络酸梭菌二联活菌对肺炎合并抗生素相关性腹泻患儿肠道菌群及炎症、免疫指标的影响

Effect of Clostridium perfringens combined with live bacteria therapy on intestinal flora,inflammation and immune indicators in children with pneumonia and antibiotic associated diarrhea

目的探讨益生菌对肺炎合并抗生素相关性腹泻新生儿肠道菌群、炎性因子及免疫功能的影响。方法选取2016年12月至2019年10月大同市第六人民医院诊治的肺炎合并抗生素相关性腹泻新生儿44例为研究对象,根据随机数字表法分为对照组和观察组各22例。在常规对症治疗基础上,对照组采用布拉酵母菌口服治疗,观察组采用络酸梭菌二联活菌散剂治疗,疗程均为2周。比较两组肠道菌群、炎性因子及免疫功能改变情况。结果治疗前两组白细胞介素2(IL-2)、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平差异均无统计学意义(均P>0.05);治疗后两组IL-2、IL-6和TNF-α水平均明显改善(均P<0.05),且观察组IL-2[(34.20±8.55)ng/L比(40.13±10.32)ng/L]、IL-6[(21.02±5.66)ng/L比(31.25±7.82)ng/L]和TNF-α[(30.10±6.20)ng/L比(43.55±9.52)ng/L]均低于对照组(t=7.501、6.885、8.264,均P<0.05)。治疗前两组肠道乳杆菌、双歧杆菌和真杆菌数量差异均无统计学意义(均P>0.05);治疗后两组肠道乳杆菌、双歧杆菌和真杆菌数量均明显增高(均P<0.05),且观察组肠道乳杆菌[(9.50±0.53)×10^8 CFU/mL比(8.95±0.44)×10^8 CFU/mL]、双歧杆菌[(10.60±0.53)×10^8 CFU/mL比(9.90±0.46)×10^8 CFU/mL]和真杆菌[(8.93±0.68)×10^8 CFU/mL比(8.08±0.40)×10^8 CFU/mL]均高于对照组(t=5.065、6.547、5.116,均P<0.05)。治疗前两组CD3^+、CD4^+、CD8^+和CD4^+/CD8^+水平差异均无统计学意义(均P>0.05);治疗后两组CD3^+、CD4^+、CD8^+和CD4^+/CD8^+水平均明显改善(均P<0.05),且观察组CD3^+[(62.55±5.06)%比(57.12±4.39)%]、CD4^+[(40.52±3.52)%比(36.43±2.55)%]和CD4^+/CD8^+[(1.78±0.22)比(1.43±0.13)]水平均高于对照组(t=7.504、6.958、5.452,均P<0.05),CD8^+[(21.22±2.05)%比(25.44±2.49)%]低于对照组(t=5.112,P<0.05)。结论在新生儿肺炎合并抗生素相关性腹泻的治疗中,络酸梭菌二联活菌能改善患儿肠道菌群,减轻炎性反应,改善免疫功能,效果更好。

Objective To investigate the effect of Clostridium perfringens combined with live bacteria therapy on intestinal flora,inflammation and immune indicators in children with pneumonia and antibiotic associated diarrhea.Methods From December 2016 to October 2019,44 neonates with pneumonia and antibiotic associated diarrhea diagnosed and treated in the Sixth People's Hospital of Datong were selected in the study,and they were divided into control group and observation group according to the random number table method,with 22 cases in each group.On the basis of routine symptomatic treatment,the control group was treated by oral administration of Saccharomyces boulardii,and the observation group was treated with Clostridium perfringens combined with live bacteria powder.The treatment course was two weeks.The intestinal flora,inflammatory factors and immune function of the two groups were compared.Results There were no statistically significant differences in the levels of IL-2,IL-6 and TNF-αbetween the two groups before treatment(all P>0.05),and the levels of IL-2,IL-6 and TNF-αin the two groups after treatment were significantly improved(all P<0.05).The levels of IL-2[(34.20±8.55)ng/L vs.(40.13±10.32)ng/L],IL-6[(21.02±5.66)ng/L vs.(31.25±7.82)ng/L]and TNF-α[(30.10±6.20)ng/L vs.(43.55±9.52)ng/L]in the observation group were significantly lower than those in the control group(t=7.501,6.885,8.264,all P<0.05).There were no statistically significant differences in the number of Lactobacillus,Bifidobacterium and Eubacterium in the two groups before treatmentt(all P>0.05),and the number of Lactobacillus,Bifidobacterium and Eubacterium in the two groups after treatment increased significantly(all P<0.05).The number of Lactobacillus[(9.50±0.53)×10^8 CFU/mL vs.(8.95±0.44)×10^8 CFU/mL],Bifidobacterium[(10.60±0.53)×10^8 CFU/mL vs.(9.90±0.46)×10^8 CFU/mL]and Eubacterium[(8.93±0.68)×10^8 CFU/mL vs.(8.08±0.40)×10^8 CFU/mL]in the observation group were significantly higher than those in the control group(t=5.065,6.547,5.116,all P<0.05).There were no statistically significant differences in the levels of CD3^+,CD4^+,CD8^+and CD4^+/CD8^+between the two groups before treatment(all P>0.05),and the levels of CD3^+,CD4^+,CD8^+and CD4^+/CD8^+in the two groups after treatment were significantly improved(all P<0.05).The levels of CD3^+[(62.55±5.06)%vs.(57.12±4.39)%],CD4^+[(40.52±3.52)%vs.(36.43±2.55)%],CD4^+/CD8^+[(1.78±0.22)vs.(1.43±0.13)]in the observation group were significantly higher than those in the control group(t=7.504,6.958,5.452,all P<0.05).The level of CD8^+[(21.22±2.05)%vs.(25.44±2.49)%]in the observation group was significantly lower than that in the control group(t=5.112,P<0.05).Conclusion Clostridium perfringens combined with live bacteria in the treatment of neonatal pneumonia with antibiotic associated diarrhea can improve intestinal flora,reduce inflammatory response and improve immune function,and the effect is better.