COLONIC FERMENTATION TO SHORT-CHAIN FATTY-ACIDS IS DECREASED IN ANTIBIOTIC-ASSOCIATED DIARRHEA
COLONIC FERMENTATION TO SHORT-CHAIN FATTY-ACIDS IS DECREASED IN ANTIBIOTIC-ASSOCIATED DIARRHEA
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DOI：
10.1016/0016-5085(91)90384-w
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发表时间：
1991-12-01
期刊：
影响因子：
29.4
通讯作者：
MORTENSEN, PB
中科院分区：
文献类型：
--
作者：
CLAUSEN, MR;BONNEN, H;MORTENSEN, PB
为了阐明抗生素相关性腹泻的发病机制，在三组受试者中研究了结肠碳水化合物发酵：一组对照，一组抗生素相关性腹泻患者，和一组接受抗生素治疗但未发生腹泻的患者。与对照组相比，腹泻相关性腹泻患者的结肠发酵明显受损，表现为极低浓度（22.1 vs. 59.5 mmol/L;P< 0.01）和短链脂肪酸的产生率。在没有腹泻的患者组中，对结肠发酵的影响取决于给予的抗生素。青霉素和匹氨苄青霉素PO未降低浓度（分别为69.9和66.7 mmol/L）或生产速率。双氯西林、红霉素以及氨苄西林、奈替米星和甲硝唑联合静脉给药可降低两种浓度（27.1、38.2和18.8 mmol/L; P< 0.01）和短链脂肪酸的产生率达到腹泻患者的水平。所有患者的l-乳酸和d-乳酸浓度均正常（< 5 mmol/L），但在短链脂肪酸产生减少的患者中，包括腹泻患者，乳酸产生减少。因此，腹泻相关性腹泻总是与粪便浓度和短链脂肪酸生产率以及乳酸生产率降低有关。这些结果表明，腹泻相关性腹泻可能继发于以其他方式处置的受试者的结肠发酵受损，导致管腔碳水化合物蓄积和/或短链脂肪酸刺激的钠和水吸收减少。
To elucidate the pathogenesis of antibiotic-associated diarrhea, colonic carbohydrate fermentation was investigated in three groups of subjects—a group of controls, a group of patients with antibiotic-associated diarrhea, and a group of patients receiving antibiotic therapy without diarrhea. Compared with controls, the colonic fermentation was markedly impaired in patients with antibiotic-associated diarrhea reflected by both very low concentrations (22.1 vs. 59.5 mmol/L;P< 0.01) and production rates of short-chain fatty acids. In the group of patients without diarrhea, the effect on the colonic fermentation was dependent on the antibiotic administered. Penicillin and pivampicillin PO did not reduce the concentrations (69.9 and 66.7 mmol/L, respectively) or production rates. Dicloxacillin, erythromycin, and combined IV treatment with ampicillin, netilmicin, and metronidazole reduced both concentrations (27.1, 38.2, and 18.8 mmol/L;P< 0.01) and production rates of short-chain fatty acids to levels seen in patients with diarrhea.l-Lactate andd-lactate concentrations were normal in all patients (< 5 mmol/L), but lactate production was reduced in the patients who had reduced production of short-chain fatty acids, including patients with diarrhea. Thus, antibiotic-associated diarrhea was always related to reduced fecal concentrations and production rates of short-chain fatty acids and production rates of lactate. These results suggest that the antibiotic-associated diarrhea might be secondary to impaired colonic fermentation in otherwise disposed subjects, resulting in accumulation of luminal carbohydrate and/or decreased short-chain fatty acid-stimulated sodium and water absorption.