黄芪建中汤肠内灌注对抗生素相关性腹泻患者肠道菌群、粘膜功能及炎性因子表达的影响

Effect of intestinal perfusion of Huangqi Jianzhong decoction on intestinal flora, mucosal function, and expression of inflammatory factors in patients with antibioticassociated diarrhea

背景临床对抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)尚无特效疗法,一般采用支持治疗与重建正常菌群-微生物制剂,但疗效不理想.黄芪建中汤源自张仲景《金匮要略》,为温阳健脾代表方,具有和胃止痛、温中健脾等功效.目的分析黄芪建中汤肠内灌注对抗生素相关性腹泻患者肠道菌群结构、肠粘膜功能损伤及炎性因子表达的影响.方法选取2016-12/2018-12于本院接受治疗的脾胃虚寒型AAD患者148例,随机数字表法将患者分成2组,分别为对照组(74例)口服双歧杆菌四联活菌片,观察组(74例)在对照组基础上采用黄芪建中汤肠内灌注.观察患者临床疗效、血清炎性因子含量、T淋巴细胞亚群、肠道菌群结构及肠粘膜屏障功能改善情况.结果观察组患者总有效率为94.59%,高于对照组79.73%,差异有统计学意义(P<0.05);治疗后2组患者血清白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、降钙素原(procalcitonin,PCT)及C反应蛋白(C-reactive protein,CRP)含量较治疗前降低,且观察组血清IL-6、TNF-α、PCT及CRP含量低于对照组,差异有统计学意义(P<0.05);治疗后2组患者粪便内双歧杆菌、肠杆菌及乳杆菌较治疗前升高,观察组粪便内双歧杆菌、肠杆菌及乳杆菌高于对照组,差异有统计学意义(P<0.05);治疗后2组患者血清细菌内毒素(endotoxin,BT)、D-乳酸(D-lactic acid,D-LC)及二胺氧化酶(diamine oxidase,DAO)含量较治疗前降低,观察组患者血清BT、D-LC及DAO含量低于对照组,差异有统计学意义(P<0.05).结论黄芪建中汤肠内灌注治疗AAD有效率高于双歧杆菌四联活菌片,能够可降低AAD患者血清炎性因子水平,加强机体免疫力,改善患者肠粘膜屏障功能与肠道菌群结构.

BACKGROUND Clinically,there is no specific treatment for antibioticassociated diarrhea(AAD).Generally,supportive treatment and reconstruction of normal microbial flora with microbial preparations are used,but the curative effect is not satisfactory.Huangqi Jianzhong decoction,derived from Zhong-Jing Zhang’s“Golden Chamber”,is a typical recipe of warming Yang and strengthening spleen,which has the effects of regulating stomach to relieve pain and warming middle energizer to strengthen spleen.AIM To analyze the effect of Huangqi Jianzhong decoction on intestinal flora structure,intestinal mucosal function damage,and expression of inflammatory factors in patients with AAD.METHODS One hundred and forty-eight patients with AAD of spleen and stomach deficiency type who were treated at our hospital from December 2016 to December 2018 were enrolled.The patients were randomly divided into either a control group or an observation group(n=74 each).Both groups were given oral bifidobacteria,and the observation group was additionally given Huangqi Jianzhong decoction by intestinal perfusion.The clinical efficacy,serum inflammatory factor contents,T lymphocyte subsets,intestinal flora structure,and intestinal mucosal barrier function improvement were observed and compared between the two groups.RESULTS The total effective rate of the observation group was 94.59%,which was higher than that of the control group(79.73%;P<0.05).After treatment,serum levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),procalcitonin(PCT),and C-reactive protein(CRP)were significantly lower than those before treatment in both groups,and the decrease of these indicators was more significant in the observation group than in the control group(P<0.05).After treatment,the bifidobacteria,Enterobacter,and Lactobacillus in the feces of the two groups were higher than those before treatment,and the increase in the observation group was more significant than that in the control group(P<0.05).After treatment,serum endotoxin(BT),D-lactic acid(D-LC),and diamine oxidase(DAO)were significantly lower than those before treatment in both groups,and the decrease in the observation group was significantly lower than that in the control group(P<0.05).CONCLUSION The effective rate of Huangqi Jianzhong decoction combined with bifidobacteria in the treatment of AAD is higher than that of bifidobacteria alone.The combination therapy can reduce the levels of serum inflammatory factors in AAD patients,strengthen their body immunity,and improve the intestinal mucosal barrier function and intestinal flora structure.