Immune Response and Intestinal Permeability in Children With Acute Gastroenteritis Treated With Lactobacillus rhamnosus GG: A Randomized, Double-Blind, Placebo-Controlled Trial
Immune Response and Intestinal Permeability in Children With Acute Gastroenteritis Treated With Lactobacillus rhamnosus GG: A Randomized, Double-Blind, Placebo-Controlled Trial
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DOI：
10.1093/cid/ciu065
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发表时间：
2014-04-15
影响因子：
11.8
通讯作者：
Kang, Gagandeep
中科院分区：
文献类型：
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作者：
Sindhu, Kulandaipalayam N. C.;Sowmyanarayanan, Thuppal V.;Kang, Gagandeep
背景资料。益生菌可能在儿童急性胃肠炎的治疗中发挥作用。我们报道了益生菌鼠李糖乳杆菌GG(LGG)对患有隐孢子虫或轮状病毒腹泻的印度儿童的肠道功能、免疫反应和临床结局的影响。患有6个月至5岁的胃肠炎，粪便中轮状病毒或隐孢子虫检测呈阳性(不包括混合感染)的儿童被随机分成两组，每天服用一次LGG(Atcc 53103)或服用安慰剂，共4周。获得了基线人口学和临床细节。检测血清中隐孢子虫和轮状病毒的免疫球蛋白G(Ig G)和免疫球蛋白A(Ig A)抗体，并在基线和随访结束时测定乳果糖/甘露醇比值。在124名登记的儿童中，82名和42名分别患有轮状病毒和隐孢子虫腹泻。腹泻持续时间的中位数为4天；三分之一的儿童有严重腹泻。在接受LGG和安慰剂治疗的儿童中，基线和临床参数是可比的。在随访结束时，服用LGG的轮状病毒腹泻儿童反复腹泻发作(25%比46%；P=.048)和肠道功能受损(48%比72%；P=0.027)较少。在接受免疫球蛋白治疗的轮状病毒腹泻患儿中，观察到干预后的免疫球蛋白水平显著升高(456比2215 EU；P=0.003)。在患有隐孢子虫腹泻的儿童中，接受LGG治疗的儿童在肠道通透性方面有显著改善。LGG具有积极的免疫调节作用，可能有助于减少轮状病毒腹泻的反复发作。轮状病毒和隐孢子虫性胃肠炎患儿肠道功能的改善强调了益生菌在治疗感染后肠道损害中的作用。CTRI/2010/091/000339号文件。
Background. Probiotics have a possible role in the treatment of pediatric acute gastroenteritis. We report the effect of the probiotic Lactobacillus rhamnosus GG (LGG) on intestinal function, immune response, and clinical outcomes in Indian children with cryptosporidial or rotavirus diarrhea.Methods. Children with gastroenteritis aged 6 months to 5 years, testing positive for either rotavirus or Cryptosporidium species in stool (coinfections were excluded), were randomized to LGG (ATCC 53103) or placebo, once daily for 4 weeks. Baseline demographic and clinical details were obtained. Sera were tested for immunoglobulin G (IgG) and immunoglobulin A (IgA) antibodies to Cryptosporidium and rotavirus, and the lactulose to mannitol ratio for intestinal permeability was determined at baseline and at the end of follow-up.Results. Of the 124 children enrolled, 82 and 42 had rotavirus and cryptosporidial diarrhea, respectively. Median diarrheal duration was 4 days; one-third of the children had severe diarrhea. Baseline and clinical parameters were comparable between children receiving LGG and placebo. At the end of follow-up, fewer children with rotavirus diarrhea on LGG had repeated diarrheal episodes (25% vs 46%; P =.048) and impaired intestinal function (48% vs 72%; P =.027). Significant increase in IgG levels postintervention (456 vs 2215 EU; P =.003) was observed in children with rotavirus diarrhea receiving LGG. Among children with cryptosporidial diarrhea, those receiving LGG showed significant improvement in intestinal permeability.Conclusions. LGG has a positive immunomodulatory effect and may be useful in decreasing repeated episodes of rotavirus diarrhea. Improvement in intestinal function in children with rotavirus and cryptosporidial gastroenteritis emphasizes the role of probiotics in treating intestinal impairment after infection.Clinical Trials Registration. CTRI/ 2010/ 091/ 000339.