专题｜补充「双歧杆菌」益生菌，可缓解司美格鲁肽等GLP-1引起的不良反应

Core Viewpoint - GLP-1 receptor agonists, such as semaglutide, have shown significant efficacy in treating type 2 diabetes and obesity, but they are often associated with gastrointestinal side effects that can affect patient adherence to treatment. Supplementing with probiotics, particularly bifidobacteria, may help alleviate these side effects and improve patient experience [2][3][14]. Group 1: Semaglutide's Effects and Side Effects - Semaglutide is a GLP-1 receptor agonist that mimics the action of glucagon-like peptide-1, promoting insulin secretion, inhibiting gastric emptying, and reducing appetite, leading to blood sugar reduction and weight loss [3]. - Approximately 40% to 70% of patients experience gastrointestinal discomfort, such as nausea, vomiting, diarrhea, and constipation, during treatment, which may be linked to the drug's mechanisms of delaying gastric emptying and affecting intestinal motility [3]. Group 2: Probiotic Benefits - Bifidobacteria are common probiotics found in the human gut, especially dominant in infancy, and they help maintain gut health by regulating gut microbiota, inhibiting harmful bacteria growth, enhancing gut barrier function, modulating immune responses, and promoting nutrient absorption [5][6][7][8]. Group 3: Mechanisms of Probiotics in Alleviating GLP-1 Drug Side Effects - Supplementing with bifidobacteria may alleviate gastrointestinal side effects caused by GLP-1 drugs by restoring gut microbiota balance disrupted by these medications, thereby reducing gastrointestinal symptoms [9]. - Probiotics enhance gut barrier function, promoting mucosal repair and reducing intestinal permeability, which prevents inflammatory factors from entering the bloodstream [10]. - They can also regulate gastrointestinal motility by influencing the enteric nervous system, alleviating symptoms like constipation or diarrhea [11]. - Probiotics produce beneficial metabolites, such as short-chain fatty acids, which help regulate gut pH and inhibit harmful bacteria growth, improving gut environment [12]. Group 4: Clinical Research and Application Prospects - Multiple studies indicate that supplementing with bifidobacteria can help alleviate gastrointestinal side effects from GLP-1 drugs, thereby improving patient adherence to treatment. For instance, Lactobacillus bifidum MN-Gup has shown positive effects in treating type 2 diabetes by improving gut microbiota, enhancing gut barrier function, and modulating immune responses [14]. - Probiotics may also lower inflammation by modulating the TLR4/MyD88/NF-κB signaling pathway, which could benefit patients with gastrointestinal disorders like irritable bowel syndrome [15]. - For patients experiencing gastrointestinal discomfort while using semaglutide or other GLP-1 drugs, considering the addition of bifidobacteria probiotics under medical guidance may help alleviate adverse reactions and enhance treatment experience. Overall, the supplementation of bifidobacteria presents a promising method for mitigating gastrointestinal side effects from GLP-1 drugs, warranting further clinical application [15].