蒙脱石散、双歧三联活菌散、丙种球蛋白三联治疗小儿迁延性慢性腹泻

The Dioctahedral Smectite Powder,Dichotomous Triple Viable Powder and Gamma Globulin Combination Therapy in Children with Persistent and Chronic Diarrhea

目的:观察蒙脱石散(思密达)、双歧三联活菌散(培菲康)、丙种球蛋白三联治疗小儿迁延性慢性腹泻的疗效及对免疫功能、炎症因子的影响。方法:将136例迁延性慢性腹泻患儿随机分为观察组和对照组各68例。对照组给予蒙脱石散联合双歧三联活菌散治疗:双歧三联活菌散1粒/次,每天3次,以温开水冲服;蒙脱石散<1岁每次1/3包,1～2岁每次2/3包,2岁以上每次1包,每天3次。观察组在对照组治疗基础上静脉滴注丙种球蛋白400 mg/kg,每天1次,连用4 d为1疗程。观察两组患儿治疗前后血清免疫球蛋白、TNF-α、IL-6、内毒素的变化,比较两组患儿症状恢复正常时间与住院时间。结果:(1)观察组总有效率(89.71%)高于对照组(77.94%),两组比较差异有统计学意义(P<0.05);(2)观察组症状恢复正常时间、平均住院时间较对照组均缩短(P<0.01);(3)两组患儿治疗后内毒素、TNF-α、IL-6均较治疗前降低,IgA、IgG较治疗前升高,但观察组较对照组改善更明显(P<0.05)。结论:蒙脱石散、双歧三联活菌散、丙种球蛋白三联治疗小儿迁延性慢性腹泻疗效确切,能有效提高患儿免疫功能,调节内毒素和炎症因子水平,保护、修复受损粘膜,双向调节肠道菌群失调,多途径达到治愈目的。

Objective： To observe the effect and the impact of triple therapy containing gamma globulin,dioctahedral smectite powder（Smecta） and dichotomous triple viable powder（Bifico） immune parameters and inflammatory factors in the treatment of infants and young children with persistent and chronic diarrhea.Methods： One hundred and thirty six chronic diarrhea children which met the inclusion criteria were randomly divided into an observation group and a control group equally.The control group was given Smecta and Bifico.The administrations of dichotomous triple viable powder,1 grain once,3 times/day,with cold boiled water.Dioctahedral smectite powder,1 year of age,1/3 package once,3 times/day,1 to 2 years,2/3 package once,3 times/day,2 years old or more,one packet once,3 times/day.On the basis of therapy for the control group,the observation group was given intravenous infusion of gamma globulin 400 mg/kg,1 time/day,4 days for a course.The serum immunoglobulin,TNF-α,IL-6 and plasma endotoxin before and after treatment were detected.The time to normalization of the symptoms and the length of hospitalization were observed.Results：（1） The effective rate of the observation group and the control group was 89.71%and 77.94%,respectively,the difference was statistically significant（χ2=6.508,P〈0.05）.（2） The time to normalization of fever,stool frequency,stool consistency,and the length of hospitalization were shorter than those of the control group,the differences were statistically significant（P〈0.01）.（3） The endotoxin,TNF-α,and IL-6 of both groups after treatment were significantly lower than those before treatment.IgA and IgG were significantly higher than those before treatment.But after treatment the endotoxin,TNF-α,and IL-6 of the observation group were significantly lower than those of the control group.IgA and IgG of the observation group were higher than those of the control group,the difference was statistically significant（P〈0.05）.Conclusions： The triple therapy containing gamma globulin,dioctahedral smectite powder and dichotomous triple viable powder have exact effect on the treatment of infants and young children with persistent and chronic diarrhea.