目的：探讨双歧杆菌三联活菌胶囊对白血病化疗所致腹泻患者肠黏膜屏障功能的影响及疗效观察。方法选取2012年1月~2014年7月在宁波市鄞州人民医院门诊或住院治疗的白血病化疗所致腹泻患者74例。采用随机数字表将其分为观察组(n=37)和对照组(n=37)。两组均采用常规对症支持治疗,包括静脉补液、口服蒙脱石散、静脉营养支持及保持水电解质平衡等。观察组加用双歧杆菌三联活菌胶囊630 mg/次,2次/d,温开水溶解后口服。对照组除不予以双歧杆菌三联活菌胶囊口服外余处理与观察组完全相同。治疗3d后记录两组患者血清内毒素(ET)、降钙素原(PCT)和肿瘤坏死因子-α(TNF-α)水平的变化情况,并对其临床效果及药物不良反应进行比较。结果治疗3 d后,与治疗前比较对照组和观察组患者ET、PCT和TNF-α水平[(0.35±0.09)EU/mL、(7.67±1.25)μg/L、(173.67±36.48)pg/mL,(0.29±0.07)EU/mL、(5.18±0.73)μg/L、(138.34±30.42)pg/mL]较前[(0.42±0.14)EU/mL、(10.19±2.76)μg/L、(215.47±40.23)pg/mL,(0.44±0.11)EU/mL、(9.95±2.97)μg/L、(219.95±38.17)pg/mL]均明显下降(t=2.27、2.42、2.34、2.87、3.42、2.99,P约0.05或P约0.01),且观察组下降值明显大于对照组(t=2.13、2.39、2.17,P约0.05)；治疗3 d后,观察组临床总有效率明显较对照组更佳(91.89%比72.97%)(字2=4.57,P约0.05)。两组患者治疗中未发生明显的药物不良反应。结论双歧杆菌三联活菌胶囊能直接补充白血病化疗后腹泻患者的肠道益生菌的数量,纠正肠道微生态平衡失调,重建肠黏膜菌群生物屏障,促进肠黏膜上皮修复,降低肠黏膜的通透性功能,降低血清ET、PCT和TNF-α水平,保护与改善肠黏膜屏障功能。%Objective To discuss influence and curative effect observation of Bifid Triple Viable Capsules on intestinal mucous membrane barrier function of patients with leukemia chemotherapy induced diarrhea. Methods Seventy four cases of patients with leukemia chemotherapy induced diarrhea, who were given medical treatment in outpatient or hos-pitalized in Yinzhou People's Hospital from January 2012 to July 2014 were selected and divided into observation group (n=37) and control group (n=37) by random number table. The patients in two groups were given oral Montmo-rillonite, fluid infusion, nutrition support, maintenance of water-electrolyte balance and other supporting treatment. The patients in observation group were additionally given Bifid Triple Viable Capsules, 630 mg per time, twice a day, through the mouth after being dissolved by warm spoiled water, and except for Bifid Triple Viable Capsules, the pa-tients in control group were given the same medical treatment as those in observation group. The changes of serum en-dotoxin (ET), procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) levels of patients in two groups before and 3 days after medical treatment were observed and recorded, and the clinical curative effect and drug adverse reactions (DAR) were compared as well. Results After 3 days' medical treatment, ET, PCT and TNF-α levels of patients in con-trol group and observation group [(0.35±0.09) EU/mL, (7.67±1.25) μg/L, (173.67±36.48) pg/mL; (0.29±0.07) EU/mL,(5.18±0.73) μg/L, (138.34±30.42) pg/mL] declined than before [(0.42±0.14) EU/mL, (10.19±2.76) μg/L, (215.47±40.23) pg/mL; (0.44±0.11) EU/mL, (9.95±2.97) μg/L, (219.95±38.17) pg/mL] with different degrees (t = 2.27, 2.42, 2.34, 2.87, 3.42, 2.99, P< 0.05 or P< 0.01), and the declining rate of patients in observation group was much higher than that in control group (t = 2.13, 2.39, 2.17, P< 0.05). After 3 days' medical treatment, total clinical efficiency of patients in observation group was much higher than that in control group (91.89% v s 72.97%) (字2=4.57, P< 0.05). No obvious DAR appeared on patients in two groups. Conclusion Bifid Triple Viable Capsules can adjust the intestinal probiotics of patients with leukemia chemotherapy induced diarrhea and the balance of intestinal microflora disorders and form flora barriers on the mucosal surface, which is favorable for repairing intestinal mucosa epithelium structure, reducing intestinal mucosa permeability function and serum ET, PCT and TNF-α levels and protecting and improving intestinal mucous membrane barrier function.
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