微生态制剂辅助四联疗法治疗Hp阳性胃溃疡患者的疗效及对免疫应答的影响

Efficacy of microecologics combined with quadruple therapy in the treatment of Hp-positive gastric ulcer and its influence on immune response

摘要:

目的 分析微生态制剂辅助四联疗法治疗幽门螺杆菌（Hp）阳性胃溃疡患者的疗效及对免疫应答的影响。方法 选取2019年2月—2021年2月就诊于海南医学院第二附属医院的96例Hp阳性胃溃疡患者，按随机数表法分为对照组和治疗组，每组48例。对照组接受四联疗法，治疗组实施四联疗法+微生态制剂（双歧杆菌乳杆菌三联活菌片）治疗。观察两组疗效、Hp转阴率、复发率，并分析患者治疗前后组织病理情况、肠道菌群、免疫应答的变化。结果 治疗组治疗总有效率、Hp转阴率较对照组高，复发率较对照组低（P <0.05）。两组治疗前肠上皮化生、炎症反应、活动性及萎缩评分比较，差异无统计学意义（P >0.05）。治疗组治疗后肠上皮化生、炎症反应、活动性及萎缩评分较对照组低（P <0.05）。两组治疗前乳杆菌、双歧杆菌、肠球菌、肠杆菌水平比较，差异无统计学意义（P >0.05）。治疗组治疗后乳杆菌、双歧杆菌较对照组高，肠球菌、肠杆菌较对照组低（P <0.05）。两组治疗前CD4⁺T细胞、CD8⁺T细胞、NKT细胞及Treg、Breg、MDSC相对表达量比较，差异无统计学意义（P >0.05）。治疗组治疗后CD4⁺T细胞、CD8⁺T细胞、NKT细胞相对表达量较对照组高，Treg、Breg、MDSC相对表达量较对照组低（P <0.05）。结论 微生态制剂辅助四联疗法治疗Hp阳性胃溃疡患者的疗效明确，可促进Hp转阴，减轻炎症反应，调节肠道菌群，改善免疫应答，降低复发率。

Abstract:

Objective To analyze the efficacy of microecologics combined with quadruple therapy in the treatment of patients with Helicobacter pylori (Hp)-positive gastric ulcer and its influence on immune response.Methods A total of 96 patients with Hp-positive gastric ulcer who visited the Second Affiliated Hospital of Hainan Medical University from February 2019 to February 2021 were enrolled and randomly divided into two groups with 48 cases in each group. The control group received quadruple therapy, while the treatment group received quadruple therapy combined with microecologics (Live Combined Bifidobacterium, Lactobacillus and Enterococcus Tablets). The therapeutic efficacy, Hp negative conversion rate, and recurrence rate were observed, and changes of histopathology, gut microbiota and immune response before and after treatments were analyzed.Results The overall effective rate (91.67%) and Hp negative conversion rate (93.75%) of the treatment group were higher than those of the control group (77.08% and 72.92%, respectively), and the recurrence rate (6.25%) was lower than that of the control group (22.92%) (P < 0.05). There was no difference in scores of intestinal metaplasia, inflammatory response, activity of the foci, or gastric mucosal atrophy between the two groups prior to the treatments (P > 0.05). After treatment, the scores of intestinal metaplasia, inflammatory response, activity of the foci and gastric mucosal atrophy in the treatment group were lower than those of the control group (P < 0.05). As for the levels of Lactobacillus, Bifidobacterium, Enterococcus and Enterobacter before the treatment, no difference was observed between the groups (P > 0.05). After treatment, the levels of Lactobacillus and Bifidobacterium were higher in the treatment group than those in the control group, whereas the levels of Enterococcus and Enterobacter were lower compared with the control group (P < 0.05). Besides, the relative expression levels of CD4⁺T cells, CD8⁺T cells, NKT cells, Treg cells, Breg cells and MDSC were not different between the groups before the treatment (P > 0.05). However, after treatment, the contents of CD4⁺T cells, CD8⁺T cells, and NKT cells in the treatment group were higher than those in the control group, but the contents of Treg cells, Breg cells, and MDSC were lower compared with the control group (P < 0.05).Conclusions The microecologics combined with quadruple therapy is effective in the treatment of Hp-positive gastric ulcer. It can promote the negative conversion of Hp infection, ameliorate inflammatory reactions, regulate gut microbiota, improve immune response, and reduce recurrence rate.