第四章 结论与展望。
4.1 结论。
本研究从问卷调查、短链脂肪酸测定和 16S 高通量测序角度出发，通过其方法流程对 20 名实验对象未服用益生菌片剂基线 V0 期、服用益生菌片剂 V2 期和V6 期三个时期排便情况、粪便类型、短链脂肪酸和肠道内肠道微生物菌落的变进行了系统的分析，其结果表明：
（1）20 名实验对象在服用菌片 60 天后，排便调查中的排便费力、排便不尽感和便秘都有显着减少，对于排便问题还是有所缓解的，而且排便频次相比较于基线 V0 期显着增加，大部分患者能达到每天排便一次，排便类型趋向于像蛇或香肠，软且滑的理想的便型。到 180 天时，相较于基线 V0 期排便调查中的排便费力、排便不尽感和便秘依然显着减少，而排便频次有所增加但不显着，排便类型趋向于基线 V0 期的排便类型，说明益生菌对于排便状况起到了调节作用，但对于粪便pH 和粪便水分含量均无变化。在干预结束时对实验对象进行终止期回访时，有实验对象反应心情比服用益生菌片剂之前改变了，变得不暴躁，愿意社交和与他人沟通。
（2）对粪便中的短链脂肪酸测定发现，服用益生菌后，20 名实验对象在进行益生菌干预 60 天时肠道内乙酸和丙酸代谢水平显着增高，丁酸变化不显着。而干预 180 天后，乙酸含量增加，丁酸、丙酸含量减少，但都不显着。异丁酸和异戊酸持续减少，但变化不大。
（3）实验对象在服用益生菌期间，口服益生菌片剂六个月对肠道菌群改善来看，肠道内的有益菌增多但有害菌或肠道其他环境并无较大改变。实验对象在服用菌片 60 天后，乳杆菌属下降，双歧菌属、肠球菌。巨单胞菌属和罗斯氏菌属人体肠道内有益菌的数量增加；到 180 天时，肠道内自身的有益菌数量虽有回降，但都高于服用有益菌之前的水平。对于其它肠道优势菌在服用益生菌期间，普氏菌属的数量增加。差异菌集中在变形菌门和厚壁菌门中。口服益生菌对血液透析病人肠道菌群有所调节但不显着，对其便秘症状会有改善的可能。肠道菌群的改变于不同透析时间、肾病类型、粪便水分含量、粪便 pH、短链脂肪酸中的乙酸、丙酸、丁酸含量还有血液指标中的尿酸和尿素这些因素存在显着相关性。
4.2 展望。
近年来，人们逐步意识到了肠道菌群与人体之间存在着某种重要的联系，意识到肠道菌群对于人体健康有极大的影响力。益生菌的概念融入到人们的生活当中，未来的功能性微生态制剂也将作为药物治疗相关疾病。随着生命科学和医学新技术的发展，人们对肠道微生物的研究将更加的深入，使得人们更深刻了解肠道微生物与健康的关系。总之，肠道菌群影响着宿主的营养、能量代谢和免疫。
肠道菌群失调参与了肥胖、２型糖尿病和尿毒症等代谢疾病的发病，但关于其具体机制以及其与临床指标之间的直接关系，尚需进一步研究。与之前的研究目前仍然存在着很多不一致的地方，相关机制仍有待更深入研究。益生菌对疾病的研究领域正在快速发展，肠道菌群作为一种新的治疗靶点和研究方向，为治疗和预防代谢疾病提供一个崭新的探索路径。益生菌作用机理研究仍是核心。微生物学的发展使得在微分子水平上研究益生菌对肾脏疾病及并发症和肠道菌群的作用机理成为可能，将这方面的研究向前推进。研究微生物菌群对宿主各器官的影响以及菌群之间的相互作用机制，为了真正弄清楚益生菌对于临床疾病肠道菌群的影响所起到的作用。
对于肠道微生态的研究，传统的方法是通过直接形态学观察来获得部分信息、通过微生物的选择性培养，再进行鉴定和分类来。传统培养方法的局限性大，不仅在培养过程费时费力，更易受操作方法的影响，敏感度低，大多数微生物很难或不能用现有的技术分离培养；培养技术只能定性检测可培养的细菌，对肠道微生物群体的数量和多样性不能正确的反映，难以全面了解肠道微生物之间和与宿主的相互关系，阻碍了人类对肠道微生物的认识，所以发展新技术来更加精准的认识菌群来解决临床疾病问题，探索人类发展会成为未来的发展方向。
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