双歧杆菌四联活菌片辅助治疗酒精性肝病的疗效及肠道菌群的变化

Effects of adjuvant treatment with tetralogy of viable bifidobacterium tablets for alcoholic liver disease and its effects on intestinal flora changes

目的探求酒精性肝病采用双歧杆菌四联活菌片辅助治疗对其疗效及肠道菌群变化的影响。方法研究对象为石家庄市第五医院2016年10月至2018年10月收治的酒精性肝病病人98例,按随机数字表法将其分为试验组(49例)和对照组(49例)。对照组在常规治疗的基础上加用蒙脱石散治疗,3克/次,3次/天。在此基础上,试验组加用双歧杆菌四联活菌片治疗,3片/次,3次/天。两组治疗期间均予以保肝治疗,连续治疗2周后,比较两组临床疗效、肝功能、血清炎性因子、肠道菌群、不良反应。结果试验组总有效率93.88%高于对照组79.59%,差异有统计学意义(χ^2=4.346,P=0.037);治疗后,两组天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、谷氨酰转肽酶(GGT)水平均较治疗前低,且试验组较对照组低,差异有统计学意义(t=11.624,4.688,3.750,P=0.000,0.000,0.000);治疗后,两组肿瘤坏死因子⁃α(TNF⁃α)、白细胞介素⁃6(IL⁃6)、超敏C⁃反应蛋白(hs⁃CRP)水平均较治疗前低,且试验组较对照组低,差异有统计学意义(t=9.684,4.601,4.780,P=0.000,0.000,0.000);治疗后,试验组肠球菌(4.26±0.96)LogCFU/g、大肠杆菌(6.26±0.84)LogCFU/g水平低于对照组肠球菌(6.98±1.04)LogCFU/g、大肠杆菌(7.18±1.06)LogCFU/g;乳酸菌(7.16±0.93)LogCFU/g、双歧杆菌(7.87±1.21)LogCFU/g水平高于照组乳酸菌(5.37±0.82)LogCFU/g、大肠杆菌(6.39±1.05)LogCFU/g,差异有统计学意义(t=13.453,10.106,6.467,4.762,P=0.000,0.000,0.000,0.000);两组不良反应发生率相比,差异无统计学意义(χ^2=0.178,P=0.399)。结论酒精性肝病采用双歧杆菌四联活菌片辅助治疗可提高临床疗效,改善肝功能,调节肠道菌群,降低炎性因子水平,且不良反应少,安全性较高。

Objective To explore the effects of tetralogy of viable bifidobacterium tablets on the efficacy and intestinal flora changes in patients with alcoholic liver disease.Methods The study subjects were 98 patients with alcoholic liver disease who had received treatment in Shijiazhuang Fifth Hospital between October 2016 and October 2018.They were divided into the experimental group(49 cases)and the control group(49 cases)according to the random number table.The control group was given Montmorillonite Powder plus conventional treatment,3 g per time,3 times/d.The experimental group was treated with Bifidobacterium Quadruple Live Tablets plus the treatment given to the control group,with 3 tablets/times,3 times/d.Both groups were treated with liver protection.After two weeks of continuous treatment,the clinical efficacy,liver function,serum inflammatory factors,intestinal flora,and adverse reactions were compared between the two groups.Results The total response rate of treatment in the experimental group was 93.88%,higher than that in the control group,which was 79.59%,and the difference was statistically significant(χ2=4.346,P=0.037).After treatment,the levels of aspartate aminotransferase(AST)and alanine amino transferase(ALT)and glutamyl transpeptidase(GGT)were reduced in both groups after treatment,and the levels in the experimental group were shown to be lower than those in the control group,where the difference was statistically significant(t=11.624,4.688,3.750,P=0.000,0.000,0.000).After treatment,the levels of tumor necrosis factor⁃α(TNF⁃α),interleukin⁃6(IL⁃6),and high⁃sensitivity C⁃reactive protein(hs⁃CRP)were reduced in both groups after treatment,with the levels in the experimental group lower than the control group,and the differences were statistically significant(t=9.684,4.601,4.780,P=0.000,0.000,0.000).After the treatment,the levels of Enterococcus and Escherichia coli in the experimental group were(4.26±0.96)LogCFU/g,(6.26±0.84)LogCFU/g,which were lower than that in the control group,where the Enterococcus was(6.98±1.04)LogCFU/g and Escherichia coli was(7.18±1.06)LogCFU/g.The levels of Lactobacillus and Bifidobacterium in the experimental group were(7.16±0.93)LogCFU/g and(7.87±1.21)LogCFU/g,both shown to be higher than the control group,where the Lactobacillus was(5.37±0.82)LogCFU/g and Bifidobacterium was(6.39±1.05)LogCFU/g,and the difference was statistically significant(t=13.453,10.106,6.467,4.762,P=0.000,0.000,0.000,0.000);there was no significant difference in the incidence of adverse reactions between the two groups(χ2=0.178,P=0.399).Conclusion For patients with alcoholic liver disease,adjuvant treatment with tetralogy of viable bifidobacterium tablets is with great safety,which can help improve the clinical efficacy and their liver function,regulate the levels of intestinal flora,reduce the level of inflammatory factors,with fewer adverse reactions and higher security.