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研究生:劉玉來
研究生(外文):Yu-Lai Liu
論文名稱:雙叉乳桿菌、嗜酸乳酸菌與納豆菌對長期照護住民之腸道功能與發炎、血脂質之影響
論文名稱(外文):Combined effect of Lactobacillus Bifidus, Lactobacillus Acidophilus and Bacillus Subtilis Natto among the institute residents on the bowel function, inflammation and serum lipid level
指導教授:楊淑惠楊淑惠引用關係
指導教授(外文):Shwu-Huey Yang, Ph.D.
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:營養學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:111
中文關鍵詞:複合乳酸菌雙叉乳桿菌嗜酸乳酸菌長期照護腸道功能機構住民
外文關鍵詞:Probiotics ProbioticsBacillus nattoLactobacillus acidophilusLactobacillus bifiduslong-term carebowel functi
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益生菌可保護腸道健康,如:防止腹瀉、便秘、糞便酸鹼值與預防疾病如:減少發炎反應與降低膽固醇及提高免疫功能。本研究即探討給予長期照護住民四週每天攝食6公克含雙叉乳桿菌、嗜酸乳酸菌與納豆菌之複合乳酸菌介入後,對腸道功能、急性感染、膽固醇與免疫功能之影響。研究方法採隨機、雙盲、交叉、安慰劑、對照試驗設計。受試者為中部某地區教學醫院護理之家55-94歲住民,共43名,其中男性20名、女性23名參與研究。受試者隨機分成兩組,實驗前經過兩週穩定期後,實驗組每天攝食6公克複合乳酸菌,安慰劑組每天攝食3公克糖飴,經過二週排空期再交換,並持續追蹤2週,實驗期共3個月。研究期間受試者不改變飲食,活動習慣及用藥種類與份量。本研究收集受試者每天活動量、住院天數、住院次數、72小時再住院人數、腸道症狀、使用軟便劑種類,並於第0週、第4週、第10週收集高敏感度C-反應蛋白(high-sensitivity C-reactive protein, hs-CRP)、紅血球沉降速率(erythrocyte sedimentation rate, ESR)、白血球(White blood cell, WBC)與細項(difference count)、膽固醇(Cholesterol,chol )、三酸甘油酯(Triglyceride,TG)、Ig A、糞便酸鹼值(pH)等數據。結果顯示:實驗組於停止攝食複合乳酸菌後,血清三酸甘油酯顯著上升,p值<0.05;單核球(monocyte %)受試後顯著上升,p 值<0.01。而白血球、ESR、Ig A、hs-CRP,實驗組與安慰劑組比較,皆無統計上差異。但若以one-way ANOVA Duncan’s Multiple Range Test 檢測hs- CRP 實驗前後差異,則實驗組攝取複合乳酸菌後,hs- CRP上升,顯現此複合乳酸菌對受試者hs- CRP有上升作用。對腸道功能影響:實驗組在介入第二週時灌腸次數減少,p值<0.02,有顯著差異;排便頻率於介入第二週顯著增加,p值<0.01;排少量糞便者(75公克)之排便次數顯著降低,p值<0.03;顯示此複合乳酸菌對排少量糞便(75公克)與排便頻率,有改善作用。
關鍵詞:複合乳酸菌、雙叉乳桿菌、嗜酸乳酸菌、長期照護、腸道功能、機構住民
Abstract
Lactobacillus is one of the gut microflora in human and it is good for disease prevention and health maintenance by some previous studies. Lactobacillus played a role in the improvement of diarrhea, constipation, stool pH, inflammation process, serum cholesterol level and immune system. The aim of this study is to evaluate the effect of a designed compound of lactobacillus (Lactobacillus bifidus, Lactobacillus acidophilus and Bacillus natto with the total amount of 108 colony forming unit) on bowel function, acute infection, serum lipid level and immunity. This is a randomized, double-blind, placebo-controlled, cross-over design study. There are 43 participants with age of 55-94 years living in the nursing home of a community hospital in Yun-Lin county. They were randomized into two groups, one is the study group with active compound (6g/day) and the other is placebo composed of glucose polymer(3g/day). The initial period is 4wks, followed by another 4wks cross-over period after 2wks washout. We collected the data of daily activity, length of stay, number of hospital admission, hospital re-admission rate within 72 hours, bowel movement, laxative amount and category during the whole study period without changing their diet, activity and usual medication. Besides, we checked the laboratory values of hs-CRP, ESR, WBC and differential count, cholesterol, triglyceride and Ig A at week 1, 4, and 10. The result revealed lower triglyceride level and more monocyte count in study group compared with placebo(p <0.01). There was no significant difference in the lymphocyte count and the level of ESR, Ig A and hs-CRP by Student t-test. In addition, the frequency of enema was decreased at week2, the stool frequency was significant(p <0.01). However, there was no significant difference in the stool amount and color between two groups. In conclusion, this study showed that the compound of lactobacillus can increase immunity, improve bowel function but no change in the markers of acute inflammation.
Keywords: Probiotics, Bacillus natto, Lactobacillus acidophilus, Lactobacillus bifidus, long-term care, bowel function, Institute residen
目錄
中文摘要 II
Abstract IV
致謝 V
目錄 VII
表目錄 IX
圖目錄 X
附件目錄 XI
第一章、前言 1
第二章、文獻回顧 4
第一節、老人長期照護需求增加 4
第二節、機構式老人照顧 4
第三節、老年人消化系統的老化 6
一、口腔 7
二、食道 7
三、胃 7
四、小腸 7
五、大腸 8
六、肝臟 8
七、膽 8
八、胰臟 8
第四節、老年人的感染 8
一、慢性氣管炎 9
二、腸道感染 9
三、泌尿道感染 9
四、免疫力降低 10
五、褥瘡 10
六、營養 10
第五節、人體免疫功能 11
一、白血球(leukocytes) 12
二、免疫系統 13
第六節、身體發炎反應 16
一、高敏感度C-反應蛋白 16
二、紅血球沉降速率 17
第七節、益生菌對人體作用 17
一、益生菌( probiotics )的定義 17
二、益菌生(prebiotics)的定義 18
三、共生菌(synbiotics)的定義 19
四、益生菌在臨床上益處 19
第八節、益生菌的作用機轉 28
一、產生短鏈脂肪酸的作用 28
二、抑制致腸病的作用 28
三、增強人類β防禦素(Human β-defensin, HβD-2)功能 30
四、促進初生的免疫蛋白質 30
五、益生菌減少腹瀉期之理論機轉 30
第九節、益生菌對老年人之作用 32
一、益生菌、益菌生與營養不良 32
二、益生菌、益菌生與便秘 33
三、益生菌與抗生素相關的腹瀉 34
四、益生菌、益菌生與免疫 35
第十節、乳酸菌 36
一、乳酸菌定義 36
二、乳酸菌分類 37
三、雙叉乳桿菌特性 38
四、嗜酸乳酸菌特性 39
五、人類腸道微生物的生態 40
六、腸內菌叢的變動因素 41
第三章、實驗材料與方法 43
第一節、研究架構 43
一、實驗步驟 43
二、採樣流程 44
第二節、實驗對象 45
一、受試者對象 45
二、受試者選擇標準 46
第三節、材料及數量 46
一、實驗材料 46
二、安慰劑-糖飴 47
三、包裝與保存 47
四、食用方法 48
第四節、資料收集項目 48
一、基本資料 48
二、活動量 49
三、住民急性感染狀況 49
四、體位測量資料準則 49
五、血液、生化數據、糞便收集 50
六、住民排便狀況 52
七、飲食紀錄資料收集 53
第五節、統計分析 53
第四章、結果 54
第一節、受試者基本資料 54
第二節、飲食狀況 54
第三節、體位測量 55
第四節、受試者疾病與用藥狀況 56
第五節、複合乳酸菌對血脂肪影響 57
第六節、複合乳酸菌對免疫反應影響 57
第七節、複合乳酸菌對發炎反應影響 58
第八節、複合乳酸菌對住院天數影響 58
第九節、複合乳酸菌對排便功能影響 58
一、排便量(stool amount)改變比較 59
二、排便困難程度 61
三、腹瀉 62
四、排便次數 62
五、受試者對糞便酸鹼值影響 62
第五章、討論 63
第一節、基本資料討論 63
第二節、受試者的飲食狀況 63
第三節、複合乳酸菌對免疫反應 64
第四節、複合乳酸菌對發炎指數作用 66
第五節、複合乳酸菌對血脂肪作用 67
第六節、複合乳酸菌對腸道作用 67
一、對排便的作用 67
二、對糞便顏色的作用 69
三、對腹瀉作用 70
第七節、糞便酸鹼值 71
第六章、結論 72
第七章、參考資料 73


表目錄
表 1、實驗材料-糖飴營養成分 47
表 2、受試者基本資料1 84
表 3、受試者飲食攝取基本資料1 84
表 4、實驗組與安慰劑組體位測量1 85
表 5、實驗組與安慰劑組與基準値之實驗診斷值比較 85
表 6、受試者發炎指數反應 86
表 7、實驗組與安慰劑組腸道功能比較表 87

圖目錄
圖 1、實驗流程 45
圖 2、實驗組與安慰劑組之乳酸菌與安慰劑外觀 88
圖 3、實驗組與對照組之乳酸菌與安慰劑標示 88
圖 4、實驗材料袋外設計餵食者簽名單 89
圖 5、受試者疾病分佈 89
圖 6、受試者發炎狀況比較 90
圖 7、受試者用藥分佈 90
圖 8、實驗前與實驗後因感染住院比較 91


附件目錄

附件 1、臨床試驗許可書 92
附件 2、臨床試驗受試者說明及同意書 93
附件 3、營養臨床試驗個案紀錄 96
附件 4、營養臨床試驗腸道紀錄表 98
附件 5、護理之家飲食紀錄表 99
附件 6、家人或親友帶來額外食物攝取紀錄 99
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