蒙脱石散联合酪酸梭菌二联活菌散剂对急性腹泻伴发热患儿肠道菌群平衡、肠屏障功能及免疫功能的影响

Effect of montmorillonite powder combined with probiotics on intestinal flora balance,intestinal barrier function and immune function in children with acute diarrhea and fever

目的观察蒙脱石散联合益生菌治疗急性腹泻伴发热患儿的临床疗效,及对肠道菌群平衡、肠屏障功能及免疫功能的影响。方法选取2021年10月—2023年10月齐齐哈尔市中医医院接诊的急性腹泻伴发热患儿118例,通过计算机产生随机数字表法均等分为联合组(蒙脱石散联合益生菌治疗)、单用组(蒙脱石散治疗)各59例。单用组在常规治疗的基础上给予蒙脱石散治疗,1岁以下每日1袋,≥1、≤2岁每日1~2袋,>2岁每日2~3袋,温水摇匀后冲服,首次剂量加倍。联合组在单用组的基础上加用酪酸梭菌二联活菌散剂,每次1袋,每天2次,凉开水摇匀后冲服。两组均治疗7 d。比较两组恢复速度、治疗效果;比较两组治疗前后肠道菌群平衡、肠屏障功能及免疫功能。结果联合组退热、大便性状改善、止泻、肠鸣音恢复时间均短于单用组(P<0.05、0.001);联合组治疗总有效率高于单用组(88.14%vs 72.88%,P<0.05)。两组治疗前双歧杆菌(B)、乳酸杆菌(E)、肠杆菌数量及B/E比值比较,差异无统计学意义;治疗后联合组肠杆菌数量低于单用组(P<0.05),B和E的数量及B/E值均高于单用组(P<0.05、0.001)。两组治疗前二胺氧化酶(DAO)、脂多糖结合蛋白(LBP)、D-乳酸比较,差异无统计学意义;治疗后联合组DAO、LBP、D-乳酸均低于单用组(P<0.001)。两组治疗前外周血CD4^(+)、CD8^(+)T淋巴细胞占比、CD4^(+)/CD8^(+)比较,差异无统计学意义;治疗后联合组外周血CD4^(+)T淋巴细胞占比、CD4^(+)/CD8^(+)均高于单用组(P<0.001),CD8^(+)T淋巴细胞占比均低于单用组(P<0.001);两组均无明显不良反应。结论蒙脱石散联合益生菌可促进急性腹泻伴发热患儿恢复,改善治疗效果,促进肠道菌群平衡,增强肠屏障功能及免疫功能,且安全性高。

Objective To observe the clinical efficacy of montmorillonite powder combined with probiotics in children with acute diarrhea and fever,and its effect on intestinal flora balance,intestinal barrier function and immune function.Methods One hundred eighteen children with acute diarrhea and fever admitted to Qiqihar Hospital of traditional Chinese Medicine from October 2021 to October 2023 were randomly divided into two groups by computer-generated random number table:combination group and monotherapy group,59 cases in each group.The monotherapy group was given montelukast on the basis of conventional treatment,1 sachet per day for less than 1 year old,1—2 sachets per day for 1—2 years old,and 2—3 sachets per day for>2 years old,shaken well with warm water,and the first dose was doubled.In the combination group,Clostridium typhimurium was added on the basis of the single-use group,1 sachet each time,2 times a day,shaken well with cool boiled water and then taken.Both groups were treated for seven days.The recovery speed and therapeutic effect of two groups were compared.The intestinal flora balance,intestinal barrier function and immune function of the two groups before and after treatment were compared.Results The combination group had shorter time of fever reduction,stool improvement,diarrhea cessation and bowel sound recovery than those in the monotherapy group(P<0.05,0.001).The combination group had higher total effective rate than that in the monotherapy group(88.14%vs 72.88%,P<0.05).After treatment,the combination group had lower number of enterobacteria than the monotherapy group(P<0.05),higher number of bifidobacteria,lactobacilli and B/E ratio than the monotherapy group(P<0.05,0.001).After treatment,the combination group had lower levels of diamine oxidase(DAO),lipopolysaccharide binding protein(LBP)and D-lactic acid than the monotherapy group(P<0.001).After treatment,the combination group had higher percentage of peripheral blood CD4^(+)T lymphocytes and CD4^(+)/CD8^(+)than those in the monotherapy group(P<0.001),lower percentage of CD8^(+)T lymphocytes than the monotherapy group(P<0.001).No obvious adverse reactions were observed in both groups.Conclusion Montmorillonite powder combined with probiotics can promote the recovery of children with acute diarrhea and fever,improve the therapeutic effect,intestinal flora balance,intestinal barrier function and immune function,and have high safety.