经肠镜右半结肠单次喷洒益生菌混悬液对腹泻型肠易激综合征的疗效及安全性

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摘要目的探讨经肠镜在右半结肠单次喷洒双歧杆菌三联活菌混悬液联合口服匹维溴铵对腹泻型肠易激综合征患者的疗效、肠道菌群和血清炎性因子的影响。方法选取2017-01至2018-03收治的腹泻型肠易激综合征患者60例,随机分为对照组(口服匹维溴铵),观察A组(口服匹维溴铵+单次喷洒1.6×10⁸CFU的双歧杆菌三联活菌混悬液),观察B组(口服匹维溴铵+单次喷洒1.6×10⁹CFU的双歧杆菌三联活菌混悬液),每组20例,疗程均为4周。比较三组患者的疗效、治疗前后肠道菌群及血清IL-10、IL-18和TNF-α水平变化。结果观察B组疗效优于对照组(90.0% vs 55.0%,P＜0.05);停药4周后,观察B组复发率显著低于对照组和观察A组,差异均具有统计学意义(分别为11.1% vs 45.5%,P＜0.05;11.1% vs 46.7%,P＜0.05)。观察A组和观察B组患者乳酸杆菌、双歧杆菌和类杆菌均较治疗前明显增加(P＜0.05),而大肠杆菌及粪肠球菌则较治疗前显著降低(P＜0.05),且三组中观察B组肠道菌群改善最为明显(P＜0.05)。治疗4周后,观察B组血清IL-18及TNF-α水平较对照组和观察A组均明显降低(P＜0.05),而血清IL-10水平较对照组和观察A组则显著升高(P＜0.05)。三组在治疗期间均无明显不良反应。结论经肠镜于右半结肠单次喷洒双歧杆菌三联活菌混悬液(总菌数为1.6×10⁹CFU)联合口服匹维溴铵,可有效治疗IBS-D,降低复发率,其作用和机制可能与改善患者的肠道菌群和免疫功能有关。

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关键词 ：腹泻型肠易激综合征, 益生菌, 肠镜, 疗效, 肠道菌群, 免疫功能

Abstract：Objective To explore the influence of bifid triple viable introduced into the right colon combined with oral pivavironium by enteroscopy on the curative effect, intestinal microflora and inflammatory factors in patients with diarrhea predominant irritable bowel syndrome. Methods Sixty patients with IBS-D who were treated in our hospital between January 2017 to March 2018 were randomly divided into the control group (pibebronium bromide), observation group A (pinaverium bromide + total bifid triple viable 1.6×10⁸ CFU) ,and observation group B (pinaverium bromide + total bifid triple viable 1.6×10⁹ CFU) , with 20 cases in each group. The course of treatment was 4 weeks. The efficacy, intestinal flora before and after treatment and serum IL-10, IL-18 and TNF-a levels were compared between the three groups. Results The curative effect of group B was higher than that of control group (90.0% vs 55.0%, P＜0.05). After 4 weeks of withdrawal, the recurrence rate of group B was significantly lower than that of control group and observation group A, and the difference was statistically significant (respectively). (Lactic acid bacteria, bifidobacteria and bacteroides were significantly increased in group A and group B after treatment (P＜0.05), while E. coli and E. faecalis were significantly lower after treatment (P＜0.05). In these three groups, the intestinal flora in group B were most obviously improved (P＜0.05). After 4 weeks of treatment, the serum levels of IL-18 and TNF-a in group B were significantly lower than those in the control group and group A (P＜0.05), while the serum IL-10 levels were significantly higher than those in the control group (P＜0.05). None of the three groups experienced significant adverse reactions during the treatment. Conclusions The single spraying of bifidobacterium triple viable cell suspension (1.6×10⁹ CFU total) in the right colon combined with oral pinaverium bromide can be used to treat IBS-D effectively and reduce the recurrence rate. The mechanism may be related to improvement of the patients’ intestinal flora and immune function.

Key words： diarrhea-predominant irritable bowel syndrome probiotics enteroscopy efficacy intestinal flora immune function

收稿日期: 2018-08-24

ZTFLH:

R574.4

通讯作者: 潘琦,E-mail:donglimin12@126.com

作者简介: 刘芊,硕士,主治医师。

引用本文:

刘芊, 潘琦. 经肠镜右半结肠单次喷洒益生菌混悬液对腹泻型肠易激综合征的疗效及安全性[J]. 武警医学, 2019, 30(4): 329-333. LIU Qian, PAN Qi. Influence of probiotics introduced into the right colon by enteroscopy on the curative effect, intestinal microflora and inflammatory factors in patients with diarrhea predominant irritable bowel syndrome. Med. J. Chin. Peop. Armed Poli. Forc., 2019, 30(4): 329-333.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2019/V30/I4/329

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