有证据表明,外骨骼机器人可以改善脊髓损伤(SCI)患者的肠道功能。然而,潜在的机制仍未阐明。本研究调查了外骨骼辅助步行(EAW)对T2-L1运动完全截瘫患者肠道功能和肠道菌群结构的影响。结果显示,EAW组的五名参与者和常规组的三名参与者报告至少一项肠道管理指数有所改善,包括肠道排空频率的增加,每天在肠道管理上花费的时间更少,和较少的外部援助(手动数字刺激,药物,和灌肠用法)。经过8周的训练,EAW组使用的甘油量显著降低(p<0.05)。EAW组在训练8周后的神经源性肠功能障碍(NBD)评分呈增加趋势,而常规组呈现恶化趋势。接受EAW干预的患者表现出Bacteroidetes和Verrucomicrobia的丰度下降,而Firmicutes,变形杆菌,放线菌被上调。此外,拟杆菌的丰度有所下降,普雷沃氏菌,副杆菌属,Akkermansia,Blautia,Ruminococus2和Megamonas。相比之下,Ruminococus1,RuminococaceaeUCG002,粪杆菌,Dialister,Ralstonia,大肠杆菌志贺氏菌,双歧杆菌在前15个属中表达上调。EAW组的Ralstonia丰度明显高于常规组,8周时,EAW个体的Dialister显着增加。这项研究表明,EAW可以以有限的方式改善SCI患者的肠道功能,并且可能与肠道菌群丰度的变化有关,尤其是有益菌的增加.在未来,我们需要进一步了解EAW培训引起的微生物群的变化以及所有相关的影响机制,尤其是肠道菌群代谢产物。临床试验注册:https://www.chictr.org.cn/.
Evidence has demonstrated that exoskeleton robots can improve intestinal function in patients with spinal cord injury (SCI). However, the underlying mechanisms remain unelucidated. This study investigated the effects of exoskeleton-assisted walking (EAW) on intestinal function and intestinal flora structure in T2-L1 motor complete paraplegia patients. The results showed that five participants in the EAW group and three in the conventional group reported improvements in at least one bowel management index, including an increased frequency of bowel evacuations, less time spent on bowel management per day, and less external assistance (manual digital stimulation, medication, and enema usage). After 8 weeks of training, the amount of glycerol used in the EAW group decreased significantly (p <0.05). The EAW group showed an increasing trend in the neurogenic bowel dysfunction (NBD) score after 8 weeks of training, while the conventional group showed a worsening trend. Patients who received the EAW intervention exhibited a decreased abundance of Bacteroidetes and Verrucomicrobia, while Firmicutes, Proteobacteria, and Actinobacteria were upregulated. In addition, there were decreases in the abundances of Bacteroides, Prevotella, Parabacteroides, Akkermansia, Blautia, Ruminococcus 2, and Megamonas. In contrast, Ruminococcus 1, Ruminococcaceae UCG002, Faecalibacterium, Dialister, Ralstonia, Escherichia-Shigella, and Bifidobacterium showed upregulation among the top 15 genera. The abundance of Ralstonia was significantly higher in the EAW group than in the conventional group, and Dialister increased significantly in EAW individuals at 8 weeks. This study suggests that EAW can improve intestinal function of SCI patients in a limited way, and may be associated with changes in the abundance of intestinal flora, especially an increase in beneficial bacteria. In the future, we need to further understand the changes in microbial groups caused by EAW training and all related impact mechanisms, especially intestinal flora metabolites. Clinical trial registration: https://www.chictr.org.cn/.