双歧杆菌三联活菌胶囊辅助三联疗法治疗儿童幽门螺杆菌阳性慢性胃炎的临床研究

The clinical study of combined capsules of live Bifidobacterium,Lactobacillus and Enterococcus assisted triple therapy in chronic gastritis children with Helicobacter pylori positive

目的研究双歧杆菌三联活菌胶囊辅助三联疗法治疗儿童幽门螺杆菌(Hp)阳性慢性胃炎的临床效果。方法回顾性分析无锡市儿童医院2019年1月至2022年3月80例Hp阳性慢性胃炎患儿的临床资料。其中,采用双歧杆菌三联活菌胶囊联合三联疗法(奥美拉唑、阿莫西林和克拉霉素)治疗40例(联合组),三联疗法治疗40例(对照组),均治疗4周。比较两组疗效、Hp根除情况(停药4周后行^(13)C呼气试验)和症状改善情况(评估上腹痛、纳差和反酸的评分)。治疗前后采集患儿粪便,检测肠道菌群双歧杆菌、乳酸杆菌、双歧杆菌/肠杆菌;治疗前和治疗14 d检测血清炎性因子C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素10(IL-10)和核转录因子κB(NF-κB)水平;记录不良反应(呕吐、腹泻、头晕和皮疹)发生情况。结果联合组总有效率和Hp清除率明显高于对照组[95.00%(38/40)比80.00%(32/40)和92.50%(37/40)比75.00%(30/40)],差异有统计学意义(P<0.05)。联合组治疗后上腹痛、纳差和反酸评分明显低于对照组[(0.56±0.14)分比(1.12±0.35)分、(1.20±0.37)分比(1.50±0.42)分和(1.02±0.28)分比(1.39±0.43)分],差异有统计学意义(P<0.01)。联合组治疗后双歧杆菌、乳酸杆菌和双歧杆菌/肠杆菌明显高于对照组[(8.56±1.35)lgcfu/g比(7.94±1.32)lgcfu/g、(9.27±1.63)lgcfu/g比(8.35±1.58)lgcfu/g和1.85±0.40比1.25±0.34],差异有统计学意义(P<0.01)。联合组治疗后CRP、TNF-α和NF-κB明显低于对照组[(12.06±3.14)ng/L比(17.36±3.08)ng/L、(10.74±3.25)μg/L比(15.30±4.18)μg/L和(1.17±0.34)μg/L比(2.21±0.82)μg/L],IL-10明显高于对照组[(43.14±6.38)μg/L比(35.29±5.03)μg/L],差异有统计学意义(P<0.01)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论双歧杆菌三联活菌胶囊辅助三联疗法治疗Hp阳性慢性胃炎患儿疗效明确,不良反应少,能明显改善临床症状,机制可能与其调控肠道菌群-血清炎性反应有关。

Objective To study the clinical effect of combined capsules of live Bifidobacterium,Lactobacillus and Enterococcus assisted triple therapy in chronic gastritis children with Helicobacter pylori(Hp)positive.Methods The clinical data of 80 chronic gastritis children with Hp positive from January 2019 to March 2022 in Wuxi Children's Hospital were retrospectively analyzed.Among them,40 children(combination group)were treated with combined capsules of live Bifidobacterium,Lactobacillus and Enterococcus combined with triple therapy(omeprazole,amoxicillin and clarithromycin),40 children(control group)were treated with triple therapy,and all children were treated for 4 weeks.The efficacy,Hp clearance rate(performed ^(13)C breath test after 4 weeks of discontinuation)and symptom improvement(the scores of upper abdomen pain,anorexia and sour regurgitation)were compared between two groups.The feces before treatment and after treatment were collected,and the intestinal flora was detected,including Bifidobacterium,Lactobacillus,Bifidobacterium/Enterobacteria;the levels of C-reactive protein(CRP),tumor necrosis factorα(TNF-α),interleukin 10(IL-10)and nuclear transcription factorκB(NF-κB)before treatment and 14 d after treatment were detected;the adverse reactions(vomiting,diarrhea,dizziness and erythra)were detected.Results The total effective rate and Hp clearance rate in combination group were significantly higher than those in control group:95.00%(38/40)vs.80.00%(32/40)and 92.50%(37/40)vs.75.00%(30/40),and there were statistical differences(P<0.05).The scores of upper abdomen pain,anorexia and sour regurgitation after treatment in combination group were significantly lower than those in control group:(0.56±0.14)scores vs.(1.12±0.35)scores,(1.20±0.37)scores vs.(1.50±0.42)scores and(1.02±0.28)scores vs.(1.39±0.43)scores,and there were statistical differences(P<0.01).The Bifidobacterium,Lactobacillus,Bifidobacterium/Enterobacteria after treatment in combination group were significantly higher than those in control group:(8.56±1.35)lgcfu/g vs.(7.94±1.32)lgcfu/g,(9.27±1.63)lgcfu/g vs.(8.35±1.58)lgcfu/g and 1.85±0.40 vs.1.25±0.34,and there were statistical differences(P<0.01).The CRP,TNF-αand NF-κB after treatment in combination group were significantly lower than those in control group:(12.06±3.14)ng/L vs.(17.36±3.08)ng/L,(10.74±3.25)μg/L vs.(15.30±4.18)μg/L and(1.17±0.34)μg/L vs.(2.21±0.82)μg/L,the IL-10 after treatment was significantly higher than that in control group:(43.14±6.38)μg/L vs.(35.29±5.03)μg/L,and there were statistical differences(P<0.01).There was no statistical difference in the incidence of adverse reactions between two group(P>0.05).Conclusions The combined capsules of live Bifidobacterium,Lactobacillus and Enterococcus assisted triple therapy has clear efficacy in chronic gastritis children with Hp positive,with few adverse reactions.It can significantly improve clinical symptoms,and its mechanism may be related to the regulation of intestinal microbiota and serum inflammation.