2023 年 12 月 21 日
嘉義長庚泌尿科研究團隊於2023年發表LM腎性益生菌臨床研究,左起為泌尿科醫師陳慧雅及教授級主治醫師陳志碩。圖/記者楊艾庭攝

生活中心/嘉義採訪報導

一般人都以為益生菌的功能是用來「健胃整腸」,事實上並不僅如此!由台灣大學動物科學技術學系陳明汝教授帶領團隊開發的LM腎性益生菌作為輔助療法可延緩腎功能惡化,這項研發成果更於2022年榮獲第19屆國家新創獎──學研新創獎的肯定。為了進一步探討LM腎性益生菌在人體的作用機轉,嘉義長庚醫院泌尿科教授陳志碩醫師帶領陳慧雅醫師等人,針對腎臟移植患者進行臨床人體試驗,發現使用LM腎性益生菌三個月的患者肌肝酸(creatinine)的數值有統計學上下降的意義,代表LM可能有保護腎功能的效果。

9成腎移植患者有慢性腎病發展

腎臟是排泄人體毒素的重要器官之一,然而當體內的毒素長期無法排出並積累越多就可造成慢性腎臟病,腎臟必須承受更大的氧化壓力,因而引發腎臟纖維化。陳志碩教授表示,當時發現LM益生菌在動物實驗階段證明了可以透過腸腎軸作用於腎臟降低尿毒素,並且改善了小鼠的腎功能,於是陳志碩醫師決定展開臨床人體試驗,在24名接受腎臟移植的患者,以其中12人定期服用LM益生菌,另12人則為對照組,並比較使用前後3個月的肌酐酸測量值和腎絲球過濾率,同時評估腎臟移植患者必須服用的免疫抑制劑在血中的濃度與感染情形。結果發現,補充LM益生菌的患者,肌肝酸的數值相較於對照組會明顯下降,腎絲球過濾率則會升高,保護腎功能。

為何會以腎臟移植患者為實驗對象?陳志碩教授說明,腎臟移植患者平時必須服用抗排斥的免疫抑制劑藥物,但當劑量太高,就會造成腎毒性使得腎功能下降,也會讓身體免疫力變差,容易受到感染導也致腎功能受損,有研究揭露,腎移植患者中高達9成隨著時間的發展會罹患慢性腎病!倘若降低抗排斥的藥物,則又會造成排斥的反應,新移植的腎臟就比較容易發展成慢性腎臟排斥,同樣必須走上洗腎的路。

LM益生菌就像會吃掉毒素的小精靈

陳志碩醫師以經典遊戲《小精靈》(Pac-Man)比喻,「LM腎性益生菌像是會吃掉體內毒素的小精靈。」並可將體內毒素排洩出去。另外,這個試驗的另一個目標是確認病人的安全性,畢竟益生菌也是一種細菌,仍可能有感染的風險,對於像是腎臟移植後這類免疫力相對低落的患者來說是否安全?陳志碩教授首先針對國內外的研究發現,目前文獻已經有肝臟移植患者接受益生菌輔助治療的研究,結果顯示並沒有增加感染的機率,他以此為基礎在這次試驗用於腎臟移植患者的身上,得到臨床證據證實了安全性,所有病人並沒有因此增加感染的風險。

一起參與這項研究的陳慧雅醫師則表示,很高興能夠參與這項試驗,未來希望讓試驗方法更精細,因為腸道中有多種好菌也有多種壞菌,若以患者單純服用LM益生菌,另一組則服用LM益生菌再加上另一種益生菌,並檢驗排便狀況,盼進一步驗證LM益生菌除了改善腎功能外,對於整腸的效果提出更精確的證據。

台灣堪稱洗腎王國!因此預防慢性腎臟病相當重要,若能延緩腎功能惡化,則能降低醫療成本與提高患者的生活品質。陳志碩教授也呼籲,平時的飲食、生活作息都必須注意,對代糖飲料的攝取更要小心,並且要定期安排健康檢查,若有發現疑慮務必配合醫囑,避免踏上洗腎之路。

本次臨床試驗文獻全文:

A Pilot Study of Nephrogenic Probiotics to Further Improve an Already

Stabilized Graft Function After Kidney Transplantation (https://pubmed.ncbi.nLM.nih.gov/37806868/

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