益生菌对儿童变应性鼻炎的辅助治疗作用

The role of probiotics in adjuvant treatment of allergic rhinitis in children

目的 探讨益生菌对儿童变应性鼻炎(AR)的辅助治疗作用,为该类患儿的治疗提供参考。方法 纳入我院耳鼻喉科2021年9月至2022年6月确诊为AR的62例患儿作为研究对象,随机选取37例作为AR组,另纳入40例健康儿童作为健康组,分别收集两组对象粪便进行高通量测序。将62例AR患儿进一步分为对照组和益生菌组,各31例。对照组患儿给予糠酸莫米松喷鼻治疗,益生菌组患儿在此基础上加用双歧杆菌四联活菌片。监测治疗期间两组患儿肠道主要菌群的变化并对治疗前后患儿临床症状进行评分。建立AR大鼠模型,验证益生菌对AR的治疗效果。结果 AR组患儿肠道菌群Faith’s PD指数、Shannon指数、Simpson指数、Pielou_e指数均显著低于健康组(U=538.000、459.000、445.000、446.000,均P<0.05)。AR患儿与健康儿童相比,肠道拟杆菌属、粪杆菌属均显著增多(U=275.000、 412.000,均P<0.05),而双歧杆菌显著减少(U=304.000,P<0.001)。与对照组相比,益生菌组患儿治疗后肠道双歧杆菌属、肠球菌属均显著增加(U=-241.500、-212.000,均P<0.05),拟杆菌属显著减少(U=-327.000,P<0.05)且症状改善更加显著(t=11.63, P<0.05)。补充益生菌可以显著缓解大鼠鼻腔黏膜的炎症。结论 AR患儿与健康儿童相比肠道菌群发生显著变化。补充的双歧杆菌、肠球菌能有效地在AR患儿的肠道中定植,且对肠道中的拟杆菌可能有抑制作用。益生菌对儿童AR有较好的辅助治疗作用。

Objective To explore the role of probiotics in adjuvant treatment of allergic rhinitis (AR) in children, providing a reference for the treatment. Methods Sixty-two children diagnosed with AR from September 2021 to June 2022 in the Department of Otolaryngology of our hospital were included as the subjects;37 cases were randomly selected as the AR group, and 40 cases of normal children were included as the health group. The stools of the two groups of subjects were collected for high-throughput sequencing respectively. Then 62 children with AR were divided into control group or probiotic group;both groups were given Mometasone furoate nasal spray treatment, while the probiotic group was additionally given Multiple probiotics containing Bifidobacterium. The changes of the main strains in both groups during treatment were observed, and the clinical symptoms before and after treatment were scored. AR rat model was established to verify the therapeutic effect of probiotics on AR. Results The Faith's PD index, Shannon index, Simpson index, and Pielou_e index of the intestinal flora of children in the AR group were significantly lower than those in the health group respectively (U = 538.000, 459.000, 445.000, 446.000;all P<0.05). Children with AR had significantly more Bacteroides and Faecalibacterium (U = 275.000, 412.000;all P<0.05) and significantly less Bifidobacterium compared to health group (U = 304.000, P<0.001). After probiotic treatment, the children with AR showed a significant increase in Bifidobacterium and Enterococcus (U = −241.500, −212.000;all P<0.05) and a significant decrease in Bacteroides (U = −327.000, P<0.05), and more significant improvement in symptoms compared to the control group (t = 11.63, P<0.05). Probiotic supplementation significantly alleviated inflammation in the rat nasal mucosa. Conclusion Children with AR have significant changes in intestinal flora compared to healthy children. Supplemented Bifidobacterium and Enterococcus can effectively colonize the intestinal tract of children with AR, and may have an inhibitory effect on Bacteroides in the intestinal tract. Probiotics have a good adjuvant therapeutic effect on children with AR.