微生态制剂联合马来酸曲美布汀治疗腹泻型肠易激综合征患者的临床疗效及对血清炎症细胞因子、肠黏膜屏障功能的影响

Clinical Efficacy of Microecological Agents Combined with Trimebutine Maleate in the Treatment of Diarrhea-predominant Irritable Bowel Syndrome and Its Effects on Serum Inflammatory Cytokines and Intestinal Mucosal Barrier Function

目的:探讨微生态制剂联合马来酸曲美布汀治疗腹泻型肠易激综合征(IBS-D)患者的临床疗效及对血清炎症细胞因子、肠黏膜屏障功能的影响。方法:选取2017年12月-2018年4月九江学院附属医院消化内科收治的IBS-D患者84例,随机分为病例组和对照组,各42例。对照组给予马来酸曲美布汀治疗,病例组在对照组基础上给予双歧杆菌四联活菌治疗。两组患者均连续治疗4周,观察两组患者的临床疗效、血清炎症细胞因子、肠黏膜屏障功能水平及不良反应发生情况。结果:对照组总有效率为83.33%,低于病例组总有效率97.62%,差异有统计学意义(P<0.05)。两组患者治疗后炎症细胞因子均优于治疗前,治疗后病例组IL-6、IL-8、IFN-γ均低于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后血清胃肠激素水平均优于治疗前,治疗后病例组VIP、MTL均低于对照组,SP高于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后肠黏膜屏障相关因子水平均优于较治疗前,治疗后病例组D-LA、TNF-α均低于对照组,MGF-E8高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生情况比较,差异无统计学意义(P>0.05)。结论:微生态制剂联合马来酸曲美布汀治疗IBS-D具有良好的临床疗效,可以明显改善患者症状,降低炎性因子水平和减轻应激反应,调节血清胃肠激素水平,安全性好,具有协同作用,具有一定的临床推广应用价值。

Objective: To explore the clinical effect of microecological agents combined with Trimebutine Maleate in the treatment of diarrhea type irritable bowel syndrome(IBS-D) and its effect on serum inflammatory cytokines and intestinal mucosal barrier function. Method: A total of 84 IBS-D patients admitted to the Department of Gastroenterology, Affiliated Hospital of Jiujiang University from December 2017 to April 2018 were randomly divided into case group and control group, 42 cases in each group. The control group was treated with Trimebutine Maleate, and the case group was treated with Bifidobacterium tetrad on the basis of the control group. Patients in both groups were treated continuously for 4 weeks, the clinical efficacy, serum inflammatory cytokines, serum gastrointestinal hormones, intestinal mucosal barrier function levels and adverse reactions in the two groups were observed. Result: The total effective rate of the control group was 83.33%, lower than that of the case group 97.62%, the difference was statistically significant(P<0.05). Inflammatory cytokines in both groups were better than those before treatment, IL-6, IL-8 and IFN-γ in the case group were lower than those in the control group after treatment, with statistically significant differences(P<0.05). After treatment, the serum gastrointestinal hormone levels of the patients in the two groups were better than that before treatment;after treatment, VIP and MTL in the case group were lower than those in the control group, SP was higher than that in the control group, with statistically significant differences(P<0.05). After treatment, the level of intestinal mucosal barrier related factors in both groups were better than those before treatment, D-LA and TNF-α in the case group were lower than those in the control group, and MGF-E8 was higher than that in the control group, with statistically significant differences(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Microecological agents combined with Trimebutine Maleate have good clinical efficacy in the treatment of diarrhea-predominant irritable bowel syndrome. It can significantly improve the symptoms of patients, reduce the level of inflammatory factors and stress response, and regulate the level of serum gastrointestinal hormones. It is safe and has a synergistic effect. It has certain clinical application value.