复合益生菌制剂联合标准四联方案治疗幽门螺杆菌感染的临床疗效及对不良反应的影响

Clinical effectiveness of compound probiotics combined with standard quadruple regimen on Helicobacter pylori infection

目的评估鼠李糖乳杆菌、乳双歧杆菌、嗜酸乳杆菌复合益生菌制剂联合标准四联方案治疗幽门螺杆菌(Helicobacter pylori)感染的临床疗效及对不良反应的影响。方法纳入2020年11月—2021年5月在徐州医科大学附属医院消化内科就诊并明确诊断为幽门螺杆菌感染的患者,随机分为研究组(n=70)及对照组(n=65)。2组均给予标准四联方案治疗(疗程14 d),研究组在此基础上加用复合益生菌制剂,在停药至少1个月后复查^(13) C或^(14)C-尿素呼气试验,结果阴性代表幽门螺杆菌成功根除。比较2组患者幽门螺杆菌感染的根除率、不良反应发生率、严重程度、症状缓解情况及Bristol粪便分型改善情况。结果按意向性(ITT)分析及符合方案(PP)分析,研究组幽门螺杆菌感染根除率显著高于对照组(P<0.05),不良反应发生率及腹泻发生率均低于对照组(P<0.05);研究组腹胀及腹泻的严重程度均轻于对照组(P<0.05);其余不良反应发生率、严重程度及症状缓解情况组间比较差异均无统计学意义(P>0.05);研究组抗幽门螺杆菌根除治疗前Bristol粪便分型>4或<3的患者治疗后Bristol粪便分型改善情况显著优于对照组(P<0.05)。结论复合益生菌制剂联合标准四联方案可以显著提高幽门螺杆菌感染的根除率,降低治疗相关不良反应及腹泻发生率,减轻腹胀和腹泻的严重程度,有助于改善根除治疗前Bristol粪便分型>4或<3者的粪便分型。

Objective To evaluate the clinical effective of Lactobacillus rhamnosus,Bifidobacterium lactis and Lactobacillus acidophilus compound probiotics combined with standard quadruple regimen in the treatment of Helicobacter pylori and related adverse reactions.Methods A total of 148 patients who were diagnosed with H.pylori infection in Department of Gastroenterology,the Affiliated Hospital of Xuzhou Medical University from November 2020 to May 2021 were included.They were randomly divided into two groups:a study group(n=70)and a control group(n=65).Both groups received standard quadruple regimen,with a treatment course of 14 days.In addition,the study group was administered with compound probiotics,with a treatment course of 30 days.Then,the ^(13)C or ^(14)C-urea breath test was performed at least one month after drug withdrawal.Negative result indicated successful eradication of H.pylori.Both groups were compared for the eradication rate of H.pylori,the incidence and severity of adverse reactions,symptom relief and improvement of Bristol stool types.Results According to both intention-to-treat(ITT)and per protocol(PP)analysis,the study group presented remarkably increases in the eradication rate of H.pylori(P<0.05)and decreases in the incidences of adverse reactions and of diarrhea than the control group(P<0.05).The severity of abdominal distension and diarrhea was less in the study group than that in the control group(P<0.05).There were no statistical differences in the incidence and severity of other adverse reactions and symptom relief among the groups(P>0.05).For patients with Bristol stool type>4 or<3 before anti-H.pylori eradication treatment,improvement in Bristol stool types after treatment was significantly better in the study group than that in the control group(P<0.05).Conclusions probiotics combined with standard quadruple regimen can significantly increase the eradication rate of H.pylori infection,reduce the incidence of anti-H.pylori-related adverse reactions and reduce the incidence of diarrhea,and reduce the severity of abdominal distention and diarrhea in adverse reactions.Patients with Bristol stool type>4 or<3 show improvement in Bristol stool type after anti-H.pylori eradication therapy.