Relationship between intestinal microecology and the translocation of intestinal bacteria.
Relationship between intestinal microecology and the translocation of intestinal bacteria.
复制标题
肠道微生态与肠道细菌易位的关系。
DOI：
10.1007/bf00422722
复制
发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Wells,CL
中科院分区：
文献类型：
--
作者：
Wells,CL
现在众所周知，内源性细菌可以从肠道转移并导致重症住院患者中出现的许多复杂感染。在肠道中的数百种细菌中，相对较少的需氧/兼性细菌似乎以任何频率易位。 Van der Waaij 及其同事（1971、1972a、1972b）最初提出，通过一种称为“定植抵抗”的过程，严格厌氧细菌可防止肠道过度生长以及这些潜在致病性需氧/兼性细菌随后的易位。旨在维持定植抵抗力的选择性抗菌净化已有效降低高危患者的感染发病率。然而，控制细菌易位的机制仍不清楚，但似乎取决于宿主因素以及微生物本身固有的因素。有临床和实验证据支持严格厌氧细菌不易移位的概念。能够在巨噬细胞内存活的细菌（例如沙门氏菌和单核细胞增生李斯特氏菌）比其他细菌更容易移位，并且最近的实验证据表明正常肠道细菌可能会移位到宿主吞噬细胞内的引流肠系膜淋巴结。还有证据表明，在与肠上皮损伤相关的情况下，即烧伤、口服蓖麻油酸和急性肠系膜缺血，厌氧菌与兼性菌种一起易位。相比之下，最近的实验证据表明，兼性细菌可以穿过组织学上完整的肠上皮，并且回肠吸收细胞在转运到更深的组织之前可能是至少一个入口。预计，进一步阐明细菌易位所涉及的途径和机制将为治疗和预防重症住院患者中大部分感染性疾病提供新的见解。
It is now well known that endogenous bacteria can translocate from the intestinal tract and cause many of the complicating infections seen in severely ill, hospitalized patients. Of the hundreds of bacterial species in the intestinal tract, relatively few aerobic/facultative species appear to translocate with any frequency. Van der Waaij and colleagues (1971, 1972a, 1972b) originally proposed that, by a process termed ‘colonization resistance’, strictly anaerobic bacteria prevented the intestinal overgrowth and subsequent translocation of these potentially pathogenic aerobic/facultative bacteria. Selective antimicrobial decontamination, designed to maintain colonization resistance, has been effective in reducing the incidence of infectious morbidity in high risk patients. However, the mechanisms controlling bacterial translocation remain unclear, but appear to depend on host factors, as well as on factors inherent in the microbe itself. There is both clinical and experimental evidence supporting the concept that strictly anaerobic bacteria do not readily translocate. Bacteria that are able to survive within macrophages (e.g.,Salmonellaspecies andListeria monocytogenes) translocate easier than others, and there is recent experimental evidence that normal intestinal bacteria may translocate to the draining mesenteric lymph node within host phagocytes. There is also evidence that anaerobic bacteria translocate along with facultative species in situations associated with intestinal epithelial damage, i.e., burn trauma, oral ricinoleic acid, and acute mesenteric ischemia. In contrast, recent experimental evidence demonstrates that facultative bacteria can translocate across a histologically intact intestinal epithelium, and that the ileal absorptive cell may be at least one portal of entry prior to transport into deeper tissues. It is anticipated that further clarification of the routes and mechanisms involved in bacterial translocation will provide new insights into the treatment and prevention of a significant proportion of the infectious morbidity seen in severely ill, hospitalized patients.