微生态制剂结合抗幽门螺杆菌三联方案治疗儿童幽门螺杆菌阳性腹型过敏性紫癜的疗效分析

Effect of probiotics combined with anti-Hp on the treatment of children with Hp-positive abdominal allergic purpura

摘要:

目的 探讨微生态制剂结合抗幽门螺杆菌（Hp）三联方案治疗儿童Hp阳性腹型过敏性紫癜（AP）的疗效及对肠道菌群的影响。方法 回顾性分析2018年10月—2021年1月在唐山市工人医院就诊的110例Hp阳性腹型AP患儿的病历资料，根据是否给予微生态制剂分为对照组和观察组，每组55例。两组均接受抗Hp三联治疗和常规药物治疗，观察组在对照组基础上增用微生态制剂。比较两组的临床疗效、转阴率及不良反应总发生率；通过实时荧光定量聚合酶链反应检测两组患儿治疗前后大肠杆菌、双歧杆菌、乳酸杆菌、粪球菌、葡萄球菌水平；采用鲎试剂动态比浊法检测血清脂肪酶（LPS）水平，化学发光法检测降钙素原（PCT）水平，双抗体夹心酶联免疫法检测肿瘤坏死因子α（TNF-α）水平；通过酶联免疫吸附试验（ELISA）检测Th1/Th2细胞因子［白细胞介素-4（IL-4）、γ干扰素（IFN-γ）］水平。结果 观察组治疗总有效率高于对照组（P <0.05）。治疗后，观察组Hp转阴率、不良反应总发生率与对照组比较，差异无统计学意义（P >0.05）。观察组治疗前后肠道双歧杆菌、大肠杆菌、乳酸杆菌、葡萄球菌、粪球菌的差值高于对照组（P <0.05）。观察组治疗前后血清PCT、LPS、TNF-α的差值高于对照组（P <0.05）。观察组治疗前后血清IFN-γ、IL-4的差值高于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 微生态制剂结合抗Hp三联方案治疗儿童Hp阳性腹型AP的临床疗效确切，可有效改善肠道菌群，进而促使Th1/Th2细胞趋于平衡，提高肠道黏膜屏障功能。

Abstract:

Objective To investigate the effect of microecological preparation combined with Helicobacter pylori on children with Hp positive abdominal Schoenlein-Henoch purpura and its influence on intestinal flora.Methods The clinical data of 110 children with Hp positive abdominal AP from October 2018 to January 2018 were analyzed retrospectively. They were divided into control group and observation group, 55 cases in each group, according to whether they were given probiotics. Both groups received anti-Hp triple therapy and conventional drug treatment. The clinical effect, negative conversion rate, and total incidence of adverse reactions were compared between the two groups. The levels of E. coli, Bifidobacterium, Lactobacillus, faecal coccus, and staphylococcus were detected by fluorescent quantitative polymerase chain reaction before and after treatment. The levels of limulus lipopolysaccharide (LPS), procalcitonin (PCT), and tumor necrosis factor (TNF-α), Th1/Th2 cytokines [Interleukin-4 (IL-4) and IFN-γ] were measured.Results The total effective rate of the observation group was higher than that of the control group (P < 0.05). After treatment, there was no significant difference in Hp negative conversion rate and total incidence of adverse reactions between the two groups (P > 0.05). The difference of intestinal Bifidobacterium, Escherichia coli, Lactobacillus, Staphylococcus, and faecal coccus before and after treatment in observation group was higher than that in control group (P < 0.05). The difference of Serum PCT, LPS, and TNF-α in the observation group was higher than that in the control group (P < 0.05). The difference of serum IFN-γ and IL-4 in the observation group before and after treatment was higher than that in the control group (P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P > 0.05).Conclusion The clinical effect of probiotics combined with anti-Hp in children with Hp positive abdominal AP is definite, which can effectively improve intestinal flora and Th1/Th2 cells balance and improve intestinal mucosal barrier function.