参苓白术颗粒对患儿抗生素相关性腹泻肠屏障功能及免疫功能的影响

Effect of Shenlingbaizhu Granule on Intestinal Barrier Function and Immune Function in Children with Antibiotic-associated Diarrhea

目的研究参苓白术颗粒对患儿抗生素相关性腹泻肠屏障功能及免疫功能的影响。方法以2018年6月~2019年6月在我院就诊的76例抗生素相关性腹泻患儿为研究对象,按随机数表法分成对照组(n=38)和试验组(n=38)。所有患儿入院后均接受止泻、补液、饮食调整、纠正电解质失衡等常规治疗,在此基础上,试验组患儿加服参苓白术颗粒,1 g/次(<3岁)或3 g/次(≥3岁),tid,温水冲服,治疗时间为5 d。评价两组患儿治疗后临床疗效、肠屏障功能[外周血细菌内毒素(bacterial endotoxin,BT)、二胺氧化酶(diamine oxidase,DAO)以及D-乳酸(D-Lactic acid,D-LC)水平]及免疫功能(CD4^+、CD8^+细胞及CD4^+/CD8^+比值、Ig A、Ig M及Ig G水平)。结果治疗后,试验组每日大便次数、大便次数恢复时间及大便性状恢复时间均明显低于对照组(P=0.001,0.003,0.004);两组临床疗效存在显著差异,试验组总有效率明显高于对照组(78.9%vs.55.3%,P=0.028)。治疗后,两组患者BT、DAO、D-LC水平明显降低,且试验组显著低于对照组(t=15.044,16.596,7.791,P=0.000,0.000,0.000);治疗后试验组患儿CD4^+、及CD4^+/CD8^+水平明显高于对照组,试验组CD8^+细胞水平明显低于对照组(P=0.000,0.000,0.000);治疗后试验组患儿Ig A、Ig M和Ig G水平明显高于对照组(P=0.000,0.004,0.016);两组不良反应发生率未见明显差别(2.6%vs.0%,P=0.314)。结论参苓白术颗粒治疗患儿抗生素相关性腹泻患儿,可提高常屏障功能,改善免疫功能,进而改善临床效果。

OBJECTIVE To study the effect of Shenlingbaizhu granules on intestinal barrier function and immune function in children with antibiotic-associated diarrhea.METHODS A total of 76 children with antibiotic associated diarrhea treated in our hospital from June 2018 to June 2019 were randomly sorted into experimental group(n=38)and control group(n=38).All patients in both group received routine treatment such as antidiarrhea,fluid supplement,diet adjustment and electrolyte imbalance correction after admission.In addition,the children in the experimental group were treated with Shenlingbaizhu granules,1 g/time(<3 years old)or 3 g/time(≥3 years old),three times a day,soluble in warm water,for 5 days.The clinical effect,intestinal barrier function[the levels of bacterial endotoxin(BT),diamine oxidase(DAO)and D-lactate(D-LC)]and immune function(the levels of CD4^+,CD8^+ cells and CD4^+/CD8^+,IgA,IgM and IgG)were evaluated and compared after treatment.RESULTS After treatment,the number of stools per day,the recovery time of stools and the recovery time of stool characteristics in the experimental group were significantly lower than those in the control group(P=0.001,0.003,0.004).And the total effective rate in the experimental group was significantly higher than that in the control group(78.9%vs.55.3%,P=0.028).Compared to control,Shenlingbaizhu granule significantly reduced the levels of BT,DAO,D-LC and CD8^+cells,and increased the levels of CD4^+,CD4^+/CD8^+,IgA,IgM and IgG.In addition,there was no significant difference in the incidence of adverse reactions between the two groups(2.6%vs.0%,P=0.314).CONCLUSION Shenlingbaizhu granule can improve the gut barrier function,immune function and clinical effect in patients with antibiotic associated diarrhea.