益生菌联合三联方案治疗儿童Hp阳性慢性胃炎的临床疗效及炎性因子水平研究

Clinical Efficacy of Probiotics Combined with Triple Regimen in the Treatment of Children with Hp-positive-associated Chronic Gastritis and Study on Levels of Inflammatory Factors

目的:探究益生菌联合奥美拉唑+阿莫西林+克拉霉素三联方案治疗儿童幽门螺杆菌(Hp)阳性相关性慢性胃炎的临床疗效及炎性因子水平。方法:将某院2018年1月1号~2021年9月1日收治488例慢性胃炎Hp阳性患儿作为研究对象,按抽签法分为实验组和对照组各244例,对照组采用克拉霉素+阿莫西林+奥美拉唑,实验组采用克拉霉素+阿莫西林+奥美拉唑+益生菌,治疗2周后对比两组患儿临床疗效、Hp根除率、不良反应,对比治疗前后炎性因子水平、肠道菌群水平。结果:实验组临床总有效率(包括显效和有效)为94.67%,高于对照组的总有效率89.75%(P=0.043);实验组Hp根除率为92.68%,高于对照组的Hp根除率87.80%(P=0.039);治疗后实验组白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平明显低于对照组(P<0.001);治疗后实验组肠杆菌、肠球菌水平明显低于对照组(P<0.001),治疗后实验组乳酸杆菌、双歧杆菌、双歧杆菌值/肠杆菌值(B/E)高于对照组(P<0.001),但酵母菌差异无统计意义(P=0.166);实验组总不良事件发生率为2.46%,低于对照组的3.29%,但两组差异无统计学意义(P=0.588)。结论:儿童慢性胃炎合并Hp感染中实施益生菌联合克拉霉素+阿莫西林+奥美拉唑三联方案治疗后,可明显提高临床疗效,提升Hp清除率,降低炎性因子水平,且治疗安全性高。

Objective:To explore the clinical efficacy of probiotics combined with triple regimen of omeprazole+amoxicillin+clarithromycin in the treatment of Helicobacter pylori(Hp)positive-associated chronic gastritis in children and the levels of inflammatory factors.Methods:488 children with Hp-positive chronic gastritis treated in the hospital from January 1,2018 to September 1,2021 were selected as the research subjects,and they were divided into experimental group(n=244)and control group(n=244)according to the lottery method.The control group was given clarithromycin+amoxicillin+omeprazole,and the experimental group was treated with clarithromycin+amoxicillin+omeprazole+probiotics.After 2 weeks of treatment,the clinical efficacy,Hp eradication rate,adverse reactions and levels of inflammatory factors and intestinal flora before and after treatment were compared between the two groups.Results:The total clinical effective rate(including markedly effective and effective)was 94.67%in the experimental group,which was higher than 89.75%in the control group(P=0.043).The Hp eradication rate was 92.68%in the experimental group,which was higher than 87.80%in the control group(P=0.039).The levels of interleukin-6(IL-6),interleukin-8(IL-8)and tumor necrosis factor-α(TNF-α)after treatment were significantly lower in the experimental group than in the control group(P<0.001).After treatment,the levels of Enterobacter and Enterococcus in the experimental group were obviously lower than those in the control group(P<0.001),while the values of Lactobacillus,Bifidobacterium and Bifidobacterium/Enterobacter(B/E)were higher than those in the control group(P<0.001),but there was no statistical significance in yeast(P=0.166).The total incidence of adverse events in the experimental group was lower than that in the control group(2.46%vs 3.29%),there was no statistically significant difference between the two groups(P=0.588).Conclusion:Probiotics combined with triple regimen of clarithromycin+amoxicillin+omeprazole in the treatment of children with chronic gastritis complicated with Hp infection can significantly improve clinical efficacy,increase Hp clearance rate and reduce levels of inflammatory factors,with high treatment safety.