重癥患者的腸道微生態(tài)

1、重癥患者的腸道微生態(tài)Contents1. Phylogenetic profiles of human gut microbiome2. Role of human gut microbiome3. Dietary constituents and diseases influence enterotypes4.Ecological effects of critical illness on the gut microbiome5. Manipulating the microbiome for patients in the ICU1.Phylogenetic profiles of hu

2、man gut microbiome16S rRNA基因測序分析Functional composition differs between enterotyps普氏菌屬（Prevotella）水解酶專門分解植物纖維，可以導(dǎo)致脂肪和蛋白的分解發(fā)酵能力下降；ET B群落結(jié)構(gòu)與富含動物蛋白和飽和脂肪酸飲食相關(guān)，并且具有擬桿菌(Bacteroides)特異的碳水化合物酶Phylogenetic profiles of human gut microbiomeEnterotypes differs significantly among countries人類腸道基因組工程Stability of e

3、nterotypesPhylogenetic profiles of human gut microbiomeThe most densely populated habitat is the gut, with an estimated 0.15 kg of microbial biomass10-fold more cells than its human hostwith Firmicutes, Bacteroidetes, Prevotella as dominant phylaPhylogenetic profiles of human gut microbiome2.Role of

4、 human gut microbiomemetabolism of carbohydrates,amino acid,lipidproduction of vitamins and hormonesprotection against enteric and systemic pathogensimmunomodulatory properties將lean donors腸道微生物移植給存在代謝綜合征的男性患者，觀察6個月后胰島素敏感性變化MetabolismPathogensNature Reviews Immunology ;2013(13):321335Immunomodulatory

5、TH17細(xì)胞：自身免疫類疾病Gut microbiota affects extra-intestinal autoimmune diseasesNature Reviews Immunology ;2013(13):321335T輔助細(xì)胞17（TH17）Nature Reviews Immunology ;2013(13):321335Direct and indirect resistance of the microbiota to enteric pathogensNature Reviews Immunology ;2013(13):321335胰島衍生蛋白3（REGIII）3.Di

6、etary constituents and Diseases influence enterotypsDietary constituents and Diseases influence enterotyps39例患者序貫接受WWB(white wheat flour bread)和BKB (barley kernel based bread)飲食三天4.Potential disruptors of the microbiota in the ICUEcological effects of critical illness on the gut microbiomeEcological

7、 effects of critical illness on the gut microbiome一項前瞻性、觀察性、隊列研究34例重癥患者，15例健康對照組比較糞便中微生物種類的差異檢測糞便中16S rRNA gene前瞻性、觀察性、多中心、隊列研究115例 機械通氣患者美國、加拿大 4個ICU中心收集 入 ICU 48hour，出院時或入ICU 10days 糞便mSphere 2016; 1:e0019916mSphere 2016; 1:e00199165.Manipulating the microbiome for patients in the ICUMicrobiome-ba

8、sed therapies can be categorized into three groups: probioticssynbioticsFMTSDD納入30項隨機對照研究，2972例患者1980-2016Fecal microbial transplantation in critical illnessWith the loss of more than 90% of the commensal organisms that occurs within the first 6 hours of the insult of critical illnessRecent evidence

9、 suggests that the refined formulas used in enteral feeding are absorbed almost in their entirety in the proximal small bowel, creating a relative nutrient deprivation at the site of the greatest microbial burden in the proximal colon一項前瞻性、隨機、對照研究納入 Reccurrent Clostridium difficile 患者分為三組組1：Vancomyc

10、in 500mg po qid, 4 days +bowel lavage + FMT組2：Vancomycin 500mg po qid, 14 days組3：Vancomycin 500mg po qid, 14 days+bowel lavage一項前瞻性、隨機、對照、雙盲、非劣效性研究納入 Reccurrent Clostridium difficile 患者2012年6月-2014年9月 加拿大, 6 所醫(yī)院隨機分為2組：分別接受冰凍(108例)、新鮮（111例）的FMTClinical use of FMT in other critical illnessConclusions and Perspectives1. 人類腸道共生菌主要有三大類：Bacteroides(擬桿菌)，Prevotella(普氏菌)，F(xiàn)irmicutes(厚壁菌)2. 人類腸道共生菌具有相對穩(wěn)定性，各類之