早期益生菌联合粪菌移植对肠易激综合征患者肠道菌群组成和肠道功能的影响分析

Effect of early probiotics combined with fecal bacteria transplantation on intestinal flora composition and intestinal function in patients with irritable bowel syndrome

目的 分析早期益生菌联合粪菌移植对肠易激综合征(IBS)患者肠道菌群组成和肠道功能的影响。方法 选取我院2017年8月—2020年8月收治的68例IBS患者,采用随机数字表法分别纳入联合组、粪菌移植组,每组34例,均行IBS常规治疗和粪菌移植治疗,联合组加用早期益生菌治疗。分别于治疗前、治疗14 d后,使用选择性培养基检测2组患者肠道菌群变化;使用全自动生化分析仪检测其血清D-乳酸、降钙素原水平,评价肠道功能变化;记录两组患者治疗期间不良反应发生情况。于治疗14 d后评价两组治疗效果,并分别于治疗前、治疗14 d后,使用全球IBS评分及IBS生活质量评分评价两组患者症状及生活质量改善情况。结果 两组患者治疗后肠道肠球菌、双歧杆菌、乳酸杆菌水平均较治疗前升高,酵母样真菌水平较治疗前下降;联合组治疗后肠道肠球菌、双歧杆菌、乳酸杆菌水平高于粪菌移植组,其酵母样真菌水平低于后者,差异有统计学意义(P<0.05)。两组患者治疗后血清D-乳酸、降钙素原水平均较治疗前下降;联合组治疗后血清D-乳酸、降钙素原水平分别为(1.31±0.30)mmol/L、(4.25±0.71)μg/L,均低于粪菌移植组的(2.11±0.49)mmol/L、(6.38±1.20)μg/L,差异有统计学意义(P<0.05)。治疗14 d后,联合组腹部疼痛缓解率、排便次数减少率、粪便性状改善率分别为82.4%、91.2%、70.6%,均高于粪菌移植组的58.8%、67.7%、44.1%,差异均有统计学意义(P<0.05)。两组患者治疗期间均未见不良反应发生。两组患者治疗后全球IBS评分、IBS生活质量评分均较治疗前升高;联合组治疗后全球IBS评分、IBS生活质量评分均高于粪菌移植组,差异有统计学意义(P<0.05)。结论 在粪菌移植的基础上,联合早期口服益生菌能够进一步改善IBS患者肠道菌群构成和肠道功能,从而缓解患者临床症状、改善其生活质量,并且安全性良好。

Objective To analyze the effect of early probiotics combined with fecal bacteria transplantation(FBT) on intestinal flora composition and intestinal function in patients with irritable bowel syndrome(IBS). Methods Sixty-eight IBS patients admitted to our hospital from August 2017 to August 2020 were randomly divided into Combination group and FBT group, with 34 cases in each group. All the patients were treated with conventional IBS treatment and FBT, and the combination group was additionally early treated with probiotics. The therapeutic effect, safety, changes of intestinal flora and intestinal function before and after treatment were compared between groups, and the clinical value of early administered with probiotics combined with FBT in IBS treatment were analyzed. Results After treatment, the levels of Enterococcus, Bifidobacterium and Lactobacillus in both groups were higher, while that of yeast-like fungi was lower than before treatment. After combination treatment, the levels of Enterococcus, Bifidobacterium and Lactobacillus in group A were higher than those in the FBT group, while that of yeast-like fungi was lower, with statistical significance(P<0.05).After treatment, the serum D-lactic acid and procalcitonin in the two groups decreased;the serum levels of D-lactic acid and procalcitonin in combination group were(1.31±0.30) mmol/L and(4.25±0.71) μg/L, respectively, lower than the(2.11±0.49) mmol/L and(6.38±1.20) μg/L in FBT group. After 14 days of treatment, the efficiency rates in terms of abdominal pain, defecation times and fecal traits in the combination group were 82.4%, 91.2% and 70.6%, respectively, significantly higher than those in the FBT group(58.8%, 67.7% and 44.1%)(Ps<0.05). No adverse reactions occurred in both groups during treatment. After treatment, the global IBS score and IBS quality of life score in both groups were higher than those before treatment. After combination treatment, the global IBS score and IBS quality of life score in group A were significantly higher than those in FBT group(P<0.05). Conclusion On the basis of FBT, early oral administration of probiotics can further improve the intestinal flora and intestinal function of IBS patients, thus alleviating their clinical symptoms and improving their quality of life, with good safety.