腹泻型肠易激综合征患者肠屏障功能的治疗研究

Treatment of intestinal barrier function in patients with diarrhea predominant irritable bowel syndrome

目的探讨肠屏障功能在腹泻型肠易激综合征(D-IBS)的作用和评价谷氨酰胺联合酪酸梭菌(米雅)的治疗效果。方法选择2016年1月至2017年12月该院消化科D-IBS患者240例(D-IBS组),另选100例健康对照者(健康对照组),检测2组研究对象的血清肠黏膜屏障功能指标,包括血内毒素、D-乳酸、二胺氧化酶活性(DAO)水平,同时检测炎性指标,包括C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)。将240例D-IBS患者随机分为3组,每组80例,分别为谷氨酰胺组(复方谷氨酰胺500mg,口服,每天3次)、酪酸梭菌组(米雅2粒,口服,每天3次),联合治疗组(复方谷氨酰胺500mg,口服,每天3次+米雅2粒,口服,每天3次)。用药1个月后检测D-IBS组患者3个亚组肠黏膜屏障功能指标、炎性指标并记录临床症状(腹痛、腹胀、腹泻次数等)。结果 D-IBS组患者血清内毒素、D-乳酸、DAO水平均明显高于健康对照组(P<0.05)。3个亚组经治疗1个月后内毒素、D-乳酸、DAO水平均明显下降,与治疗前比较差异有统计学意义(P<0.05);组间比较显示联合治疗组优于另外2个组(P<0.05),单一用药的2个组之间比较差异无统计学意义(P>0.05);3个亚组治疗后CRP、IL-6、IL-1β均较治疗前下降,差异有统计学意义(P<0.05);谷氨酰胺组与酪酸梭菌组之间差异有统计学意义(P<0.05);谷氨酰胺组与联合治疗组之间差异无统计学意义(P>0.05)。3个亚组的症状均有明显改善,治疗总有效率分别为联合治疗组95%,谷氨酰胺组86.1%,酪酸梭菌组84.8%,联合治疗组明显高于其他2个组,差异有统计学意义(P<0.05)。相关性分析显示疗效与肠黏膜屏障指标呈正相关关系。3个亚组均无严重的不良反应。结论 D-IBS患者存在肠黏膜屏障功能受损。谷氨酰胺、酪酸梭菌可通过改善黏膜通透性、修复黏膜屏障,有效改善症状,且联合治疗的效果最佳。

Objective To investigate the role of intestinal barrier in irritable bowel syndrome and the effect evaluation of the therapeutic effect of glutamine combined with clostridium butyricum(Mia).Methods A total of 240 patients with D-IBS and 100 healthy controls were detected in serum of intestinal mucosal barrier function index including blood endotoxin,D-lactate and double amine oxidase(DAO)levels.The results were compared and analysised.A total of 240 cases of D-IBS patients were randomly divided into 3 groups,with different treatment,glutamine group,Mia group and combination group.After one month treatment,the plasma levels changes of endotoxin,D-lactate and DAO of the theree groups were detected again and compared.The inflammatory cytokines including C-reactive protain(CRP),interleukin(IL)-6 and IL-1βwere also examed.The clinical symptoms(abdominal pain,abdominal distension,diarrhea times)were recorded and compared.Results The levels of serum endotoxin,D-lactic acid and DAO in patients with D-IBS were significantly higher than those in the control group(P<0.05).After one month treatment,endotoxin,D-lactic acid and DAO were significantly decreased compared with those before treatment in all three groups(P<0.05).The comparison between the two groups showed that the combination group was superior to the other two groups(P<0.05),and there was no significant difference between the two single drug group.After treatment CRP,IL-6,and IL-1βdecreased than before in all groups,the difference was statistically significant.Comparison among groups showed significant difference between the glutamine group and Mia group(P<0.05),and there was no significant difference between the glutamine group and combination group.The total efficiency of treatment was 95.0%in the combination group,glutamine group 86.1%,Mia group 84.8%,so combined group was significantly higher than that of MIA group and glutamine group,the differences were statistically significant(P<0.05).The correlation analysis showed that the curative effect was positively correlated with the index of intestinal mucosal barrier.There was no seirous adverse effect observed in all groups.Conclusion The intestinal mucosal barrier function is impaired in the patients with D-IBS.Combination of glutamine and clostridium butyricum are effective in the recovery of the permability of mucosal ombination,they are effective for diarrhea predominant irritable bowel disease.