切换至 "中华医学电子期刊资源库"
高级检索
中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 410 -414. doi: 10.3877/cma.j.issn.1674-0785.2022.05.007

临床研究

益生菌辅助治疗小儿支气管肺炎相关腹泻及其对肠道菌群改善的效果
刘宇1,†(), 王宁1, 李丹1, 张波1   
  1. 1. 063000　唐山，唐山市工人医院儿科
  • 收稿日期:2021-09-02 出版日期:2022-05-15
  • 通信作者: 刘宇

Probiotics for adjuvant treatment of diarrhea associated with bronchopneumonia in children: efficacy and impact on intestinal flora

Yu Liu1,†(), Ning Wang1, Dan Li1, Bo Zhang1   

  1. 1. Department of Pediatrics, Tangshan Workers Hospital, Tangshan 063000, China
  • Received:2021-09-02 Published:2022-05-15
  • Corresponding author: Yu Liu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

刘宇, 王宁, 李丹, 张波. 益生菌辅助治疗小儿支气管肺炎相关腹泻及其对肠道菌群改善的效果[J/OL]. 中华临床医师杂志(电子版), 2022, 16(05): 410-414.

Yu Liu, Ning Wang, Dan Li, Bo Zhang. Probiotics for adjuvant treatment of diarrhea associated with bronchopneumonia in children: efficacy and impact on intestinal flora[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(05): 410-414.

目的

探讨益生菌辅助治疗小儿支气管肺炎相关腹泻的效果及其肠道菌群改善。

方法

将2019年7月至2021年8月就诊于唐山市工人医院的148例小儿支气管肺炎相关腹泻患儿纳入本研究，按随机数字表法分为对照组和研究组。对照组74例，男39例，女35例；年龄（1.56±0.67）岁（1~3岁）。研究组74例，男40例，女34例；年龄（2.14±0.68）岁（0~3岁）。对照组采用常规治疗，即维持水电解质平衡、补液、抗感染、抗菌等对症治疗，并给予蒙脱石散口服。研究组在对照组基础上采用益生菌辅助治疗。比较两组临床疗效、症状缓解时间、肠道菌群、炎性因子、免疫功能等指标。

结果

研究组治疗总有效率为94.59%比对照组的83.78%高，差异有统计学意义（P＜0.05）。研究组大便性状恢复正常时间［（2.44±0.29）d］、大便次数恢复正常时间［（3.43±0.59）d］、止泻时间［（3.17±0.50）d］均比对照组［（3.11±0.41）d、（4.16±0.79）d、（3.92±0.62）d］低，差异均有统计学意义（均P＜0.05）。研究组治疗5d后肠道双歧杆菌、乳酸杆菌、类杆菌、粪肠球菌水平均比对照组高，肠杆菌均比对照组低（均P＜0.05）。研究组治疗5 d后血清白细胞介素-6（IL-6）、白细胞介素-17（IL-17）、C反应蛋白（CRP）水平均比对照组低，免疫球蛋白M（IgM）、免疫球蛋白A（IgA）、免疫球蛋白G（IgG）均比对照组高（均P＜0.05）。

结论

双歧杆菌三联活菌用于小儿支气管肺炎相关腹泻患儿的辅助治疗可提高治疗效果，缩短症状缓解时间，改善肠道菌群和免疫功能，缓解肠道炎症。

关键词: 支气管肺炎, 小儿, 腹泻, 益生菌, 肠道菌群, 免疫功能
Objective

To investigate the efficacy of probiotics in the adjuvant treatment of bronchopneumonia related diarrhea in children and the improvement of intestinal flora.

Methods

In this study, 148 children with infantile bronchopneumonia associated diarrhea who were admitted to Tangshan Workers Hospital from July to August 2019 were divided into either a control group or a study group according to the random number table method, with 74 cases in each group. There were 39 males and 35 females in the control group, with an average age of (1.56±0.67) years (range: 1-3 years). There were 40 males and 34 females in the study group, with an average age of (2.14±0.68) years (range: 0-3 years). The control group was treated with routine therapy, such as maintaining water-electrolyte balance, rehydration, anti-infection, and anti-bacterial therapy. The study group was treated with probiotics on the basis of the routine therapy. The clinical efficacy, time to symptom remission, intestinal flora, inflammatory factors, and immune function were compared between the two groups.

Results

The total effective rate of the study group was 94.59%, and it was 83.78% in the control group; the difference between them was statistically significant (P＜0.05). The time to recovery of stool characteristics [(2.44±0.29) d], time to return of stool frequency to normal [(3.43±0.59) d], and time to disappearance of diarrhea [(3.17±0.50) d] in the study group were significantly shorter than those of the control group [(3.11±0.41) d, (4.16±0.79) d, and (3.92±0.62) d, respectively; P＜0.05). After 5 days of treatment, the levels of intestinal bifidobacteria, lactobacillus, bacteroides, and enterococcus faecalis in the study group were all higher than those in the control group, and the level of enterobacter was lower than that in the control group (P＜0.05). After 5 days of treatment, the levels of serum interleukin-6, interleukin-17, and C-reactive protein in the study group were all lower than those in the control group, but the levels of immunoglobulin (Ig) M, IgA, and IgG were all higher than those in the control group (P＜0.05).

Conclusion

Bifidobacterium triple viable bacteria used in the adjuvant treatment of children with bronchopneumonia related diarrhea can improve the therapeutic effect, shorten the time to symptom relief, improve intestinal flora and immune function, and alleviate intestinal inflammation.

Key words: Bronchopneumonia, Children, Diarrhea, Probiotics, Intestinal flora, Immunity
表1 两组小儿支气管肺炎相关腹泻患儿症状缓解时间对比（n=74，
xˉ
±s，d）
组别 大便性状恢复正常时间 止泻时间 大便次数恢复正常时间
对照组 3.11±0.41 3.92±0.62 4.16±0.79
研究组 2.44±0.29 3.17±0.50 3.43±0.59
t值 11.477 8.100 6.369
P值 ＜0.001 ＜0.001 ＜0.001
表2 两组小儿支气管肺炎相关腹泻患儿治疗前后肠道菌群对比（n=74，
xˉ
±s，LogCFU/g）
组别 双歧杆菌 乳酸杆菌 肠杆菌 粪肠球菌 类杆菌
治疗前 治疗5 d后 治疗前 治疗5 d后 治疗前 治疗5 d后 治疗前 治疗5 d后 治疗前 治疗5 d后
对照组 7.02±1.24 7.51±1.28 5.84±0.70 6.02±0.74 12.16±1.68 11.87±1.60 8.87±1.32 8.52±1.27 7.41±1.22 7.83±1.18
研究组 7.10±1.21 9.36±1.55a 5.90±0.77 6.81±0.90a 12.24±1.66 8.57±1.48a 8.93±1.36 9.58±1.06a 7.37±1.18 9.49±1.41a
t值 0.397 7.917 0.496 5.833 0.291 13.025 0.272 5.512 0.203 7.767
P值 0.692 ＜0.001 0.621 ＜0.001 0.771 ＜0.001 0.786 ＜0.001 0.839 ＜0.001
表3 两组小儿支气管肺炎相关腹泻患儿血清炎性因子比较（n=74，
xˉ
±s，ng/L）
组别 IL-6 IL-17 CRP
治疗前 治疗5 d后 治疗前 治疗5 d后 治疗前 治疗5 d后
对照组 25.09±5.21 11.51±3.29a 29.98±5.30 15.67±4.03a 27.61±4.92 18.44±4.46a
研究组 24.87±5.16 9.80±2.69a 30.16±5.38 13.89±2.64a 27.82±4.88 15.22±4.09a
t值 0.258 3.461 0.205 3.178 0.261 4.577
P值 0.797 0.001 0.838 0.002 0.794 ＜0.001
表4 两组两组小儿支气管肺炎相关腹泻患儿免疫功能对比（n=74，
xˉ
±s，g/L）
组别 IgM IgA IgG
治疗前 治疗5 d后 治疗前 治疗5 d后 治疗前 治疗5 d后
对照组 1.46±0.33 1.50±0.39 0.83±0.18 1.22±0.33a 8.13±1.53 12.25±2.39a
研究组 1.43±0.34 1.74±0.46a 0.81±0.19 1.39±0.38a 8.17±1.60 14.29±2.57a
t值 0.545 3.423 0.657 2.906 0.155 5.000
P值 0.587 0.001 0.512 0.004 0.877 ＜0.001
1
周华, 姜源渊, 吴斌, 等. 布拉氏酵母菌对儿童抗生素相关性腹泻预防与治疗的Meta分析[J]. 湖北医药学院学报, 2016, 35(6):547-552,556. DOI: 10.13819/j.issn.1006-9674.2016.06.005.
2
何小双. 布拉氏酵母菌治疗小儿支气管肺炎继发腹泻患儿的临床研究[J]. 贵州医药, 2020, 44(9):1436-1438. DOI: 10.3969/j.issn.1000-744X.2020.09.048.
3
You C, Ran G, Wu X, et al. High immunoglobulin E level is associated with increased readmission in children with bronchopneumonia[J]. Ther Adv Respir Dis, 2019, 13:1753466619879832. DOI: 10.1177/1753466619879832.
4
Brennan AT, Bonawitz R, Gill CJ, et al. A meta-analysis assessing diarrhea and pneumonia in HIV-exposed uninfected compared with hiv-unexposed uninfected infants and children[J]. J Acquir Immune Defic Syndr, 2019, 82(1):1-8. DOI: 10.1097/QAI.0000000000002097.
5
杜春艳, 王春晖. 不同益生菌对新生儿抗生素相关性腹泻肠道菌群平衡的影响[J]. 实用临床医药杂志, 2020, 24(19):34-36,40. DOI: 10.7619/jcmp.202019010.
6
洪庆成. 实用儿科新诊疗[M]. 上海交通大学出版社, 2011.
7
郑跃杰, 武庆斌, 方峰, 等. 儿童抗生素相关性腹泻诊断、治疗和预防专家共识[J]. 中华实用儿科临床杂志, 2021, 36(6):424-430. DOI: 10.3760/cma.j.cn101070-20210201-00137.
8
中华医学会儿科学分会消化学组, 中华医学会儿科学分会感染学组, 《中华儿科杂志》编辑委员会. 儿童腹泻病诊断治疗原则的专家共识[J]. 中华儿科杂志, 2009, 47(8):634-636. DOI: 10.3760/cma.j.issn.0578-1310.2009.08.018.
9
Batra P, Soni KD, Mathur P. Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials[J]. J Intensive Care, 2020, 8:81. DOI: 10.1186/s40560-020-00487-8.
10
Mantegazza C, Molinari P, D'Auria E, et al. Probiotics and antibiotic-associated diarrhea in children: a review and new evidence on Lactobacillus rhamnosus GG during and after antibiotic treatment[J]. Pharmacol Res, 2018, 128:63-72. DOI: 10.1016/j.phrs.2017.08.001.
11
忽欣怡, 李雲, 李学尧, 等. 小儿感染性腹泻病因研究进展[J]. 临床军医杂志, 2021, 49(1):114-116. DOI: 10.16680/j.1671-3826.2021.01.41.
12
Mahmoodpoor A, Hamishehkar H, Asghari R, et al. Effect of a probiotic preparation on ventilator-associated pneumonia in critically ill patients admitted to the intensive care unit: a prospective double-blind randomized controlled trial[J]. Nutr Clin Pract, 2019, 34(1):156-162. DOI: 10.1002/ncp.10191.
13
Xiao Y, Zhao J, Zhang H, et al. Mining Lactobacillus and Bifidobacterium for organisms with long-term gut colonization potential[J]. Clin Nutr, 2020, 39(5):1315-1323. DOI: 10.1016/j.clnu.2019.05.014.
14
吕志发, 杜虎, 王辉. 益生菌辅助四联方案根除幽门螺杆菌的疗效研究[J]. 临床内科杂志, 2018, 35(9):636-637. DOI: 10.3969/j.issn.1001-9057.2018.09.020.
15
Barengolts E, Smith ED. Considerations for gut microbiota and probiotics in patients with diabetes amidst the Covid-19 pandemic: a narrative review[J]. Endocr Pract, 2020, 26(10):1186-1195. DOI: 10.4158/EP-2020-0336.
16
Cukrowska B, Bierła JB, Zakrzewska M, et al. The relationship between the infant gut microbiota and allergy. the role of bifidobacterium breve and prebiotic oligosaccharides in the activation of anti-allergic mechanisms in early life[J]. Nutrients, 2020, 12(4)DOI: 10.3390/nu12040946.
17
Sakanaka M, Gotoh A, Yoshida K, et al. Varied pathways of infant gut-associated bifidobacterium to assimilate human milk oligosaccharides: prevalence of the gene set and its correlation with bifidobacteria-rich microbiota formation[J]. Nutrients, 2019, 12(1)DOI: 10.3390/nu12010071.
18
杨洋, 赵勇. 丙氨酰谷氨酰胺及双歧杆菌三联活菌胶囊在结直肠癌术后辅助化疗中对肠道屏障功能的影响[J]. 中国现代医学杂志, 2020, 30(15):79-84. DOI: 10.3969/j.issn.1005-8982.2020.15.015.
19
时晓光, 张薇莉, 赵隽. 双歧杆菌四联活菌片联合小剂量红霉素治疗小儿功能性消化不良的疗效及对胃动素水平的影响[J]. 中国医师进修杂志, 2021, 44(6):538-542. DOI: 10.3760/cma.j.cn115455-20201118-01613.
20
Agamennone V, Krul C, Rijkers G, et al. A practical guide for probiotics applied to the case of antibiotic-associated diarrhea in The Netherlands[J]. BMC Gastroenterol, 2018, 18(1):103. DOI: 10.1186/s12876-018-0831-x.
21
Uusitupa HM, Rasinkangas P, Lehtinen MJ, et al. Bifidobacterium animalis subsp. lactis 420 for metabolic health: review of the research[J]. Nutrients, 2020, 12(4):892. DOI: 10.3390/nu12040892.
22
赵晓青. 益生菌对支气管肺炎患儿继发性腹泻的防治效果及对胃肠功能的影响分析[J]. 山西医药杂志, 2020, 49(3):257-259. DOI: 10.3969/j.issn.0253-9926.2020.03.005.
23
Vitetta L, Vitetta G, Hall S. Immunological tolerance and function: associations between intestinal bacteria, probiotics, prebiotics, and phages[J]. Front Immunol, 2018, 9:2240. DOI: 10.3389/fimmu.2018.02240.
[1] 杨瑾, 刘雪克, 张媛媛, 金钧, 韦瑶. 肠道微生物来源石胆酸对脓毒症相关肝损伤的保护作用[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 265-274.
[2] 戴睿, 张亮, 陈浏阳, 张永博, 吴丕根, 孙华, 杨盛, 孟博. 肠道菌群与椎间盘退行性变相关性的研究进展[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 546-549.
[3] 李嘉兴, 孙乙文, 李文星. NLRP3炎性小体在急性胰腺炎中作用的研究进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 300-304.
[4] 李玲, 刘亚, 李培玲, 张秀敏, 李萍. 直肠癌患者术后肠道菌群的变化与抑郁症相关性研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 607-610.
[5] 杨小栎, 李万富, 马柱, 马兰, 郑义, 付晓丽, 王晶. 钳式针一步法在小儿腹腔镜疝囊高位结扎术中的应用效果[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 535-538.
[6] 王雪玲, 曹欢, 顾劲扬. 肠道菌群在器官缺血再灌注损伤中的作用及机制研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 247-250.
[7] 方道成, 唐春华, 胡媛媛. 肠道菌群对草酸钙肾结石形成的影响[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 509-513.
[8] 胡菊英, 李银华, 洪兰, 王宏勇, 丁先军, 李承美, 谭心海. 儿童感染大叶性肺炎与支气管肺炎临床特征分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 813-816.
[9] 刘春军, 严方方, 王宝锋, 常婷婷, 郭红红, 李志强. 替加环素联合人免疫球蛋白治疗XDRAB致VAP 的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 797-800.
[10] 白若靖, 郭军. 维生素D对肺部疾病临床意义的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 659-662.
[11] 蔡艺丹, 方坚, 张志强, 陈莉, 张世安, 夏磊, 阮梅, 李东良. 经颈静脉肝内门体分流术对肝硬化门脉高压患者肠道菌群及肝功能的影响[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 285-293.
[12] 韩俊岭, 王刚, 马厉英, 连颖, 徐慧. 维生素D 联合匹维溴铵治疗腹泻型肠易激综合征患者疗效及对肠道屏障功能指标的影响研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 560-564.
[13] 宋燕秋, 戚桂艳, 杨双双, 周萍. 重症急性胰腺炎肠道菌群特征及早期肠内营养联合微生态制剂治疗的临床价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 442-447.
[14] 邱岭, 朱旭丽, 浦坚, 邢苗苗, 吴佳玲. 糖尿病肾病患者肠道菌群生态特点与胃肠道功能障碍的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 453-458.
[15] 赵小民, 杨军, 田巍巍. 枳术颗粒联合利那洛肽治疗便秘型肠易激综合征的临床研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 465-469.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号