Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study.
Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study.
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DOI：
10.1186/cc10579
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Yin HH
中科院分区：
文献类型：
--
作者：
Tan M;Zhu JC;Du J;Zhang LM;Yin HH
创伤性脑损伤与严重的免疫功能障碍有关，表现为T辅助细胞1型(Th1)向辅助性T细胞2型(Th2)的严重转变。这使患者容易感染、败血症和不良后果。益生菌已被证明在过敏小鼠模型和患者中平衡Th1/Th2细胞因子。在目前的研究中，我们假设益生菌的肠内给药可以调整Th1/Th2失衡，并改善脑外伤患者的临床结果。我们设计了一项前瞻性、随机、单盲研究。纳入严重颅脑损伤和格拉斯哥昏迷评分在5~8分之间的患者，结果对照组和益生菌组分别为26例和26例。所有患者在入院后24至48小时内经鼻胃管接受肠内营养。此外，益生菌组每天接受109种活益生菌，持续21天。观察患者血清Th1/Th2细胞因子水平、急性生理学与慢性健康状况评分(APACHE II)、序贯器官衰竭评分(SOFA)、医院感染、ICU住院时间及28d病死率。患者对活性益生菌有反应，血清IL-12p70和干扰素γ水平显著升高，而IL-4和IL-10浓度也显著下降。益生菌治疗对APACHE II和SOFA评分无显著影响。在研究接近尾声时，益生菌组患者的医院感染发生率降低。在接受益生菌治疗的患者中，也观察到较短的ICU停留时间。然而，28天的死亡率没有受到影响。本研究表明，每日预防性应用益生菌可减轻重型颅脑损伤所致的Th1/Th2应答偏差，并可降低医院感染率，尤其是在晚期。ChiCTR-TRC-10000835。
Traumatic brain injury (TBI) is associated with a profound immunological dysfunction manifested by a severe shift from T-helper type 1 (Th1) to T-helper type 2 (Th2) response. This predisposes patients to infections, sepsis, and adverse outcomes. Probiotic bacteria have been shown to balance the Th1/Th2 cytokines in allergic murine models and patients. For the present study, we hypothesized that the enteral administration of probiotics would adjust the Th1/Th2 imbalance and improve clinical outcomes in TBI patients. We designed a prospective, randomized, single-blind study. Patients with severe TBI and Glasgow Coma Scale scores between 5 and 8 were included, resulting in 26 patients in the control group and 26 patients in the probiotic group. All patients received enteral nutrition via a nasogastric tube within 24 to 48 hours following admission. In addition, the probiotic group received 109 bacteria of viable probiotics per day for 21 days. The associated serum levels of Th1/Th2 cytokines, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, nosocomial infections, length of ICU stay, and 28-day mortality rate were studied. The patients responded to viable probiotics, and showed a significantly higher increase in serum IL-12p70 and IFNγ levels while also experiencing a dramatic decrease in IL-4 and IL-10 concentrations. APACHE II and SOFA scores were not significantly affected by probiotic treatment. Patients in the probiotic group experienced a decreased incidence of nosocomial infections towards the end of the study. Shorter ICU stays were also observed among patients treated with probiotic therapy. However, the 28-day mortality rate was unaffected. The present study showed that daily prophylactic administration of probiotics could attenuate the deviated Th1/Th2 response induced by severe TBI, and could result in a decreased nosocomial infection rate, especially in the late period. ChiCTR-TRC-10000835.
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