潰瘍性疾患、慢性胃炎、食道炎の患者さんの食道、胃、腸内細菌叢の状態と役割

[The state and role of esophagus, stomach, intestinal microbiota in patients with ulcer disease, chronic gastritis, esophagitis.]

• V M Chervinets
• A Y Mironov
• Y V Chervinets
• S N Bazlov

抄録

健康なボランティアの食道、胃、十二指腸の粘膜のfibrogastroduodenoscopy時に採取した64検体と、食道炎、慢性胃炎、消化性潰瘍疾患患者の消化管の同じ部位から採取した1120検体の微生物叢を調べた。患者の年齢は18歳から62歳までであった。微生物の分離と同定には伝統的な細菌学的手法を用いた。健常者の生検からStaphylococcus属、Streptococcus属、Lactobacillus属、Bacteroides属、Stomatococcus属、Enterobacteriaceae、Corynebacterium属、Micrococcus属、Neisseria属、Veilonella属が平均3.2～4.68 lg CFU/gで分離された。H.pyloriは食道で60％（5.66 lg CFU/g）、胃底部からは33.3％（5.12 lg CFU/g）、胃肛門部からは44.4％（5.25 lg CFU/g）、十二指腸粘膜からは5.5％（4.2 lg CFU/g）で検出された。食道、胃、十二指腸の炎症・浸食した粘膜からは、クレブシエラ属、エンテロバクター属、プロテウス属、シュードモナス属、ペプトコッカス属、アクチノミセス属、カンジダ属などの日和見菌が4 lg CFU/gを超える量で検出された。H. pyloriは6.3～16.7％（4.25～4.6 lg CFU/g）の患者で分離され、他の微生物との関連で支配的ではなく、ほとんどの症例で発生頻度が低かった。消化性潰瘍疾患の再発、慢性胃炎および食道炎の増悪を伴う患者では、日和見性微生物叢の種数および量的組成の増加、その酵素活性および細胞毒性活性の増加を特徴とするジスビオシスが発現し、炎症性および壊死性プロセスの維持に寄与し、病理学的プロセスの排除を阻害する可能性があった。

The microflora of 64 biopsies taken during fibrogastroduodenoscopy of the mucous membrane of the esophagus, stomach and duodenum in healthy volunteers and 1120 samples obtained from the same parts of the digestive tract in patients with esophagitis, chronic gastritis and peptic ulcer disease were studied. The patients ranged in age from 18 to 62 years. Traditional bacteriological method was used to isolate and identify microorganisms. Staphylococcus spp., Streptococcus spp., Lactobacillus spp., Bacteroides spp., Stomatococcus spp., Enterobacteriaceae, Corynebacterium spp., Micrococcus spp., Neisseria spp., Veilonella spp. were isolated from biopsies of healthy respondents in an average amount from 3.2 to 4.68 lg CFU/g. H.pylori was found in 60% (5.66 lg CFU/g) in the esophagus, in 33.3% of cases (5.12 lg CFU/g) from the fundal part of the stomach, in 44.4% (5.25 lg CFU/g) from the antral part of the stomach, in 5.5% (4.2 lg CFU/g) in the duodenal mucosa. In samples obtained from the inflamed and eroded mucous membrane of the esophagus, stomach and duodenum, opportunistic bacteria of the genera Klebsiella, Enterobacter, Proteus, Pseudomonas, Peptococcus, Actinomyces, yeast fungi of the genus Candida etc. were detected in an amount exceeding 4 lg CFU/g. H. pylori isolated in 6.3-16.7% of patients (4.25-4.6 lg CFU/g) and did not dominate in relation to other microorganisms, and in most cases had a low frequency of its occurrence. In patients with the recurrence of peptic ulcer disease, exacerbation of chronic gastritis and esophagitis, dysbiosis was developed, characterized by an increase in the species and quantitative composition of opportunistic microflora, an increase in its enzymatic and cytotoxic activity, which can contribute to the maintenance of inflammatory and necrotic processes and inhibit the elimination of the pathological process.