益生菌辅助乳果糖治疗老年重症肺炎的疗效及对肠道菌群、免疫功能的影响

Therapeutic effect of probiotics-assisted lactulose on severe pneumonia in the elderly and its impact on intestinal flora and immune function

目的探究益生菌辅助乳果糖治疗老年重症肺炎的疗效,并通过肠道菌群、免疫功能改善情况验证其临床效果。方法选取2022年5月至2023年5月郑州大学第一附属医院收治的98例老年重症肺炎患者作为研究对象,按随机数表法分为研究组和对照组各49例。两组患者入院后均行基础治疗,于此基础上对照组给予乳果糖治疗,研究组给予益生菌辅助乳果糖治疗,两组均持续治疗2周。治疗结束后,比较两组患者的治疗效果、症状缓解时间,以及治疗前后的肠道菌群、免疫功能指标[T淋巴细胞亚群(CD3^(+)、CD4^(+)/CD8^(+))、免疫球蛋白(Ig)A、IgG]、炎症-应激因子[丙二醛(MDA)、4-羟基壬烯醛(4-HNE)、C反应蛋白(CRP)、白介素-6(IL-6)]、慢性健康状况评分系统Ⅱ(APACHEⅡ)和临床肺部感染评分(CPIS)的变化,同时比较两组患者治疗期间的不良反应发生情况。结果研究组患者的治疗总有效率为89.80%,明显高于对照组的73.47%,差异有统计学意义(P<0.05);研究组患者的咳嗽、咳痰、发热、胸闷、气短缓解时间明显短于对照组的,差异均有统计学意义(P<0.05);治疗2周后,研究组患者的双歧杆菌、乳杆菌数量分别为(9.79±0.76)log CFU/g、(9.05±0.67)log CFU/g,明显多于对照组的(8.84±0.81)log CFU/g、(8.61±0.62)log CFU/g,大肠埃希菌、肠球菌数量分别为(6.24±0.87)log CFU/g、(8.08±0.85)log CFU/g,明显少于对照组的(7.14±0.93)log CFU/g、(8.91±0.88)log CFU/g,差异均有统计学意义(P<0.05);治疗2周后,研究组患者的外周血CD3^(+)、CD4^(+)/CD8^(+)及血清IgA、IgG水平分别为(70.83±7.45)%、2.65±0.31、(2.53±0.64)μg/L、(9.98±2.21)μg/L,明显高于对照组的(65.18±7.19)%,2.21±0.33、(2.11±0.59)μg/L、(8.36±2.04)μg/L,差异均有统计学意义(P<0.05);治疗2周后,研究组患者的血清MDA、4-HNE、CRP、IL-6水平分别为(4.28±1.01)μmol/L、(10.67±2.18)mg/L、(35.81±10.25)mg/L、(22.56±5.38)pg/mL,明显低于对照组的(6.35±1.17)μmol/L、(13.05±2.42)mg/L、(44.56±11.73)mg/L、(26.91±6.14)pg/mL,差异均有统计学意义(P<0.05);治疗2周后,研究组患者的APACHEⅡ、CPIS评分分别为(8.25±1.76)分、(2.91±0.83)分,明显低于对照组的(9.61±1.89)分、(3.82±0.97)分,差异均有统计学意义(P<0.05);治疗期间研究组患者的不良反应总发生率为8.16%,略低于对照组的12.24%,但差异无统计学意义(P>0.05)。结论益生菌辅助乳果糖治疗老年重症肺炎能更有效改善患者肠道菌群、免疫功能,明显提高治疗效果,且具有一定安全性。

Objective To explore the therapeutic effect of probiotics-assisted lactulose in the treatment of se-vere pneumonia in the elderly,and to verify its clinical effect through the improvement of intestinal flora and immune function.Methods A total of 98 elderly patients with severe pneumonia admitted to the First Affiliated Hospital of Zhengzhou University from May 2022 to May 2023 were selected as the research subjects and randomly divided into a study group and a control group,each with 49 cases.Both groups received basic treatment after admission.On this basis,the control group was given lactulose treatment,while the study group was given probiotics-assisted lactulose treatment,both for 2 weeks.After the treatment,the therapeutic effects and symptom relief time of the two groups of patients were compared,as well as the changes in intestinal flora,immune function indicators[T lymphocyte subsets(CD3^(+),CD4^(+)/CD8^(+)),immunoglobulin(Ig)A,IgG],inflammatory-stress factors[malondialdehyde(MDA),4-hydroxynonenal(4-HNE),C-re-active protein(CRP),interleukin-6(IL-6)],acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ),and clinical pulmonary infection score(CPIS)before and after treatment.The adverse reactions of the two groups of patients during the treatment were also compared.Results The total effective rate of treatment in the study group was 89.80%,which was significantly higher than 73.47%in the control group(P<0.05).The relief time of cough,expectoration,fever,chest tightness,and shortness of breath in the study group was significantly shorter than that in the control group(P<0.05).After 2 weeks of treatment,the number of bifidobacteria and lactobacilli in the study group was(9.79±0.76)log CFU/g and(9.05±0.67)log CFU/g,respectively,which was significantly higher than(8.84±0.81)log CFU/g and(8.61±0.62)log CFU/g in the control group,and the number of Escherichia coli and enterococci was(6.24±0.87)log CFU/g and(8.08±0.85)log CFU/g,respectively,which was significantly lower than(7.14±0.93)log CFU/g and(8.91±0.88)log CFU/g in the control group,with statistically significant differences(P<0.05).After 2 weeks of treatment,the levels of CD3^(+),CD4^(+)/CD8^(+),serum IgA,and IgG in the study group were(70.83±7.45)%,2.65±0.31,(2.53±0.64)μg/L,and(9.98±2.21)μg/L,respectively,which were significantly higher than(65.18±7.19)%,2.21±0.33,(2.11±0.59)μg/L,and(8.36±2.04)μg/L in the control group(P<0.05).After 2 weeks of treatment,the levels of serum MDA,4-HNE,CRP,and IL-6 in the study group were(4.28±1.01)μmol/L,(10.67±2.18)mg/L,(35.81±10.25)mg/L,and(22.56±5.38)pg/mL,respectively,which were significantly lower than(6.35±1.17)μmol/L,(13.05±2.42)mg/L,(44.56±11.73)mg/L,and(26.91±6.14)pg/mL in the control group(P<0.05).After 2 weeks of treatment,the APACHEⅡand CPIS scores in the study group were(8.25±1.76)points and(2.91±0.83)points,respectively,which were significant-ly lower than(9.61±1.89)points and(3.82±0.97)points in the control group(P<0.05).During the treatment period,the total incidence rate of adverse reactions in the study group was 8.16%,which was slightly lower than 12.24%in the control group(P>0.05).Conclusion Probiotics-assisted lactulose in the treatment of elderly patients with se-vere pneumonia can more effectively improve the intestinal flora and immune function,significantly improve the thera-peutic effect,and has a certain safety.