益生菌联合抗幽门螺杆菌治疗对 消化性溃疡患者的疗效

目的探讨益生菌联合抗幽门螺杆菌(H.pylori)治疗对消化性溃疡患者的疗效及其对患者肠道菌群的影响。方法将120例经14 C呼气试验(14 C-UBT)检测确定为H.pylori感染阳性的消化性溃疡患者随机分为观察组和对照组,每组60例。其中,对照组采用四联疗法(奥美拉唑+阿莫西林+克拉霉素+铋剂)治疗,观察组采用四联疗法联合益生菌治疗;比较两组患者H.pylori根除情况、溃疡愈合质量及不良反应情况。治疗前后留取全部患者的新鲜粪便标本进行细菌培养,比较两组患者肠道菌群数量和肠道微生物定植抗力(B/E值)。结果观察组患者H.pylori根除率和溃疡愈合率分别为88.3%、95.0%,显著高于对照组的70.0%和76.7%(P0.05),不良反应率为3.3%,显著低于对照组的20.0%(P0.05)。与治疗前比,对照组患者治疗后肠道内产气荚膜梭菌、双歧杆菌及乳杆菌数量显著减少(P0.05),肠杆菌、肠球菌及酵母菌数量显著增加(P0.05),B/E值显著降低(P0.05);观察组患者治疗后双歧杆菌和乳杆菌数量均显著增加(P0.05),产气荚膜梭菌数量显著减少(P0.05),肠杆菌、肠球菌及酵母菌数量无明显变化(P0.05),B/E值显著升高(P0.05)。结论常规抗H.pylori治疗易引起消化性溃疡患者肠道菌群紊乱,降低肠道定植抗力。益生菌联合治疗可有效改善患者肠道微生态,提高H.pylori根除率和溃疡愈合质量,减少不良反应。

Efficacy of probiotics combined with anti-Helicobacter pylori treatment in patients with peptic ulcer

Abstract: Objective To investigate the efficacy of probioticscombined with anti-Helicobacter pylori treatment in patients with peptic ulcer and the effect on intestinal flora. Methods 120 cases of H. pylori-positive peptic ulcer determined by 14C-urea breath test (14C-UBT) were randomly divided into observation group (n=60) or control group (n=60). The control group was treated with quadruple chemotherapy (Omeprazole, Amoxicillin, Clarithromycin and Bismuth), while the observation group was treated with the quadruple chemotherapy combined with probiotics. The H. pylori eradication rate, quality of ulcer healing and adverse reactions were compared between the two groups. Fresh stool specimen were collected from all the patients before and after treatment for bacterial culturing. Then the intestinal flora, intestinal colonization resistance (ratio of B/E) and intestinal immune function were compared between the two groups. Results The H. pylori eradication rate and ulcer healing rate in the observation group were 88.3% and 95.0%, respectively, significantly higher than the 70.0% and 76.7% in the control group (Ps<0.05), while the adverse reaction rate (3.3%) in the observation group was significantly lower than that in the control group (20.0%) (P<0.05). In the control group, the numbers of Clostridium perfringens, Bifidobacteria and Lactobacilli after treatment were significantly less (P<0.05), while those of Escherichia coli, Enterococcus and Yeasts were significantly more than those before treatment (Ps<0.05), respectively, and the ratio of B/E was significantly lower than that before treatment (P<0.05). In the observation group, the numbers of Bifidobacteria and Lactobacilli increased significantly (P<0.05), while that of Clostridium perfringens decreased significantly (P<0.05) after treatment; There were no obvious changes in Escherichia coli, Enterococci and Yeasts (P>0.05), but the ratio of B/E was significantly higher than that before treatment (P<0.05). Conclusion Conventional anti H. pylori therapy is prone to causing intestinal flora disorder and reducing intestinal colonization resistance and immune function in patients with peptic ulcer. When combined with probiotics, it can effectively improve intestinal microecosystem, H. pylori eradication rate and quality of ulcer healing, and reduce adverse reactions.