抗幽门螺杆菌四联疗法临床疗效和治疗前后肠道菌群变化

Clinical effect of bismuth-containing quadruple therapy against helicobacter pylori and changes of intestinal flora before and after treatment

目的:研究抗幽门螺杆菌含铋剂四联疗法临床疗效及治疗前后肠道菌群的变化,寻找导致治疗失败的菌群。方法:幽门螺杆菌感染患者含铋剂四联方案治疗14天,留取治疗前、治疗2周及停药1个月后的粪便进行16SrDNA测序,分析患者肠道菌群变化。结果:抗幽门螺杆菌治疗过程中,肠道菌群α多样性指数差异有统计学意义(P<0.05),成功组与失败组α多样性指数差异无统计学意义(P>0.05)。在治疗失败组中,多尔氏菌属序列数升高,双歧杆菌属序列数降低,差异有统计学意义(P<0.05)。结论:在抗幽门螺杆菌治疗过程中,肠道菌群的多样性和优势菌群发生改变,致病菌序列数增加和产生短链脂肪酸菌群序列数降低,导致肠道屏障作用减弱,促炎因子增多,炎症水平升高,可能影响根除效果,最终导致根除治疗失败。

Objective:To study the clinical effect of anti-Helicobacter pylori quadruple therapy with bismuthcontaining agent and the changes in intestinal flora before and after treatment,and to find out the flora leading to treatment failure.Methods:Patients with Helicobacter pylori infection were treated with bismuth-containing quadruple therapy for 14 days.16SrDNA sequencing was performed on stool before treatment,2 weeks after treatment and 1 month after drug withdrawal to analyze the changes in the patients'intestinal flora.Results:In the course of anti-Helicobacter pylori treatment,α-diversity index of intestinal flora was significantly different(P<0.05),but there was no significant difference between successful and unsuccessful groups(P>0.05).In the unsuccessful group,the sequence number of Dorea was increased,while the sequence number of Bifidobacterium was decreased,with statistical significance(P<0.05).Conclusions:In the course of anti-Helicobacter pylori therapy,the diversity and dominant flora of intestinal flora are changed,the sequence number of pathogenic bacteria increases and the sequence number of short-chain fatty acid producing bacteria decreases,leading to the weakened intestinal barrier effect,the increase of pro-inflammatory factors,and the increase of inflammation level,which may affect the eradication effect and ultimately lead to the failure of eradication therapy.