益生菌联合四联疗法对Hp相关性胃炎胃黏膜Th亚群表达谱系的影响

Influence of probiotics combined with quadruple therapy on the differentiation of Th subsets in gastric mucosa of patients with Helicobacter pylori-associated gastritis

[目的]评估益生菌序贯联合四联疗法治疗幽门螺杆菌(Helicobacter pylori,Hp)相关性胃炎的效果及对胃黏膜Th亚群相关因子分泌谱系的影响。[方法]将Hp阳性的慢性胃炎患者120例随机分为对照组和观察组,每组60例。2组均先给予常规根除Hp四联疗法(埃索美拉唑+克拉霉素+阿莫西林+胶体果胶铋)方案,共14 d。14 d后,观察组及对照组分别服用双歧杆菌三联活菌胶囊、安慰剂,共90 d;2组患者分别于治疗前、后行胃黏膜组织活检取材,通过免疫组化、RT-PCR和流式CBA法比较2组治疗前、后胃黏膜组织中Th亚群相关因子的表达谱系是否存在显著性差异。[结果]与对照组相比,观察组消化道症状总积分进一步下降;胃黏膜CD3+T淋巴细胞浸润显著缓解;胃黏膜Th1型核转录因子TBX和IFN-γ、IL-2、IL-6及TNF-α等促炎性细胞因子的表达或分泌水平均显著下降(P<0.01)。[结论]相对于单一的四联疗法,益生菌联合治疗有利于纠正胃黏膜组织中Th1亚群分化的偏倚,并在一定程度上缓解患者消化道症状和胃黏膜的炎性反应。

[Objective]To assess the influence of probiotics combined with quadruple therapy on the clinical outcome and secretion spectrum of Th subgroup related factors in the gastric mocosa of Helicobacter pylori(Hp)-associated gastritis.[Methods]The total of 120 patients with Hp-associated gastritis were randomly divided into observation group(n=60)and control group(n=60).Both groups were given traditional quadruple drugs therapy including Esomeprazole, clarithromycin, Amoxicillin and Bismuthi Pectinum Colloidale for 14 days.Afterwards, the observation group and the control group took Bifidobacterium triple viable capsule and placebo for 90 days respectively.Samples of gastric mucosa biopsy were taken before and after treatment, respectively.Immunohistochemistry, RT-PCR and flow CBA were used to analyze whether there existed any significant differences in Th cytokines pattern between the above two groups before and after treatment.[Results]Compared with the control group, the score of digestive tract symptoms decreased.The total score of digestive tract symptoms in the observation group decreased further.In the observation group, the infiltration of CD3+T lymphocytes in gastric mucosa was significantly relieved;In observation group, The expression or secretion levels of Th1 nuclear transcription factor TBX,IFN-γ,IL-2,IL-6 and TNF-α in gastric mucosa decreased significantly(P<0.01).[Conclusion]In contrast with the single "quadruple therapy",probiotic combined therapy is beneficial to correct the bias of Th1 subgroup differentiation in gastric mucosa, and attenuate the mucosal inflammatory reactions as well as the gastrointestinal symptoms to some extent.