酪酸梭菌活菌散联合多潘立酮治疗小儿功能性消化不良的疗效及相关作用机制

Efficacy and mechanism of Clostridium Butyricum Powder combined with domperidone in the treatment of children with functional dyspepsia

目的分析酪酸梭菌活菌散联合多潘立酮治疗小儿功能性消化不良(FD)的疗效及相关作用机制。方法选取2019年3月—2020年7月就诊于合肥市第一人民医院的FD患儿144例。根据不同治疗方法将患儿分为对照组和观察组。两组患儿均给予调整饮食、建立良好排便习惯、预防及纠正水电解质与酸碱平衡等常规支持治疗,在此基础上,对照组接受多潘立酮治疗,观察组采取酪酸梭菌活菌散+多潘立酮治疗,均治疗1周。评估两组疗效、用药安全性,并观察治疗前后胃动力学、脑肠轴相关因子[5-羟色胺(5-HT)、神经肽S受体1(NPSR1)、P物质(SP)]、胃肠激素[生长抑素(SST)、胃动素(MTL)、促胃泌素(GAS)、瘦素(Leptin)]变化。结果观察组总有效率较对照组高(P<0.05)。对照组治疗前后胃窦收缩幅度、胃窦收缩频率及胃窦运动指数差值较观察组高(P<0.05)。对照组治疗前后5-HT、SP差值较观察组低,NPSR1差值较观察组高(P<0.05)。对照组治疗前后MTL、GAS差值较观察组高,治疗前后SST、Leptin差值较观察组低(P<0.05)。两组患儿不良反应率比较,差异无统计学意义(P>0.05)。结论酪酸梭菌活菌散联合多潘立酮治疗FD患儿的疗效确切,且未明显增加不良反应,其作用机制可能与改善胃动力学、调节脑肠轴因子及胃肠激素水平有关。

Objective To analyze the efficacy and related mechanism of Clostridium Butyricum Powder combined with domperidone in the treatment of children with functional dyspepsia(FD).Methods A total of 144 children with FD who were treated in Hefei First People's Hospital from March 2019 to July 2020 were divided into two groups according to the random number table.The two groups of children were both given routine supportive treatments such as adjusting diets,establishing good bowel habits,preventing and correcting water-electrolyte and acid-base imbalance.Besides,the control group received domperidone treatment,and the combination group took Clostridium Butyricum Powder plus domperidone.All treatments lasted for 1 week.The efficacy and safety of medication in the two groups were evaluated,and the changes in gastric kinetics,brain-gut axis related factors[5-hydroxytryptamine(5-HT),neuropeptide S receptor 1(NPSR1),substance P(SP)],and gastrointestinal hormones[somatostatin(SST),motilin(MTL),gastrin(GAS),leptin]after the treatments were observed.Results The overall effective rate of the treatment in the combination group(91.67%)was higher than that of the control group(79.17%)(P<0.05).The differences in contraction amplitude,contraction frequency and motility index of gastric antrum before and after the treatments were higher in the control group than those of the combination group(P<0.05).The changes of 5-HT and SP levels in the control group were lower than those in the combination group after treatment,while the difference in NPSR1 level before and after the treatments was higher in the control group compared with the combination group(P<0.05).Besides,in comparison with the control group,the differences in levels of MTL and GAS were lower but those in levels of SST and leptin were higher in the combination group(P<0.05).The incidence of adverse reactions in the combined group(9.72%)was comparable to that in the control group(4.17%)(P>0.05).Conclusions Clostridium Butyricum Powder combined with domperidone has a definite effect in the treatment of children with FD,and does not significantly increase the adverse reactions.Its mechanism of action may be related to the improvement of gastric kinetics,and the regulation of brain-gut axis associated factors and gastrointestinal hormone levels.