Altered gut flora and environment in patients with severe SIRS
Altered gut flora and environment in patients with severe SIRS
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DOI：
10.1097/01.ta.0000197374.99755.fe
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发表时间：
2006-01-01
影响因子：
--
通讯作者：
Sugimoto, H
中科院分区：
文献类型：
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作者：
Shimizu, K;Ogura, H;Sugimoto, H
背景：肠道被认为是严重损伤（如脓毒症、创伤和休克）后损伤的重要靶器官。已经在动物中研究了细菌移位或肠系膜淋巴对全身炎症反应和多器官损伤的影响，但危重患者肠道植物群和环境的动态变化尚未完全阐明。方法：选择重症全身炎症反应综合征（SIRS）患者25例，血清CRP> 10 mg/dL，在重症监护室接受治疗2 d以上，均符合SIRS诊断标准。18例患者的SIRS是脓毒症的结果，6例是创伤，1例是烧伤。使用粪便样品通过平板或试管技术定量评价微生物菌群（包括双歧杆菌和乳杆菌的10个关键组的细菌计数）和肠道环境（通过高速液相色谱法测定pH和9种有机酸）。结果：粪便植物群分析证实，严重SIRS患者的厌氧菌总数（尤其是有益的双歧杆菌和乳酸杆菌）显著低于健康志愿者，致病的葡萄球菌和假单胞菌群显著高于健康志愿者。总有机酸（特别是“有益的”短链脂肪酸，如乙酸，丙酸和丁酸）在粪便中的浓度显着降低，而pH值显着increased.Conclusion：肠道植物群和环境显着改变，在严重的SIRS患者。肠道植物群和环境的异常可能影响严重损伤后的全身炎症反应。
Background: The gut is considered an important target organ of injury after severe insult such as sepsis, trauma, and shock. The impact of bacterial translocation or mesenteric lymph on systemic inflammatory response and multiple organ damage has been investigated in animals, but dynamic changes in the gut flora and environment have not been fully clarified in critically ill patients. In the present study, we quantitatively evaluated changes in the gut microflora and environment in patients with severe systemic inflammatory response syndrome (SIRS).Methods: Twenty-five patients with severe SIRS, who fulfilled the criteria for SIRS, had a serum CRP level > 10 mg/dL, and were treated in the intensive care unit for more than 2 days, were included in our study. SIRS was a result of sepsis in 18 patients, trauma in 6, and burn in 1. A fecal sample was used for quantitative evaluation of microflora (bacterial counts of 10 key groups including Bifidobacterium and Lactobacillus) by plate or tube technique and of the gut environment (pH and 9 organic acids by high speed liquid chromatography). Data obtained from patients were compared with corresponding data from healthy volunteers.Results: Analysis of fecal flora confirmed that patients with severe SIRS had significantly lower total anaerobic bacterial counts (especially 2-4 log fewer "beneficial" Bifidobacterium and Lactobacillus) and 2 log higher "pathogenic" Staphylococcus and Pseudomonas group counts than those of healthy volunteers. Concentrations of total organic acids (especially "beneficial" short-chain fatty acids such as acetic acid, propionic acid, and butyric acid) in the feces were significantly decreased in the patients, whereas pH was markedly increased.Conclusion: The gut flora and environment are significantly altered in patients with severe SIRS. Abnormal gut flora and environment may affect systemic inflammatory response after severe insult.