盐酸小檗碱对溃疡性结肠炎患者肠道菌群及免疫状态的影响

Effects of chlorhexidine hydrochloride on intestinal flora and immune status in patients with ulcerative colitis

[目的]探讨盐酸小檗碱对溃疡性结肠炎(UC)患者肠道菌群、炎症水平、免疫水平的影响。[方法]纳入2015年3月~2019年5月接诊收治的UC患者64例,按照随机数字表法分为观察组和对照组,各32例;对照组按照UC诊治指南给予常规治疗;观察组在对照组基础上辅以盐酸小檗碱治疗;2组患者均连续治疗3个月;比较2组患者炎性因子(IL-1β、IL-6、IL-8、TNF-α)水平,检测2组患者治疗前后T淋巴细胞亚群CD4+、CD8+、CD4+/CD8+及Th17、Treg细胞比例,检测2组患者治疗前后免疫球蛋白(IgM、IgA、IgG)水平;检测2组患者治疗前后肠内容物中肠道菌群分布情况。[结果]治疗后2组患者IL-1β、IL-6、IL-8、TNF-α水平均不同程度下降,观察组IL-1β、IL-6、IL-8、TNF-α水平低于对照组,差异有统计学意义(P<0.05);治疗后2组患者CD4+水平升高,CD8+水平降低,CD4+/CD8+比值升高,观察组CD4+、CD4+/CD8+比值高于对照组,差异有统计学意义(P<0.05);治疗后Th17比例降低,Treg细胞比例升高,Treg/Th17比值升高,观察组Th17比例低于对照组,Treg细胞比例、Treg/Th17比值高于对照组,差异有统计学意义(P<0.05);肠道菌群方面,治疗后2组患者Chao指数、Ace指数、Shannon指数均出现不同程度升高,Simpson指数降低,观察组Chao指数、Ace指数、Shannon指数高于对照组,Simpson指数低于对照组,差异有统计学意义(P<0.05)。[结论]盐酸小檗碱能够改善UC肠道菌群紊乱状态,提高免疫球蛋白和相关T淋巴细胞亚群水平,抑制炎性因子过度表达,维持肠黏膜屏障功能,值得临床借鉴。

[Objective]To investigate the effect of chlorhexidine hydrochloride on intestinal microflora,inflammation level and immune level in patients with ulcerative colitis(UC).[Methods]Sixty-four cases of UC patients from March 2015to January 2019were included and divided into observation group and control group according to random number table method,with 32cases each;The control group was given routine treatment in accordance with the guidelines for the diagnosis and treatment of ulcerative colitis;the observation group was supplemented with chlorpyrine hydrochloride treatment on the basis of the control group;Both groups of patients were treated continuously for 3months;the levels of inflammatory factors(IL-1β,IL-6,IL-8,TNF-α)were compared between the two groups of patients.To detect the proportion of T lymphocyte subsets CD4+,CD8+,CD4+/CD8+,Th17and Treg cells before and after treatment in the two groups of patients.And to detection of immunoglobulin(IgM,IgA,IgG)levels before and after treat-ment in two groups of patients;To detect the distribution of intestinal flora in intestinal contents before and after treatment in two groups of patients.[Results]After treatment,the levels of IL-1β,IL-6,IL-8,and TNF-αin the two groups of patients decreased to varying degrees.The levels of IL-1β,IL-6,IL-8,and TNF-αin the observation group were lower than those in the control group.The difference is statistically significant(P<0.05).After treatment,the CD4+level increased,the CD8+level decreased,and the CD4+/CD8+ratio increased in the two groups.The CD4+and CD4+/CD8+ratios in the observation group were higher than those in the control group(P<0.05).After treatment,the ratio of Th17decreased,the proportion of Treg cells increased,and the ratio of Treg/Th17increased.The ratio of Th17in the observation group was lower than that in the control group.The ratio of Treg cells and the ratio of Treg/Th17were higher than the control group(P<0.05);In terms of intestinal flora,the Chao index,Ace index,and Shannon index of the two groups of patients all increased to different degrees after treatment,and the Simpson index decreased.The Chao index,Ace index,and Shannon index of the observation group were higher than the control group,and the Simpson index was lower than the control Group.These differences were statistically significant(P<0.05).[Conclusion]Xiaopian hydrochloride can improve the disorder of intestinal flora of ulcerative colitis,increase the level of immunoglobulin and related T lymphocyte subsets,inhibit the overexpression of inflammatory factors,and maintain the intestinal mucosal barrier function,which is worthy of clinical recommendation.