 轻中度急性缺血性脑卒中并发卒中相关性肺炎的危险因素分析[J]. 《中国康复理论与实践》, 2023, 29(6): 708-713.
[2]	张春龙, 刘福亮, 商娜, 李芳, 刘慧珍. 血清脂联素、超敏C-反应蛋白与急性缺血性脑卒中短期预后的相关性[J]. 《中国康复理论与实践》, 2023, 29(10): 1221-1226.
[3]	赖海芳,顾琳,纵亚,牛传欣,谢青. 采用多层感知器神经网络构建亚急性期缺血性脑卒中患者短期预后的预测模型[J]. 《中国康复理论与实践》, 2022, 28(3): 335-339.
[4]	朱慧,夏有兵,巩尊科,王世雁,马柯,闫金秋. 高频重复经颅磁刺激对缺血性脑卒中后中枢性面瘫的效果[J]. 《中国康复理论与实践》, 2022, 28(2): 199-203.
[5]	王娜,李培兰,刘芦姗,王丰容. 不同评分系统预测急性缺血性脑卒中患者的短期和长期死亡风险比较[J]. 《中国康复理论与实践》, 2021, 27(3): 256-260.
[6]	王娜娜, 杜小正, 何文洁, 张馨予, 郑欣, 李梦莘. 针刺治疗缺血性脑卒中的Notch信号通路研究进展[J]. 《中国康复理论与实践》, 2021, 27(1): 67-70.
[7]	陈小平,王明洋,马登磊,龚诗立,张丽,李雅莉,李林,胡朝英,张兰. 痘苗病毒致炎兔皮提取物对脑缺血再灌注脑损伤大鼠凋亡和神经炎症的影响[J]. 《中国康复理论与实践》, 2020, 26(9): 1038-1044.
[8]	刘建华,魏清川,胡秀茹,叶赛青,闫志宇,高强. 弥散张量成像各向异性分数与缺血性脑卒中患者上肢运动功能的相关性[J]. 《中国康复理论与实践》, 2020, 26(7): 749-752.
[9]	魏海萍,郭佳,王欢,葛朝明. 迷走神经刺激对脑缺血再灌注大鼠磷酸腺苷活化蛋白激酶-沉默信息调节因子2相关酶1自噬通路的影响[J]. 《中国康复理论与实践》, 2020, 26(7): 775-779.
[10]	刘慧珍,郭树彬,商娜,李芳,刘芦姗,李培兰,陈敬绵,王丰容,李俊玉. 血清25羟基-维生素D对急性缺血性脑卒中急诊患者结局的预测价值[J]. 《中国康复理论与实践》, 2020, 26(7): 830-835.
[11]	龚诗立,杨翠翠,胡朝英,王明洋,张兰. 痘苗病毒致炎兔皮提取物促进小胶质细胞M1向M2极化、抑制炎性因子分泌的体外研究[J]. 《中国康复理论与实践》, 2020, 26(6): 662-667.
[12]	王传杰,吴毅,陶峰,杨雷. 丰富环境对缺血性脑卒中小鼠海马区Bcl-2和Bax蛋白表达和认知功能的效果[J]. 《中国康复理论与实践》, 2020, 26(5): 539-543.
[13]	邓杜萍,范金,谢晓龙,李凌鑫. 调控缺血性脑卒中小胶质细胞极化的药物研究进展[J]. 《中国康复理论与实践》, 2020, 26(5): 559-562.
[14]	符家武,吴昊,李君良,叶烨,陈婧,周海红,李友. microRNA-137基因多态性与缺血性卒中后抑郁的相关性[J]. 《中国康复理论与实践》, 2020, 26(5): 588-591.
[15]	汪俊宇,庞日朝,王文春,王美玉,向武,赵小华,张安仁. 脊髓损伤患者肠道菌群属水平的特征及意义[J]. 《中国康复理论与实践》, 2020, 26(4): 393-399.

肠内营养对缺血性脑卒中患者肠道菌群的影响

Effect of Enteral Nutrition on Intestinal Flora in Patients with Ischemic Stroke

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0