Clinical and animal studies have found that sepsis can lead to a serious imbalance in the gut microecology, a reduction in probiotics, a reduction in short-chain fatty acid, a reduction in bone mass, and an increase in bone destruction, maintaining the stability of microecology can be one of the effective means of bone protection. But at present, the treatment of sepsis with early supplementation of probiotics is still controversial, and dietary fiber intake has significantly changed the composition of the microbiota, it may be a safe and effective method to prevent bone loss in sepsis. Further study on it will provide reliable theoretical basis and intervention target for early, safe and effective prevention of osteoporosis.
In recent years, researchers have found that the incidence of bone loss in ICU patients is significantly higher than that in the control group of the same age, patients with sepsis whose bone balance is disrupted by higher overresorption, bone destruction and release of multiple active cytokines and toxins become the"Invisible killer"of the ICU, however, the pathogenesis of osteoporosis is not clear, and the existing drugs for osteoporosis can not be safely used in critically ill patients. The gastrointestinal tract is the"Initiating organ"and"Central organ" of multiple organ dysfunction and forms a complex and powerful"Gut-bone axis"with bone, which plays a key role in bone metabolism, but the mechanism is unclear. The human gut contains a dense and diverse microbial community, which plays an important role in nutrition, metabolism and immunity, small intestinal microecology can affect bone turnover through a variety of pathways, especially the metabolite short-chain fatty acid FAS (SCFAs) , which can inhibit osteoclast activity by regulating inflammatory cytokines and immune cells, promote the formation of osteoblasts and other aspects to maintain the stability of bone metabolism, and then protect the health of bones, forming a"Gut-microcology-bone"axis. Clinical and animal studies have found that sepsis can lead to a serious imbalance in the gut microecology, a reduction in probiotics, a reduction in short-chain fatty acid, a reduction in bone mass, and an increase in bone destruction, maintaining the stability of microecology can be one of the effective means of bone protection. But at present, the treatment of sepsis with early supplementation of probiotics is still controversial, and dietary fiber intake has significantly changed the composition of the microbiota, it may be a safe and effective method to prevent bone loss in sepsis. Further study on it will provide reliable theoretical basis and intervention target for early, safe and effective prevention of osteoporosis. Therefore, based on the above research background, Investigators intend to evaluate the overall safety and efficacy of dietary fiber-containing enteral nutrition supplementation in patients with sepsis by observing changes in bone metabolism-related indicators, to provide the basis for further basic and mechanism research
Study Type
OBSERVATIONAL
Enrollment
2
Whether to add nutrients containing dietary fiber
Zhujiang hospital
Guangzhou, Guangdong, China
The changes of bone metabolic markers β-CTX
The venous blood was drawn daily before and after the enrollment (the first, third, seventh and fourteenth days) ,and β- CTX for comparison
Time frame: 28 day
The changes of bone metabolic markers PINP
Time frame: 28 day
Changes in intestinal flora
Collect stool before and after the enrollment (the first, third, seventh and fourteenth days) ,observe the changes of intestinal flora in the two groups. Total bacterial DNA were extracted from samples using the QIAamp DNA stool Mini Kit from Qiagen according to the manufacture's protocol.
Time frame: 28 day
Changes in short-chain fatty acid of metabolites
Collect stool before and after the enrollment (the first, third, seventh and fourteenth days) ,observe the changes of metabolite short chain fatty acids in the two groups. Fresh feces were collected and frozen in liquid nitrogen timely.SCFAs was extracted and quantified using a Metrohm ion chromatograph(850 Professional Ic, Metrohm, Herisau, Switzerlan) system
Time frame: 28 day
Abdominal symptoms (abdominal distention)
To evaluate and compare the difference of abdominal symptoms (abdominal distension) between the two groups,It is divided into three levels according to the severity of abdominal distension, it can be divided into light, medium and severe (for example:Mild, soft abdomen, tolerable,Moderate: abdominal bulge, obvious discomfort,Severe: abdominal muscles are obviously tense/intolerable)
Time frame: 28 day
Abdominal symptoms ( diarrhea incidence)
To evaluate and compare the difference of abdominal symptoms (diarrhea incidence ) between the two groups,it can be divided into light, medium and severe (for example:Mild, 3-5 times/day, 250-500ml/day,Moderate:\>5 times/day, 500-1000ml/day,Severity:\>5 times/day,\>1500ml/day)
Time frame: 28 day
The change of systemic inflammatory response index: the value of TNF-α in systemic inflammatory response
The changes of TNF-α were observed and compare before and after treatment, It can be tested in the laboratory of our hospital, the higher the value, the heavier the infection.
Time frame: 28 day
The change of systemic inflammatory response index: the value of IL-6 in systemic inflammatory response
The changes of IL-6 were observed and compare before and after treatment. It can be tested in the laboratory of our hospital, the higher the value, the heavier the infection
Time frame: 28 day
The change of systemic inflammatory response index: the value of Procalcitonin in systemic inflammatory response
The changes of procalcitonin were observed and compare before and after treatment, the higher the value, the heavier the infection
Time frame: 28 day
Length of ICU stay
The total hospitalization time were observed before and after treatment
Time frame: 28 day
Length of Apache II score
The total Apache II score were observed before and after treatment,The higher the score is, the more serious the disease is.
Time frame: 28 day
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