双歧杆菌四联活菌片联合曲美布汀对糖尿病性腹泻患者胃肠动力及肠道菌群的影响

Influence of Tetrad Live Bifidobacterium tablets combined with Trimebutine on gastrointestinal motility and intestinal flora of patients with diabetic diarrhea

目的探讨双歧杆菌四联活菌片联合曲美布汀对糖尿病性腹泻(DD)患者胃肠动力及肠道微生态的影响。方法将78例DD患者随机分为联合组(n=39)和对照组(n=39)。两组患者均继续予以调整饮食和药物控制血糖等基础治疗。联合组患者予以曲美布汀联合双歧杆菌四联活菌片进行治疗,对照组单用曲美布汀进行治疗,剂量和用法同联合组,两组患者均连用8周。观察两组患者治疗前后胃肠动力[口—结肠转运时间(OCTT)]、胃肠激素[胃动素(MTL)和生长抑素(SS)]及肠道菌群(双歧杆菌、乳杆菌、肠杆菌和肠球菌)的变化,并比较其临床效果。结果与治疗前相比,治疗后两组患者OCTT时间显著延长,血清MTL显著下降,血清SS显著上升(P<0.05),且联合组患者各指标变化幅度较对照组更显著(P<0.05)。两组患者肠道双歧杆菌和乳杆菌数量较治疗前显著增加,肠杆菌和肠球菌数量较治疗前显著减少(P<0.05),且联合组变化幅度较对照组更显著(P<0.05)。治疗8周后,联合组患者临床总有效率高于对照组(94.87%vs 79.49%,χ~2=4.13,P<0.05)。联合组和对照组患者分别发生不良反应4例和2例,症状均较轻,两组比较差异无统计学意义(χ~2=0.18,P>0.05)。结论曲美布汀联合双歧杆菌四联活菌片对DD患者的临床疗效确切,安全性较高,其作用机制可能为通过调节胃肠激素紊乱,改善肠道微生态失调,从而延缓胃肠排空、缓解腹泻症状。

Objective To discuss the influence of Tetrad Live Bifidobacterium tablets combined with Trimebutine on gastrointestinal motility and intestinal flora of patients with diabetic diarrhea(DD).Methods 78 patients with DD were randomly divided into the combination group(n=39)or control group(n=39).Both groups were given the same basic treatment;the patients in combination group were given Trimebutine combined with Tetrad Live Bifidobacterium tablets,while those in control group were given the same dose of Trimebutine alone.The treatment course was 8 weeks.The changes of gastrointestinal motility[oral-colon transit time(OCTT)],gastrointestinal hormone[motilin(MTL)and somatostatin(SS)]and intestinal flora(Bifidobacteria,Lactobacilli,Enterobacteriaceae and Enterococci)of patients in both groups were observed,and the clinical effect was compared between groups.Results After 8 weeks of treatment,the OCTT in both groups increased,the serum MTL greatly declined,while the serum SS greatly rose(Ps<0.05);the changes in combination group were more significant than those in control group(Ps<0.05).The quantities of bifidobacteria and lactic acid bacteria greatly increased,while those of enterobacteriaceae and enterococci greatly declined(Ps<0.05),with combination group superior to control group(Ps<0.05).The total clinical efficiency rate in combination group was higher than that in control group(94.87%vs 79.49%,χ~2=4.13,P<0.05).4 and 2 cases of untoward effects appeared in combination group and control group respectively with mild symptoms;the difference between the two groups was not significant(χ~2=0.18,P>0.05).Conclusion Trimebutine combined with Tetrad Live Bifidobacterium tablets has reliable curative effect on patients with DD with high safety,the mechanism of action of which may be related to the delayed gastric emptying and remission of the diarrhea symptoms by adjusting the disorder of gastrointestinal hormone and improving the disequilibrium of intestinal microecology.