Zhongguo quanke yixue (Jul 2022)
Effect of Probiotic Intervention on Class Ⅳ andⅤLupus Nephritis
Abstract
Background As an adjuvant therapy, probiotics can significantly improve the therapeutic effect in lupus nephritis. But there is a lack of comparative studies of efficacies of drug treatments and effects of probiotics on gut flora. Objective To observe the therapeutic efficacy, and gut flora changes induced by probiotics as an adjuvant therapy for lupus nephritis. Methods Ninety-eight patients with class Ⅳ andⅤlupus nephritis were selected from Department of Nephrology, Affiliated Hospital of Xiangnan University from 2019 to 2020, and randomized into a routine group (routine treatment) and an intervention group (routine treatment plus probiotics) under allocation concealment. Intergroup comparison of clinical efficacies was conducted after 24-week treatment in terms of levels of 24-hour urine protein, blood urea nitrogen, serum creatinine, serum IgE, IgG, and serum inflammatory markers, as well as fecal flora changes and fecal short-chain fatty acid concentrations. Results A total of 93 cases (46 in routine group, and 47 in intervention group) who completed the therapeutic follow-up were included for final analysis. Both groups had no statistically significant differences in sex ratio, mean age, BMI, baseline levels of systolic blood pressure, diastolic blood pressure, hemoglobin, serum albumin, serum creatinine, complement C3 and complement C4 (P>0.05) . At the end of treatment, the intervention group demonstrated lower mean Systemic Lupus Erythematosus Disease Activity Indexof Renal (P<0.05) . The 24-hour urinary protein, blood urea nitrogen and serum creatinine decreased notably in both groups at the end of 4, 12 and 24 weeks of treatment (P<0.05) , and the 24-hour urinary protein and blood urea nitrogen in intervention group at the end of 24-week treatment were even more lower (P<0.05) . When the 24-week treatment ended, serum IgE and IgG levels decreased notably in both groups (P<0.05) , and they deceased even more significantly in intervention group (P<0.05) . Moreover, serum C-reactive protein, IL-6 and TNF-α decreased significantly in both groups (P<0.05) , and they deceased even more significantly in the intervention group (P<0.05) . Linear discriminant analysis effect size analysis indicated that at baseline, harmful gut flora such as Helicobacter pylori, Clostridium, and Enterococcus, significantly increased while Verrucomicrobia and other beneficial gut flora significantly decreased in all participants. After the 24-week treatment, the above-mentioned harmful gut flora decreased and beneficial gut flora increased in all participants, and such changes were more significant in the intervention group. Fecal acetic acid, propionic acid, and butyric acid increased significantly in all participants compared to the baseline levels, and they increased even more significantly in the intervention group (P<0.05) . Conclusion Adjuvant treatment of lupus nephritis with probiotics could promote the recovery of renal function, by elevating the abundance of Akkermansiaceae, contents of fecal acetic acid, propionic acid, and butyric acid, and lowering serum immunoglobulin.
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