益生菌联合标准治疗方案根除儿童幽门螺旋杆菌的疗效分析

Efficacy analysis of probiotics combined with standard therapy for eradication of Helicobacter pylori in children

目的评价复方嗜酸乳杆菌片或布拉酵母菌散联合标准方案根除儿童幽门螺旋杆菌(Hp)的有效性和安全性。方法选取2017年3月至2018年3月就诊于湖北省妇幼保健院儿童消化内科120例Hp感染患儿。其中男67例,女53例;年龄3~10岁。按随机数字表法分为3组(对照组、复方嗜酸乳杆菌组及布拉酵母菌组)。对照组予克拉霉素+阿莫西林+奥美拉唑,口服14 d;复方嗜酸乳杆菌组和布拉酵母菌组分别在对照组基础上,于服药第1天开始加用复方嗜酸乳杆菌500 mg,2次/d,或布拉酵母菌散250 mg,2次/d,口服14 d。治疗期间观察患儿不良反应,治疗结束停药至少4周后行尿素13C呼气试验或大便Hp抗原检测,结果阴性者判定为Hp根除成功。观察并比较3组患儿溃疡愈合情况、Hp根除率及不良反应发生率(恶心、呕吐、食欲下降、便秘、腹泻)。结果对照组、复方嗜酸乳杆菌组、布拉酵母菌组根除率分别为80.0%(32/40例)、85.0%(34/40例)、87.5%(35/40例),差异无统计学意义(P>0.05);3组共101例Hp根除者溃疡愈合率达100.0%,19例Hp未根除者溃疡愈合率为48.15%,二者比较差异有统计学意义(χ2=51.30,P<0.01)。但总有效率组间差异无统计学意义(P>0.05),复方嗜酸乳杆菌组,布拉酵母菌组不良反应的总体发生率(P=0.021)及腹泻(P=0.002)、食欲下降(P=0.021)的发生率均低于对照组,差异均有统计学意义,而2个益生菌组之间不良反应发生率比较差异无统计学意义(P>0.05)。结论复方嗜酸乳杆菌片和布拉酵母菌散在不影响Hp根除率的情况下均可降低儿童标准Hp根除方案中不良反应的总体发生率及腹泻、食欲下降的发生率。

Objective To evaluate the efficacy and safety of compound Lactobacillus acidophilus tablets or Saccharomyces boulardii Sachets combined with standard protocols for eradication of Helicobacter pylori(Hp)in children.Methods From March 2017 to March 2018,120 children aged 3-10 years with Hp infection were admitted into the Department of Gastroenterology,Maternal and Child Health Hospital of Hubei Province,including 67 male and 53 female childen.They were divided into 3 groups(control group,compound Lactobacillus acidophilus group,Saccharomyces boulardii Sachets group)by the method of random number table.Control group was given Clarithromycin+Amoxicillin+Omeprazole,for 14 days orally;compound Lactobacillus acidophilus group and Saccharomyces boulardii Sachets group were given drugs respectively on the first day,500 mg of compound Lactobacillus acidophilus was added,twice a day or 250 mg of Saccharomyces boulardii Sachets group,twice a day orally,for 14 days,respectively.The adverse reactions in children were observed during the treatment,andurea 13C breath test or the stool Hp antigen test was performed at least 4 weeks by the end of the treatment,and the children with negative results were judged to be eradicated successfully.The ulcer healing,Hp eradication rate and incidence of adverse reactions(nausesa,vomiting,loss of appetite,constipation,diarrhea)among the 3 groups were observed and the Hp eradication rate and the incidence of adverse reactions(nausea,vomiting,loss of appetite,constipation,diarrhea)were compared.Results The eradication rates in the control group,the compound Lactobacillus group,and Saccharomyces boulardii Sachets group were 80.0%(32/40 cases),85.0%(34/40 cases),and 87.5%(35/40 cases),respectively,and the difference was not statistically significant(P=0.646);the ulcer healing rate was 100.0%of 101 Hp eradicators in 3 groups,and the ulcer healing rate of 19 cases without Hp eradicated was 48.15%,and there was a significant difference between them(χ2=51.30,P<0.01).However,there was no significant difference in the total effective rate among 3 groups(P>0.05).The overall incidence of adverse reactions in Saccharomyces boulardii Sachets group(P=0.021)and the incidence of diarrhea(P=0.002)and loss of appetite(P=0.021)was lower than that in the control group,and the differences were statistically significant.There was no significant difference in the incidence of adverse reactions between the two probiotic groups(P>0.05).Conclusions Both compound Lactobacillus acidophilus tablets and Saccharomyces boulardii Sachets group can reduce the overall incidence of adverse reactions and the incidence of diarrhea and appetite declines in children′s standard Hp eradication regimen without affecting Hp eradication rate.