抗生素-培菲康序贯治疗有效缓解腹泻型肠易激综合征病人临床症状

Sequential therapy with antibiotic and probiotic effectively relieve the symptoms of patients with diarrhea-predominant irritable bowel syndrome

观察抗生素和益生菌制剂对腹泻型肠易激综合征(IBS-D)病人的疗效。方法 83例门诊IBS-D病人分为3组:A组(序贯治疗组,36例)先服用左氧氟沙星、匹维溴安和复方谷氨酰胺胶囊(GLU)治疗1周,然后继续服用匹维溴安、培菲康和GLU治疗;B组(培菲康组,26例)口服匹维溴安、培菲康、GLU;C组(普通治疗组,25例)仅口服匹维溴安、GLU,总疗程8周。记录治疗前后消化道症状评分、Bristol评分、大便次数。结果治疗后各组症状总分都下降(P均<0.05),第10周(即停药后2周)和第12周(即停药后4周)时A组和B组仍然保持较低积分,而C组在第12周时总分高于第8周(P=0.032)。3组治疗后腹痛时间、腹痛频率都下降(P均=0.001),其中,A组在第4周时腹痛时间缩短、频率下降更明显(P=0.000),第12周(停药后第4周)依然保持较低积分。治疗后各组大便频率积分均有下降(P<0.01),第8周时,A组和B组的总分低于C组(P<0.05),第12周时,A组积分依然低于C组,而此时B组与C组评分无统计学差异(P=0.822),治疗后A组和B组黏液便比例也有明显下降(P<0.01),而C组变化不明显(P>0.05)。结论左氧氟沙星-培菲康序贯治疗对缓解腹痛症状、减少排便次数、减少黏液便的作用优于培菲康治疗组和普通治疗组,而且这种作用可以延续到停药后的第4周。因此,对缓解IBS-D患者临床症状可能更有优势。

Objective To evaluate the effects of antibiotic-probiotics sequential therapy on patients with diarrhea-predominant irritable bowel syndrome（IBS-D）. MethodsEighty-three patients with definite IBS-D were divided into 3 groups. The patients in group A received Levofloxacin,pinaverium bromide and complex glutamine capsule（GLU） for the first week,and then pinaverium bromide,GLU and Bifid Triple Viable Capsule（BTVC） for remaining 7 weeks.Patients in group B received pinaverium bromide,GLU and BTVC for 8 weeks,while patients in group C only pinaverium bromide and GLU for 8 weeks.The scores of gastrointestinal symptoms,Bristol score,and stool frequency were registered respectively before and after treatment. ResultsAfter 8-week treatment,the symptom scores significantly decreased in patients（P0.05）.At the end of 10th week and 12th week,the scores remained respectively lower in group A and group B,while not in group C（P=0.032）.The duration of abdominal pain was shorter（P=0.001）, and the pain frequency was lower（P=0.001） post-treatment than prior treatment in all three groups,while the pain score remained lower only in group A at the end of the 12th week. After the treatment,the scores of stool frequency（SSF） showed a significant decrease in all three groups（P0.01）.At the end of the 8th week,the SSFs were significantly lower in group A and group B than those in group C（P0.05）,and at the end of the 12th week,SSF remained lower in group A,while not in group A and group C（P=0.822）.Moreover,the proportion of mucous stool post-treatment was lower in group A and group B（P0.01）,but not in group C（P0.05）. ConclusionSequential therapy with levofloxacin and Bifid Triple Viable Capsule effectively relieves abdominal pain,lower the frequency of bowel movement and reduces the mucous in stool in patients with IBS-D,so this may be helpful for the patients with IBS-D.