婴儿肝炎综合征应用微生态调节剂后肠道菌群及胆汁成分的随机双盲对照临床研究

Influence of probiotics on the intestinal flora and bile composition in infantile hepatitis syndrome

目的探讨微生态调节剂乐托儿(冻干灭活的嗜酸乳杆菌)对婴儿肝炎综合征(infantile hepatitis syndrome,IHS)肠道菌群及胆汁成分的影响。方法 2002年3月至2008年5月在华中科技大学同济医学院附属同济医院儿科住院的60例IHS为纳入研究对象,随机分为乐托尔组和对照组,随机方法为随机数字表法。患儿均给予熊去氧胆酸(25mg/次,日3次)及护肝治疗。乐托尔组口服乐托尔散剂(嗜酸乳杆菌散剂)每次1袋,2次/d;15d为1个疗程,连续2个疗程。对照组口服中和冻干培养基。监测两组患儿治疗前后血清和十二指肠引流液(胆汁)中总胆红素(TB)、结合胆红素(DB)、丙氨酸转氨酶(ALT)、γ-谷氨酰转肽酶(γ-GT)、总胆汁酸(TBA)水平及肠道菌群数量。采用SPSS10.0软件进行统计学分析。结果两个疗程结束后,乐托尔组总有效率为92.86%,对照组为74.07%,差异有统计学意义(P<0.05)。乐托尔组患儿血清中TB、DB、ALT、γ-GT、TBA与对照组比较均显著降低,差异有统计学意义(P<0.05)。乐托尔组肝脏明显缩小,差异有统计学意义(P<0.05)。十二指肠引流液中TB、DB、γ-GT、TBA与对照组比较均显著升高,差异有统计学意义(P<0.05)。对照组肠道菌群无明显变化,乐托尔组双歧杆菌、乳酸杆菌、粪肠球菌显著增加,差异有统计学意义(P<0.05)。两组均未见明显药物副反应。结论 IHS存在肠道菌群紊乱,微生态调节剂(冻干灭活的嗜酸乳杆菌)与熊去氧胆酸合用能促进胆汁酸排泄,改善肝功能及肠道菌群,在IHS的治疗中有明确的有效性。

Objective To explore influence of probiotics （lactobacillus acidophilus） on the intestinal flora and bile composition in infantile hepatitis syndrome（IHS）. Methods Researchers randomly assigned 60 IHS children who were the patients in Tongji Hospital from Mar.2002 to May 2008 into treatment group and control group in desired random number table. The treatment group received Lactobacillus LB sachet （two times a day, a packet each time,15 days as a course of treatment）and the control group received freeze dried culture medium,both on the basis of basic therapies such as UDCA（three times a day, 25 mg each time） and liver protection therapy. Total bilirubin（TB）,direct bilirubin（DB）,alanine aminotransferase（ALT）, γ-glutamyltranspeptidase（γ-GT）, totle bile acid（TBA） of serum and intraduodenal drain（bile） were observed before and after the treatment. SPSS 10.0 software was used to analyze the data. Results After two treatment courses, the effective rates were 92.86% in the treatment group and 74.07% in the control group respectively. Significant differences were observed between the two groups（P 〈 0.05）. Compared with the control group,the levels of TB,DB,ALT,γ-GT and TBA in serum of treatment group reduced significantly（P 〈 0.05）,and the liver size reduced obviously（P 〈 0.05）,while the level of TB,DB,γ-GT and TBA in bile of treatment group increased significantly （P 〈 0.05） . There was no obvious side effect in the two groups. Conclusion There is intestinal flora disturbance in infantile hepatitis syndrome. Probiotics （Lactobacillus acidophilus） and UDCA can increase the excretion of bile flow, improve the function of liver, and stabilize the balance of intestinal flora, which has significant curative effect on infantile hepatitis syndrome （IHS）.