标题：双歧杆菌三联活菌胶囊辅助治疗2型糖尿病对患者肠道菌群及血糖的影响

      作者：陈诚，雷涛，沙雯君，徐碧林，陈琳，朱近悦，申甜    上海中医药大学附属普陀医院内分泌科，上海 200062

      卷次： 2020年31卷18期

      【摘要】 目的 探讨双歧杆菌三联活菌胶囊辅助治疗对2型糖尿病(T2DM)患者的肠道菌群、血糖、胰岛素、胰岛素抵抗及胰高血糖素的影响。方法 选取2017年1月至2019年10月期间上海中医药大学附属普陀医院内分泌科收治的100例T2DM患者作为研究对象，采用随机数表法将患者分为对照组和观察组，每组50例。对照组患者给予控制血糖、调节血脂以及改善糖尿病并发症等常规治疗，观察组患者在对照组常规治疗的基础上加用双歧杆菌三联活菌胶囊辅助治疗，8周为一个疗程。比较两组患者治疗前及治疗8周后的血糖指标、胰岛素、胰岛素抵抗指数、胰高血糖素和各类肠道菌群数量。结果 治疗前，观察组患者的粪便样本中各肠道菌群数量与对照组比较差异均无统计学意义(P>0.05)；治疗 8周后，观察组和对照组患者的双歧杆菌[(9.82±0.56) Log10 CFU/g vs (8.67±0.71) Log10 CFU/g]、乳酸杆菌[(8.96±0.62) Log10 CFU/g vs (8.24±0.68) Log10 CFU/g]数量比较，观察组明显多于对照组，而拟杆菌[(8.17±0.42) Log10 CFU/g vs (8.63±0.62) Log10 CFU/g]、肠杆菌[(7.26±0.39) Log10 CFU/g vs (7.74±0.59) Log10 CFU/g]、肠球菌[(6.68±0.52) Log10 CFU/g vs (7.05±0.56) Log10 CFU/g]数量比较，观察组明显少于对照组，差异均有统计学意义(P<0.05)；治疗前，两组患者的空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、空腹胰高血糖素(FGC)比较差异均无统计学意义(P>0.05)；治疗8周后，观察组和对照组患者的FBG [(6.67±0.93) mmol/L vs (7.25±1.16) mmol/L]、HbA1c [(7.24±0.52)% vs (7.71±0.65)%]、FINS [(5.58±2.40) mU/L vs(5.36±3.39) mU/L]、HOMA-IR [(0.22±0.06) vs (0.36±0.12)]、FGC [(87.21±14.05) pg/mL vs (98.72±10.28) pg/mL]比较，观察组明显低于对照组，差异均具有统计学意义(P<0.05)。结论 双歧杆菌三联活菌胶囊应用于2型糖尿病患者的辅助治疗中，可有效调节肠道菌群，增加肠道有益菌的数量，抑制肠道有害菌生长，促进菌群平衡，同时可有效改善胰岛素抵抗，减少胰高血糖素分泌，起到维持血糖水平稳定的作用。
      【关键词】 2型糖尿病；双歧杆菌三联活菌胶囊；肠道菌群；血糖；胰岛素抵抗；疗效
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2020）18—2330—04

Effect of bifidobacterium triple viable capsules as adjuvant therapy on intestinal flora and blood glucose inpatients with type 2 diabetes mellitus.
CHEN Cheng, LEI Tao, SHA Wen-jun, XU Bi-lin, CHEN Lin, ZHU Jin-yue,SHEN Tian. Department of Endocrinology and Metabolism, Putuo Hospital Affiliated to Shanghai University of TraditionalChinese Medicine, Shanghai 200062, CHINA
【Abstract】 Objective To explore the effect of bifidobacterium triple viable capsules as adjuvant therapy on in-testinal flora, blood glucose level, insulin level, insulin resistance, and glucagon in patients with type 2 diabetes (T2DM).Methods From January 2017 to October 2019, 100 T2DM patients from Department of Endocrinology and Metabolism,Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were enrolled into the study. Accordingto the random number table, the 100 patients were divided into an observation group and a control group, with 50 patientsin each group. The patients in the control group were given routine treatment such as controlling blood sugar, regulatinglipids and improving diabetic complications, while the patients in the observation group were additionally given bifidobac-terium triple viable capsules, with 8 weeks as a course of treatment. The changes of blood glucose, insulin level, insulin re-sistance index, glucagon level, and number of gut microbiota in the control group and observation group are compared be-fore and after 8 weeks of treatment. Results Before treatment, the number of intestinal flora in the stool samples ofT2DM patients in the observation group was not significantly different as compared with that in the control group (P>0.05). After 8 weeks of treatment, the observation group was significantly more than the control group in the number ofBifidobacterium and Lactobacillus (P<0.05): Bifidobacterium, (9.82±0.56) Log10 CFU/g vs (8.67±0.71) Log10 CFU/g;Lactobacillus, (8.96±0.62) Log10 CFU/g vs (8.24±0.68) Log10 CFU/g, while the observation group was significantlyless than the control group in the number of Bacteroides, Enterobacteriaceae, Enterococcus (P<0.05): Bacteroides,(8.17±0.42) Log10 CFU/g vs (8.63±0.62) Log10 CFU/g; Enterobacteriaceae, (7.26±0.39) Log10 CFU/g vs (7.74±0.59) Log10 CFU/g; Enterococcus, (6.68±0.52) Log10 CFU/g vs (7.05±0.56) Log10 CFU/g. There were no significantdifferences in fasting blood glucose (FBG), glycated hemoglobin (HbA1c), fasting insulin level (FINS), insulin resis-tance index (HOMA-IR), and fasting glucagon (FGC) in the two groups of T2DM patients before treatment (P>0.05);