腸道菌群與宿主健康ppt演示課件

1、腸道菌群與宿主健康,Gut microbiota and host health,1,.,腸道微生態(tài)是醫(yī)學(xué)革命的中心和未來(lái),Nature reviews. Microbiology 最新的影響因子為22.490 (2013),2,.,一篇值得關(guān)注的綜述,Nature reviews. Microbiology 最新的影響因子為22.490 (2013),3,.,與腸道菌群紊亂有關(guān)的疾病,4,.,什么是甲烷和氫呼氣試驗(yàn),原理檢查方法檢

2、查項(xiàng)目甲烷的重要意義設(shè)備的技術(shù)原理,5,.,甲烷和氫呼氣檢測(cè)的原理,碳水化合,,細(xì)菌酵解,氣體： 氫、甲烷、二氧化碳、其它,14-21%,腸粘膜,,,血液循環(huán),肺泡呼出,肺泡呼出,人體自身代謝不產(chǎn)生氫分子和甲烷分子,人體的氫分子和甲烷分子全部來(lái)自于消化道細(xì)菌對(duì)碳水化合物的分解。,6,.,甲烷和氫呼氣試驗(yàn)的方法,7,.,正常人呼出氣中氫氣濃度變化,服用小腸可以吸收的糖,服用小腸不可以吸收的糖,8,.,甲烷-氫呼氣原理的核心,與糖代謝

3、有關(guān)的疾病消化酶的原發(fā)性缺乏消化酶的繼發(fā)性缺乏與HCl有關(guān)的疾病酸過(guò)多酸減少,與細(xì)菌有關(guān)的疾病位置和數(shù)量甲烷口盲時(shí)間,9,.,檢查項(xiàng)目,糖不耐受先天缺乏后天缺乏口盲時(shí)間小腸細(xì)菌過(guò)度生長(zhǎng)胃酸分泌量,10,.,果糖不耐受,沒(méi)有果糖不耐受：果糖氫呼氣試驗(yàn)結(jié)果陰性。,果糖不耐受：果糖氫呼氣試驗(yàn)結(jié)果陽(yáng)性。,11,.,口盲時(shí)間：氫呼氣試驗(yàn),傳輸速度快,傳輸速度正常,12,.,氫呼氣檢測(cè)SIBO,乳果糖氫呼氣檢測(cè),葡

4、萄糖氫呼氣檢測(cè),13,.,胃酸分泌測(cè)定,口服金屬鎂后，它在胃內(nèi)可與鹽酸反應(yīng)而產(chǎn)生H2，并經(jīng)胃粘膜彌散入血而隨呼氣排出。呼氣中H2排出量與胃內(nèi)鹽酸量呈正相關(guān)。因此，檢測(cè)呼氣中H2濃度即可反映其胃泌酸功能。,14,.,呼氣氫儀器技術(shù)原理,氣相色譜法:采用氫離子探頭或以氫氣為載體的熱導(dǎo)氣相色譜儀，近年采用以空氣為載體的固相探頭檢測(cè);電化學(xué)檢測(cè)法:采用電化學(xué)法使呼出氣標(biāo)本中H2氧化生成水，以百萬(wàn)分之一濃度10xl0-6/L或ppm表示H2含量

5、。固態(tài)傳感器檢測(cè)法：,15,.,羅馬共識(shí)的結(jié)論,The lack of the data on stability of electrochemical cell suggests the need for periodic evaluation of measurement accuracy by the owner.因?yàn)殡娀瘜W(xué)的穩(wěn)定性缺少數(shù)據(jù)支持，建議用戶定期評(píng)估測(cè)量的準(zhǔn)確性。,16,.,,（英國(guó)產(chǎn)品）在濃度大于100ppm時(shí)就

6、不準(zhǔn)了，不能用于研究，不能檢查甲烷是一個(gè)嚴(yán)重的弱點(diǎn)。因?yàn)橹挥型瑫r(shí)檢測(cè)氫氣和甲烷才能提供可靠的信息。,17,.,甲烷和氫呼氣試驗(yàn)的臨床意義,把復(fù)雜的變簡(jiǎn)單把不能變成能把以前不知道的變成知道開(kāi)辟臨床診治新方法在新的醫(yī)學(xué)革命占據(jù)核心位置,18,.,甲烷和氫呼氣試驗(yàn)的臨床應(yīng)用,消化不良糖不耐受vs酶缺乏vsSIBO腹瀉糖不耐受vs酶缺乏vsSIBO便秘口盲時(shí)間vs甲烷胃酸潰瘍vs萎縮性胃炎口盲傳輸速度,小腸細(xì)菌過(guò)度生長(zhǎng)

7、腸道疾病免疫疾病腸腦軸：腸肝對(duì)話心血管疾病糖尿病、肥胖、代謝性疾病重癥監(jiān)護(hù)其它,19,.,碳水化合物酶缺乏的疾病,糖類不耐受乳糖、乳果糖酶缺乏癥山梨醇吸收不良癥海藻糖酶缺乏癥木糖吸收不良癥果糖吸收不良癥葡萄糖吸收不良癥蔗糖吸收不良癥其它碳水化合物,淀粉酶分泌不足慢性胰腺炎胰腺癌胰腺手術(shù)評(píng)估糖尿病膽囊疾病與胰腺疾病相關(guān)的并發(fā)癥,20,.,胰腺外分泌功能測(cè)定選用支鏈淀粉（米粉）作為底物，如果胰

8、腺分泌的胰淀粉酶不足，則服用的底物不會(huì)在小腸內(nèi)完全分解，進(jìn)入大腸后會(huì)導(dǎo)致氫氣大量產(chǎn)生。,判定標(biāo)準(zhǔn):胰腺外分泌功能輕度低：[H2]數(shù)據(jù)高于本底值10-20ppm，伴相關(guān)臨床癥狀：胰腺外分泌功能中度低下：[H2]數(shù)據(jù)高于本底值20-30ppm，伴相關(guān)臨床癥狀：胰腺外分泌功能重度低下：[H2]數(shù)據(jù)高于本底值30ppm及以上，伴相關(guān)臨床癥狀：,健康對(duì)照,胰腺疾病,21,.,,胰腺炎和胰腺癌病人,正常人,米粉乳果糖,米粉乳果糖,22,.

9、,值得思考的話題,23,.,呼氣氫試驗(yàn)診斷壞死性小腸炎,采用呼氣氫試驗(yàn)作為致死性新生兒壞死性小腸炎的早期診斷。對(duì)監(jiān)護(hù)中的早產(chǎn)兒觀察表明，在腸炎發(fā)作前，呼氣中氫增多。,]. Hamilton LH. Breath tests and gastroenterology-a discussion of breath H2 and breath CH4 testing. Quintron Division, The E.F

10、. Brewer company Menomonee Falls, WI, USA,1992,11-12,26-33,36-39,45-48,68-70.,24,.,氫呼氣做為早期診斷壞死性小腸炎的篩查檢查,Breath H2 excretion is a simple noninvasive test that may be useful in the management of the premature neonate at ri

11、sk for the development of NEC.,25,.,甲烷呼氣的重要性,彌補(bǔ)氫呼氣的缺陷與便秘和結(jié)腸癌關(guān)系密切與肥胖有關(guān)系,26,.,甲烷彌補(bǔ)氫氣的不足,小腸細(xì)菌過(guò)度生長(zhǎng)同時(shí)測(cè)量氫氣和甲烷呼氣試驗(yàn)，氫氣呼氣試驗(yàn)結(jié)果為陰性，甲烷呼氣試驗(yàn)結(jié)果為陽(yáng)性。,同一個(gè)人：小腸細(xì)菌過(guò)度生長(zhǎng),27,.,甲烷和便秘相關(guān),28,.,甲烷vs結(jié)腸癌,29,.,,,30,.,A.Haines, et al., Breath Methane

12、in Patients with Cancer of the Large Bowel. Lancet, 1977:2:481-3.,31,.,甲烷-便秘-結(jié)腸癌,-結(jié)腸癌,甲烷,便秘,32,.,一個(gè)思考,-結(jié)腸癌,甲烷,便秘,50歲以上便秘史家族史,結(jié)腸癌手術(shù)前后,33,.,肥胖與腸道菌群,34,.,,,35,.,產(chǎn)甲烷肥胖的人有較高的身體質(zhì)量指數(shù),58人，BMI顯著較高的甲烷陽(yáng)性者（45.2±2.3公斤/米2）比甲烷陰性

13、（38.5±0.8公斤/米2，P= 0.001）。甲烷陽(yáng)性者也有更大程度的便秘與甲烷陰性者相比（21.3±6.4比9.5±2.4，P?= .043）。多元回歸分析說(shuō)明了BMI甲烷之間有顯著的關(guān)系。結(jié)論：這是人類第一次有研究表明，較高濃度的甲烷檢測(cè)呼氣測(cè)試是預(yù)測(cè)顯著更大的肥胖超重者。,B.Basseri等，肝臟病雜志胃腸病學(xué)雜志，2012年1月8（1）：22-28,,36,.,頭腦風(fēng)暴,40歲以上腹痛、腹

14、脹食欲減退不耐受油膩糖耐量異常,37,.,肝膽胰和SIBO,肝臟、膽道、胰腺、結(jié)腸和小腸這五個(gè)消化器官有著共同的胚胎起源，保持著“天然的”密切關(guān)系，在各種解剖和生物學(xué)功能之間存在很多內(nèi)在的聯(lián)系。腸道和肝臟疾病共患的臨床現(xiàn)象也提示我們某些肝腸疾病之間可能存在著相互關(guān)聯(lián)的發(fā)病機(jī)制。肝與腸之間的相互作用越來(lái)越受到重視，加強(qiáng)肝腸互動(dòng)方面的研究對(duì)探索肝病治療的新途徑具有十分重要的意義。,腸粘膜屏障受損，細(xì)菌進(jìn)入門靜脈，炎性因子改變肝臟結(jié)

15、構(gòu)和功能。,腸肝軸概念胰腺疾病-腸道菌群關(guān)系糖尿病-腸道菌群關(guān)系,38,.,腸-肝軸之間的互動(dòng)腸道菌群失調(diào)，大量G-桿菌繁殖,LPS產(chǎn)生顯著增多腸粘膜屏障功能受損,致病菌和LPS大量移位，經(jīng)門靜脈入肝，損害肝功能。,肝功能異常KCs代謝和清除LPS降低，導(dǎo)致腸道功能異常,,Gakuhei Son, et al., Contribution of Gut Bacteria to Liver Pathobiology. Gastroe

16、 Res and Prac, Vol 2010, Article ID 453563, 13 pages.,39,.,腸道菌群致非酒精性脂肪肝,Valentina Tremaroli & Fredrik Bäckhed, Functional interactions between the gut microbiota and host metabolism. NATURE | VOL 489 | 13 SEPTEM

17、BER 2012,40,.,腸道菌群導(dǎo)致脂肪肝,Carmine Finelli and Giovanni Tarantino, NONALCOHOLIC FATTY LIVER DISEASE, DIET AND GUT MICROBIOTA. EXCLI Journal 2014;13:461-490,41,.,腸-腦軸的概念,Augusto J. Montiel-Castro, et al., The microbiota–gut–

18、rainaxis: neurobehavioral correlates, healthand sociality. Front in Integ Neuro. Oct 2013 | Vol7 | Article 70 | 1-16.,42,.,腦-腸軸/腸-腦軸：迷走神經(jīng),Sue Grenham,et al., Brain–gut–microbe communication in health and disease. Frontie

19、rs in Physio. Gastroint Sci Dec 2011 Vol 2 p 1-15.,43,.,腸腦軸/腦腸軸,Q. AZIZ, et al., Gut microbiota and gastrointestinal health: current concepts and future directions. Neurogastroenterol Motil (2013) 25, 4–15.,44,.,腸-腦軸和自閉

20、癥,,Caroline G.M. de Theije, et al., Pathways underlying the gut-to-brain connection in autism spectrum disorders as future targets for disease management. European Journal of Pharmacology 668 (2011) S70–S80,45,.,自閉癥的神經(jīng)和胃

21、腸免疫互動(dòng),C. G.M. de Theije, et al., Pathways underlying the gut-to-brain connection in autism spectrum disorders as future targets for disease management. Eur. Jl of Pharm 668 (2011) S70–S80,46,.,腸道菌群與代謝性疾病,,47,.,腸道菌群增加能量?jī)?chǔ)存

22、,Nathalie M. Delzenne & Patrice D. Cani, Interaction Between Obesity and the Gut Microbiota: Relevance in Nutrition. Annu. Rev. Nutr. 2011. 31:15–31.,48,.,腸道菌群導(dǎo)致能量聚集,Patrice D Cani and Nathalie M Delzenne, Interplay

23、between obesity and associated metabolic disorders: new insights into the gut microbiota. Current Opinion in Pharmacology 2009, 9:737–743.,49,.,腸道菌群引發(fā)多種代謝疾病,50,.,,,51,.,腸道菌群和肥胖是一個(gè)新的熱門話題,,52,.,腸道菌群致肥胖原因,Valentina Tremarol

24、i & Fredrik Bäckhed, Functional interactions between the gut microbiota and host metabolism. NATURE | VOL 489 | 13 SEPTEMBER 2012,53,.,不同胖瘦人群腸道菌群種類,Fabrice Armougom, et al., Monitoring Bacterial Community of Hum

25、an Gut Microbiota Reveals an Increase in Lactobacillus in Obese Patients and Methanogens in Anorexic Patients. PLoS ONE 4(9): e7125.,54,.,腸道菌群致肥胖原理,Giulio G Muccioli, et al., The endocannabinoid system links gut microbio

26、ta to adipogenesis. Molecular Systems Biology 6: 392; p 1-15.,55,.,腸道菌群致肥胖-糖尿病機(jī)理,Patrice D. Cani,et al., Involvement of gut microbiota in the development of low-grade inflammation and type 2 diabetes associated with obes

27、ity. Gut Microbes 3:4, 279-288.,56,.,腸道菌群致肥胖原理,JOHN K. DIBAISE, et al., Gut Microbiota and Its Possible Relationship With Obesity. Mayo Clin Proc. 2008;83(4):460-469.,57,.,腸道菌群和I型糖尿病,58,.,腸道菌群和I型糖尿病,59,.,菌群紊亂導(dǎo)致炎癥,June L.

28、 Round and Sarkis K. Mazmanian. The gut microbiota shapes intestinal immune responses during health and disease. NATURE REVIEWS | IMMUNOLOGY, VOLUME 9 | MAY 2009 | 313-324.,60,.,腸道菌群紊亂導(dǎo)致過(guò)敏和炎癥,61,.,腸漏導(dǎo)致免疫疾病,62,.,腸道菌群紊亂引發(fā)的

29、免疫疾病,63,.,腸道菌群對(duì)血管疾病的影響,Kristina Harris,et al., Is the GutMicrobiota a New Factor Contributing to Obesity and ItsMetabolic Disorders? Journal of Obesity, Volume 2012, p 1-14.,64,.,,65,.,腸道菌群致動(dòng)脈粥樣硬化,R. Caesar, et al., Effe

30、cts of gut microbiota on obesity and atherosclerosis via modulation of inflammation and lipid metabolism. J Intern Med 2010; 268: 320–328.,66,.,67,.,腸道菌群致癌,INNA SEKIROV, et al., Gut Microbiota in Health and Disease. Phys

31、iol Rev 90: 859–904, 2010;,68,.,腸道菌群和心臟猝死,,69,.,腸道菌群和心血管風(fēng)險(xiǎn),70,.,腸腎軸,71,.,腸道微生態(tài)研究對(duì)健康管理的挑戰(zhàn)和機(jī)遇,72,.,調(diào)節(jié)腸道菌群的方法,73,.,益生素,具有選擇性刺激結(jié)腸中一種或幾種特定細(xì)菌生長(zhǎng)或增強(qiáng)其活性，從而調(diào)節(jié)腸道微生物菌群，對(duì)機(jī)體產(chǎn)生有益作用又不被消化的食物成分。酸化腸道的pH 值，還能夠顯著提高腸道的B /E 值(腸道內(nèi)雙歧桿菌和腸桿菌數(shù)量對(duì)數(shù)值

32、的比值)，增加腸道中有益菌的比例，有益于穩(wěn)定腸道的微生態(tài)平衡。,非淀粉多糖膳食纖維菊粉低聚果糖果寡糖甘露寡糖異麥芽乳寡糖木寡糖水蘇糖低聚木糖低聚異麥芽糖,74,.,益生菌調(diào)節(jié)腸道免疫,75,.,改善腸粘膜的物質(zhì),氨基酸谷氨酰胺(Gln)谷氨酸(Glu)天冬氨酸(Asp)尿素酪蛋白酶解物長(zhǎng)鏈脂肪酸短鏈脂肪酸,為腸黏膜的生長(zhǎng)、發(fā)育和新陳代謝提供能量降低高分解代謝、促進(jìn)蛋白質(zhì)合成、提高機(jī)體免疫功能、保護(hù)腸

33、黏膜屏障、加快創(chuàng)面愈合胃腸道激素的釋放，刺激腸道蠕動(dòng)，促進(jìn)腸黏膜上皮胞的增殖及腸內(nèi)泌細(xì)胞分泌SIgA 等免疫球蛋白，從而改善腸通透性,76,.,膳食纖維的作用,77,.,糖尿病治療的新機(jī)遇,,78,.,糖尿病治療新機(jī)遇,Re´my Burcelin, Gut microbiota and diabetes: from pathogenesis to therapeutic perspective. Acta Diabetol

34、 (2011) 48:257–273.,79,.,益生菌對(duì)體重和糖尿病控制的影響,Rodrigo Bibiloni, et al., 腸道菌群、肥胖和糖尿病. 雀巢年刊 2009;67:35-43.,80,.,常用益生菌,Lactobacillus speciesL acidophilusL bulgaricusL casei (rhamnosus)L johnsonnL lactisL plantarumL reuter

35、i,Bifidobacterium speciesB adolescentisB bifidumB breveB infantisB lactisB longum,Other speciesBacillus cereusEnterococcus faecalisE coli Nissle 1917S boulardiiS cerevisiaeS thermophilus,81,.,益生素的作用原理,Patrice

36、 D. Cani,et al., Involvement of gut microbiota in the development of low-grade inflammation and type 2 diabetes associated with obesity. Gut Microbes 3:4, 279-288.,82,.,益生素的作用原理,Henrike M. Hamer, et al., Functional analy

37、sis of colonic bacterial metabolism: relevant to health? Am J Physiol Gastrointest Liver Physiol 302:G1-G9, 2012.,83,.,益生素作用原理,Nathalie M. Delzenne & Patrice D. Cani, Interaction Between Obesity and the Gut Microbiot

38、a: Relevance in Nutrition. Annu. Rev. Nutr. 2011. 31:15–31.,84,.,益生素作用原理,85,.,飲食的作用,Kendle M Maslowski & Charles R Mackay， Diet, gut microbiota and immune responses， nature immu vol 12 ：1 jan 2011， p 5-9.,86,.,食物酵解和功