长期使用质子泵抑制剂对反流性食管炎小肠细菌过度生长的影响及双歧杆菌的纠正作用

Effects of long-term use of proton pump inhibitors on bacterial overgrowth in small intestine of patients with reflux esophagitis and the correction of bifidobacteria

目的探讨长期使用质子泵抑制剂(PPIs)对反流性食管炎(RE)小肠细菌过度生长(SIBO)的影响,以及双歧杆菌的纠正作用。方法选取2017年1月至2018年12月在德阳市人民医院诊治的RE患者100例(RE组),并选取同期健康志愿者60例作为对照组,采用乳果糖氢呼气试验(LHBT)诊断SIBO。按照治疗方法将RE组分为A组(口服PPIs+双歧杆菌)和B组(口服PPIs)各50例,治疗时间为1个月,比较两组治疗前及治疗后1个月(治疗后)大便目标菌群。结果治疗前RE组的SIBO阳性率为12.0%(12/100),与对照组的10.0%(6/60)比较,差异无统计学意义(P>0.05);治疗后RE组的SIBO阳性率为53.0%(53/100),明显高于治疗前,差异有统计学意义(P<0.05)。RE组大便菌群中双歧杆菌、乳酸杆菌数量与对照组比较明显较低,差异有统计学意义(P<0.01);RE组大便菌群中葡萄球菌数量与对照组比较明显较高,差异有统计学意义(P<0.01)。A组大便菌群中双歧杆菌、乳酸杆菌数量与B组比较明显较高,差异有统计学意义(P<0.05);A组大便菌群中大肠埃希菌、葡萄球菌数量与B组比较明显较低,差异有统计学意义(P<0.05)。结论长期使用PPIs后RE患者的SIBO阳性率明显增高,并可降低双歧杆菌和乳酸杆菌,同时联合双歧杆菌可纠正PPIs导致的肠道菌群失调。

Objective To investigate the effect of proton pump inhibitors(PPIs)on intestinal bacterial overgrowth(SIBO)in patients with reflux esophagitis(RE)and the corrective effect of bifidobacteria.Methods A total of 100 RE patients who received treatment at Deyang people's Hospital from January 2017 to December 2018 were selected as RE group,and 60 healthy volunteers in the same period were selected as the control group.SIBO was diagnosed by lactulose hydrogen breath test(LHBT).According to the treatment,RE group was divided into group A(oral PPIs+bifidobacterium)and group B(oral PPIs only)with 50 cases each.The treatment time was one month.The fecal flora before treatment and one month after treatment were compared between the two groups.Results There was no significant difference in the positive rate of SIBO between RE group and control group before treatment[12.0%(12/100)vs 10.0%(6/60),P>0.05].The positive rate of SIBO in RE group was higher after the treatment[53.0%(53/100)vs 12.0%(12/100),P<0.05].The number of bifidobacteriacteria and lactobacilli in feces of RE group was significantly lower than that of control group(P<0.01).The number of Staphylococcus in fecal flora of Re Group was significantly higher than that of control group(P<0.01).The number of bifidobacteria and lactobacilli in group A was significantly higher than that in group B(P<0.05).The number of Escherichia coli and Staphylococcus in group A was significantly lower than that in group B(P<0.05).Conclusion After long-term use of PPIs,the positive rate of Sibo in RE patients was significantly increased,and bifidobacteria and lactobacilli were reduced.The combination of bifidobacterium can correct the imbalance of intestinal flora caused by PPIs.