2026 年第 5 期 第 21 卷

添加双歧杆菌的早期肠内营养对老年慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者肠道菌群和辅助性T 细胞17/调节性T细胞细胞因子的影响

Intestinal flora and T helper 17/regulatory T cell cytokines in elderly patients with acute exacerbation of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure

作者：章文豪李静刘颖

英文作者：Zhang Wenhao Li Jing Liu Ying

单位：南京医科大学附属南京医院（南京市第一医院）重症医学科，南京210006

英文单位：Department of Critical Care Medicine Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital) Nanjing 210006 China

关键词：慢性阻塞性肺疾病急性加重期；Ⅱ型呼吸衰竭；肠内营养；双歧杆菌三联活菌胶囊；肠道菌群；辅助性T细胞17/调节性T细胞

英文关键词：Acuteexacerbationofchronicobstructivepulmonarydisease;TypeⅡrespiratoryfailure;Enteralnutrition;Bifidobacteriumtripleviablecapsules;Intestinalflora;HelperTcell17/regulatoryTcell

• 摘要：

• 目的 探讨肠内营养混悬液联合双歧杆菌三联活菌胶囊对老年慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者肠道菌群和辅助性T细胞17/调节性T细胞（Th17/Treg）细胞因子的影响。方法 选取2023年8月至2025年3月南京医科大学附属南京医院收治的205例老年AECOPD合并Ⅱ型呼吸衰竭患者。采用随机信封法分为对照组（102例）和治疗组（103例），对照组接受早期肠内营养,治疗组在早期肠内营养的同时加用双歧杆菌三联活菌胶囊，2组患者连续治疗10 d。观察2组临床疗效，比较治疗前后的营养指标、肠道菌群、血清Th17/Treg 细胞因子和不良反应发生情况。结果 治疗组临床总有效率明显高于对照组［95.1%（98/103）比85.3%（87/102）］（P＜0.05）。在营养指标方面，2组患者治疗后的白蛋白、总蛋白和血红蛋白水平相较于治疗前均获显著提升，治疗组上述指标水平均显著高于对照组（均P＜0.05）。肠道菌群分析显示，相较于治疗前，2组患者有益菌（双歧杆菌、嗜酸乳杆菌）的丰度治疗后均显著提升，而有害菌（大肠杆菌、肠球菌）丰度则呈逆向变化；组间比较进一步证实，治疗组在优化菌群结构方面显著优于对照组（均P＜0.05）。与治疗前相比，2组患者治疗后血清白细胞介素17（IL-17）和肿瘤坏死因子α（TNF-α）水平明显下降，而IL-10和IL-35水平显著升高，同时治疗组患者血清IL-17和TNF-α水平明显低于对照组，而IL-10和IL-35水平显著高于对照组（均P＜0.05）。2组患者治疗期间不良反应发生率差异无统计学意义（P＞0.05）。结论 早期肠内营养联合双歧杆菌三联活菌胶囊能够有效提升老年AECOPD合并Ⅱ型呼吸衰竭患者的临床疗效，同时改善营养指标和肠道菌群，调节Th17/Treg 细胞因子，且安全性较好。

• Objective To investigate the effects of enteral nutrition suspension combined with bifidobacterium triple viable capsules on intestinal flora and T helper cell 17/regulatory T cell (Th17/Treg) cytokines in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type Ⅱ respiratory failure. Methods A total of 205 elderly patients with AECOPD complicated with type Ⅱ respiratory failure admitted to Nanjing Hospital Affiliated to Nanjing Medical University from August 2023 to March 2025 were enrolled. They were divided into control group (102 cases) and treatment group (103 cases) by random envelope method. The control group received early enteral nutrition, while the treatment group was additionally given bifidobacterium triple viable capsules on the basis of early enteral nutrition. Both groups were treated continuously for 10 d. The clinical efficacy of the two groups was observed, and the nutritional indicators, intestinal flora, serum Th17/Treg cytokines and adverse reactions before and after treatment were compared. Results The total clinical effective rate of the treatment group was significantly higher than that of the control group ［95.1%（98/103） vs 85.3%（87/102）］(P＜0.05). In terms of nutritional indicators, the levels of albumin, total protein and hemoglobin in both groups were significantly increased after treatment compared with those before treatment, and the levels in the treatment group were significantly higher than those in the control group (all P＜0.05). Intestinal flora analysis showed that compared with before treatment, the abundance of beneficial bacteria (Bifidobacterium, Lactobacillus acidophilus) in both groups was significantly increased after treatment, while the abundance of harmful bacteria (Escherichia coli, Enterococcus) showed an opposite change; comparison between groups further confirmed that the treatment group was significantly better than the control group in optimizing flora structure (all P＜0.05). Compared with before treatment, the serum levels of interleukin-17 (IL-17) and tumor necrosis factor-α (TNF-α) in both groups were significantly decreased after treatment, while the levels of IL-10 and IL-35 were significantly increased. Meanwhile, the serum levels of IL-17 and TNF-α in the treatment group were significantly lower than those in the control group, and the levels of IL-10 and IL-35 were significantly higher than those in the control group (all P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment (P>0.05). Conclusion Early enteral nutrition combined with bifidobacterium triple viable capsules can effectively improve the clinical efficacy of elderly patients with AECOPD complicated with type Ⅱ respiratory failure, improve nutritional indicators and intestinal flora, regulate Th17/Treg cytokines, with good safety.