补充益生菌对妊娠期糖尿病血糖控制和血脂分布的影响

Karamali et al. Diabetes & Metabolism (2016)

DOI 10.1016/j.diabet.2016.04.009

补充益生菌对妊娠期糖尿病血糖控制和血脂分布的影响

Effects of probiotic supplementation onglycaemic control and lipid profiles in gestational diabetes: A randomized,double-blind, placebo-controlled trial

Abstract

Background: To our knowledge, data on the effects of probiotic supplementationon glycaemic control and lipid concentrations in patients with gestationaldiabetes mellitus (GDM) are scarce.

Aim: The aim of the present study was to determine the effects ofprobiotic supplementation on glycaemic control and lipid profiles in GDMpatients.

Methods. Sixty pregnant women with GDM, primigravida and aged 18–40 years,were divided into two groups to receive either probiotic capsules (n = 30) or amatching placebo (n = 30) in this randomized double-blind, placebo-controlledtrial. The patients in the probiotic group took a daily capsule that containedthree viable freeze-dried strains: Lactobacillusacidophilus (2 × 109 CFU/g), L.casei (2 × 109 CFU/g) andBifidobacterium bifidum (2 × 109 CFU/g) for 6 weeks. The placebogroup took capsules filled with cellulose for the same time period. Fastingblood samples were taken at the beginning and end of the study to quantify therelevant markers.

Results: After 6 weeks of intervention, probiotic supplementation vs aplacebo resulted in significant decreases in fasting plasma glucose (−9.2± 9.2 mg/dL vs +1.1 ± 12.2mg/dL, P < 0.001), serum insulinlevels (−0.8 ± 3.1 􏰧IU/mL vs +4.5 ±10.6 􏰧IU/mL, P = 0.01),homoeostasis model assessment (HOMA) for insulin resistance (−0.4± 0.9 vs +1.1 ± 2.5, P = 0.003) and HOMA for beta-cellfunction (+1.1 ± 9.8 vs +18.0 ± 42.5, P=0.03), and a significant increase inthe quantitative insulin sensitivity check index (+0.007±0.01 vs −0.01±0.02, P=0.007). Inaddition, significant decreases in serum triglycerides (−1.6±59.4mg/dL vs +27.1±37.9mg/dL, P=0.03)and VLDL cholesterol concentrations (−0.3 ± 11.9 mg/dL vs +5.4 ± 7.6 mg/dL, P = 0.03) were seen followingsupplementation with the probiotics compared with the placebo. However, nosignificant changes in other lipid profiles were seen with the intervention.

Conclusion: Overall, the results of our study have demonstrated that takingprobiotic supplements for 6 weeks in patients with GDM had beneficial effectson glycaemic control, triglycerides and VLDL cholesterol concentrations,although there was no effect on other lipid profiles.

肠道微生物群可以帮助降低胰岛素抵抗和血脂。已有研究显示孕期使用益生菌可以控制血糖，降低血脂水平，帮助预防妊娠期糖尿病（GDM）。本研究通过前瞻性随机双盲、安慰剂对照临床试验，检测血糖和胰岛素水平等，评估益生菌补充剂对GDM孕妇血糖和血脂状况的影响。

研究对象：伊朗某诊所就医的60名GDM孕妇，并将其随机分为益生菌干预组和安慰剂对照组。

入组条件：年龄在18岁至40岁之间；首次怀孕；孕期无糖尿病；妊娠24-28周经“一步”2-h 75-g口服糖耐量试验诊断为GDM。

检测方法：在第0周和第6周，使用酶检测试剂盒测定空腹血糖（FPG），血清甘油三酯，极低密度脂蛋白（VLDL）、总低密度脂蛋白（LDL）和高密度脂蛋白（HDL）的胆固醇浓度，使用酶联免疫吸附试验（ELISA）试剂盒进行测定胰岛素水平。

干预方法：实验组的病人每天服用益生菌胶囊，包含3种菌株：嗜酸乳杆菌（2×10 9CFU / g），干酪乳杆菌（2×10 9CFU / g）和双歧杆菌（2×10 9CFU/ g），服用6周。安慰剂组在同一时间内服用纤维素胶囊。研究开始和结束时采集空腹血样，以量化相关标志物。所有入组者在整个研究中，保持其原来的日常身体活动或平时膳食摄入量，不能补充除研究需要外的其他任何补充剂，不能服用任何可能会影响研究结果的药物。

研究结果:

1.经过6周的干预，相比于对照组，补充益生菌后GDM孕妇的低空腹血糖、血清胰岛素水平、胰岛素抵抗的稳态模型评估和beta细胞的稳态模型评估显著降低，定量胰岛素敏感度检查指数显著增加。

2.与安慰剂相比，GDM孕妇补充益生菌后血清甘油三酯和VLDL胆固醇浓度显著降低，而其他血脂分析没有明显的变化。

3.益生菌可能通过抑制beta细胞活性通路中的核转录因子(NF)和kapa轻链激活剂达到降低甘油三酯和VLDL胆固醇的目的，肠道菌群-短链脂肪酸-荷尔蒙通路也可能是其中一个作用机制。

4.另一种作用机制可能是，益生菌提高长链脂肪酸在肝脏和肌肉组织的beta氧化，从而改变脂肪酸氧化的能量通道，降低甘油三酯的合成，达到最终降低血清甘油三酯和VLDL胆固醇的目的。

5.由于选用的益生菌菌株、剂量、纯度、生物活性及使用时间的不同，不同研究中益生菌对GDM的预防或干预疗效存在有差异。

Fig. 1. The study patients’ flow chart.

图1. 试验流程图。

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