| Backgrounds and objectivesChronic obstructive pulmonary disease（COPD）is a common clinical disease and refractory disease.In China,the prevalence of COPD is increasing year by year following the increase in smoking,air pollution and population aging,resulting in the current mortality rate of chronic obstructive pulmonary disease in China is significantly higher than the global average.The pathogenesis and pathological evolution of COPD suggest that chronic airway inflammation is the key.The microecological balance of the intestinal flora is an important guarantee factor for maintaining the stability of the body’s environment,and it can participate in the regulation of the release of inflammatory transmitters in the body.Therefore,this article studied the status of intestinal flora in different groups of patients with COPD at stable phase,and analyzed its correlation with inflammation indicators and lung function,and explored the relationship between COPD and intestinal flora,at the same time,we selected probiotics（Bifidobacterium Lactobacillus triple live bacteria tablets）as the intestinal live bacteria preparation for intervention,to explore its therapeutic effect in patients with intestinal flora imbalance in COPD at stable phase,with a view to clinically promptly intervening in patients with intestinal flora imbalance in stable COPD,to provide evidence to improve the prognosis of patients.Methods 1This was a prospective cohort study with 80 patients of COPD at stable phase included as the observation group in order.The 80 patients who met the inclusion criteria at the respiratory and critical care medicine clinic as well as the respiratory and critical care medicine ward of Yixing Hospital Affiliated to Jiangsu University（among them,28 were outpatients and 52 were ward patients）from June 2017 to December 2018 were divided into four groups: A,B,C and D with 20 patients each according to the GOLD2017 comprehensive assessment grouping standard,and at the same time,20 healthy outpatients in the same period were chosen as the control group.In the meantime,we collect basic clinical data of all patients,detect the intestinal flora content of each group of patients,compare and analyze the differences in the status of the intestinal flora of patients among each group,and we detect the content of CRP,IL-8,IL-6,and TNF-α by the ELISA method,detect the content of PCT by the fluorescein-enhanced immunochemiluminescence method,detect the content of endotoxin by the limulus reagent chromogenic matrix azo method,and detect FEV1,FEV1%pred and FEV1/FVC and other pulmonary function indicators in each group of patients,and then we use Pearson correlation to analyze the intestinal flora status with inflammation indicators and lung function at the same time.Methods 2A total of 60 patients in stable COPD group C and D combined with intestinal flora imbalance（among them,there are 32 patients in group C and 28 patients in group D）who met the inclusion criteria from December 2017 to June 2019 at the respiratory and critical care medicine clinic as well as the respiratory and critical care medicine ward of Yixing Hospital Affiliated to Jiangsu University were selected as the research objects.The above 60 patients were divided into two groups,30 patients in each group.The random allocation method was random number table.Patients in the control group received conventional treatment,including long-term home oxygen therapy,inhalation of tiotropium bromide powder inhalation,etc,and those with underlying diseases were treated with symptomatic treatment.In addition to the above treatments,patients in the observation group were additionally given Bifidobacterium Lactobacillus triple viable tablets（Bifidobacterium gold）orally,the usage of Golden Bifidus is 2 g/time,three times/day.After two weeks of treatment,the inflammation level,clinical symptoms,intestinal flora and lung function were compared between the two groups of patients before and after treatment.Results 11.The contents of lactobacillus and bifidobacterium in group C and D were significantly lower than those in group A,B and the control group（P<0.05）,and the contents of Enterococcus faecium and Enterococcus faecalis in group C and D were significantly higher than those in group A,B and the control group（P<0.05）.2.Pearson correlation analysis showed that the contents of lactobacillus and bifidobacterium were significantly negatively correlated with Procalcitonin（PCT）,ndotoxin,IL-8,IL-6 and TNF-α（P<0.05）,and positively correlated with lung function（P<0.05）;and the contents of Enterococcus faecium and Enterococcus faecalis were positively correlated with endotoxin,IL-8,IL-6 and TNF-α（P<0.05）,and negatively correlated with lung function（P<0.05）.Results 21.The total effective rate of the probiotic group（93.33%）was higher than that of the control group（66.67%）（P<0.05）.2.There was no significant difference in the contents of Bifidobacterium（5.48 ± 0.52,5.29 ± 0.44）lg CFU/g,Lactobacillus（5.46 ± 0.49,5.55 ± 0.35）lg CFU/g,Escherichia coli（6.38±0.64,6.23±0.58）lg CFU/g,Enterococcus faecium（9.99±0.59,9.91 ± 0.84）lg CFU/g and Enterococcus faecalis（9.26 ± 0.33,9.14 ± 0.56）lg CFU/g between the probiotic group and the control group before treatment（P>0.05）;After two weeks of treatment,the contents of Bifidobacterium（8.63 ± 0.61,6.99 ± 0.51）lg CFU/g and Lactobacillus（8.49±0.57,7.03±0.28）lg CFU/g of the two groups were higher than those before treatment,and the probiotic group was higher than the control group;the contents of Enterococcus faecium（6.12±0.37,7.81±0.47）lg CFU/g and Enterococcus faecalis（6.27 ± 0.89,7.69 ± 0.43）lg CFU/g were lower than those before treatment,and the probiotic group was lower than the control group（P<0.05）.The content of Escherichia coli（6.49±0.76,6.35±0.75）lg CFU/g was not significantly different from that before treatment（P>0.05）.And there was no significant difference between the probiotic group（6.49±0.76）lg CFU/g and the control group（6.35±0.75）lg CFU/g after two weeks of treatment（P>0.05）.3.There was no statistically significant difference in the serum levels of CRP（2.27 ± 1.42,2.24 ± 1.67）mg/L,PCT（0.014±0.010,0.015±0.010）μ g/L,IL-8（18.66±11.33,18.20±11.45）μg/L,IL-6（16.77±2.06,16.12±2.13）ng/L,endotoxin（0.16±0.02,0.15±0.03）ng/L and TNF-α（28.45±11.45,29.09±10.97）ng/L between the the probiotic group and the control group before treatment（P>0.05）.After two weeks of treatment,the serum levels of PCT（0.008±0.006,0.011±0.009）μg/L,IL-8（10.45 ± 9.45,14.11 ± 9.35）μ g/L,IL-6（9.50 ± 2.16,12.12 ± 2.22）ng/L,endotoxin（0.08±0.03,0.11±0.05）ng/L,TNF-α（15.12±9.38,22.12±9.43）ng/L are lower than those before treatment,and the probiotics group was lower than the control group（P<0.05）.The level of CRP（2.23 ± 1.57,2.37 ± 1.48）mg/L was not significantly different from that before treatment.And there was no significant difference between the probiotic group（2.23±1.57）mg/L and the control group（2.37±1.48）mg/L after two weeks of treatment（P>0.05）.4.There was no statistically significant difference in the lung function indexes of FEV1（0.93±0.21,0.91±0.24）L,FEV1%pred（36.38±6.41,36.12±6.18）% and FEV1/FVC（41.72±6.46,42.41±6.18）% between the probiotic group and the control group before treatment（P>0.05）.After two weeks of treatment,the lung function indexes of FEV1（0.95±0.38、0.90±0.22）L,FEV1% pred（36.29±0.33、36.43±1.01）%,FEV1/FVC（36.29±0.33、42.33±5.35）% were not significantly different from that before treatment.And the lung function indexes of the control group was not significantly different from that of the probiotic group after two weeks of treatment at the same time（P>0.05）.Conclusions1.Patients of C and D group of COPD at stable phase are more likely to have intestinal flora imbalance than group A and B.2.The intestinal flora status is closely related to the inflammatory levels and lung function in patients with COPD at stable phase.3.Probiotics can effectively improve the intestinal flora microecology of patients with stable COPD group C and D combined with intestinal flora imbalance,correct intestinal dysfunction,reduce inflammatory reactions,and improve patient prognosis. |
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