益生菌调节轮状病毒肠炎患儿肠道菌群的动态变化

摘要

Objective To observe the dynamic changes of intestinal dysbacteriosis of children with rotavirus enteritis intervened by probiotics,and explore the efficacy of probiotics on reducing severity of diarrhea, shortening duration of enteritis and preventing secondary enteric bacteria infection.Methods A randomized,controUed trial was performed on 100 cases of rotaviras enteritis in West China Second University Hospital ,who were randomly divided into control group (smectite powder with rehydration oral or intravenous) and probiotics treatment group (live combined bifidobacterium,lactobacillus and streptococcus thermophilus tablets oral and smectite powder with rehydration oral or intravenous).There were no differences of age, gender and severity of disease between the 2 groups.Stool samples were collected at diarrheal episode of 1 -2 days,3 -4 days,5 -6 days,7 -8 days,9 - 10 days and 11 - 14 days.Stool intestinal flora,frequency of stool and incidence of secondary enteric bacteria infection were analyzed and recorded.Results At the peak stage of diarrhea (3 -4 days), the incidence of intestinal dysbacteriosis I , II and Ⅲ degree in control group were 42％ ,8％ and 6％ respectively,and in probiotios treatment group were 38％ ,10％ and 4％ respectively, there were no differences between the 2 groups( Pa ＞0.05 ).And totally about 18％ of children suffered secondary enteric bacteria infection in control group,and about 4％ in probioties treatment group,there was significant difference between the 2 groups (P ＜0.05 ).During prophase of diarrhea ( 1 -2 days), there were no differences between control group and probioties treatment group on incidence of intestinal dysbacteriesis, percentage of secondary enteric bacteria infection and stool frequency ( Pa ＞ 0.05 ).While from beginning intervention 3 days, the intestinal dysbacteriosis and stool frequency significantly released in probiofics treatment group (Pa ＜ 0.05 ) ,and the incidence of secondary bacteria infection markedly declined from 18％ in control group to 4％ in probiotics group ( P ＜0.05 ).But no difference was found in duration of diarrhea between probiotics treatment group and control group (P ＞ 0.05 ) ,which were respectively (5.50 ± 1.57 )days and (5.80 ± 1.68 ) days.Conclusions Probiotics is effective in relieving intestinal dysbacteriosis,reducing severity of diarrhea and preventing secondary enteric bacteria infection for rotavirus enteritis.But the effective time is slow, almost need 3 days.At the same time, probiotics have poor effect on shortening duration of rotavirus enteritis.%目的 观察益生菌治疗轮状病毒肠炎时肠道菌群的动态变化,探讨益生菌能否减轻轮状病毒肠炎腹泻病情、缩短病程及减少继发肠道细菌感染的概率.方法 100例轮状病毒肠炎患儿(年龄3个月～2.2岁)来自本院门诊及住院患儿,采用随机对照试验方法,按就诊顺序随机均分为2组:对照组(蒙脱石散口服+口服或静脉补液对症治疗),益生菌治疗组(双歧杆菌乳杆菌三联活菌片口服+蒙脱石散口服+口服或静脉补液对症治疗).分别于腹泻病程1～2 d、3～4 d、5～6 d、7～8 d、9～10 d、11～14 d,收集6次粪便,进行粪便涂片菌群分析,监测肠道菌群紊乱程度变化过程,记录腹泻频次及继发肠道细菌感染情况.结果 腹泻高峰期时(3～4 d),对照组肠道菌群紊乱状况为菌群失调Ⅰ度 42%,Ⅱ度8%,Ⅲ度6%;益生菌治疗组分别为38%、10%、4%,2组比较差异无统计学意义(Pa>0.05).病程中对照组18%的患儿发生继发肠道细菌感染,益生菌治疗组为4%,2组比较差异有统计学意义(P<0.05).在腹泻病程早期(1～2 d),益生菌治疗组菌群紊乱发生比率、大便频次及继发肠道细菌感染概率与对照组比较差异均无统计学意义(Pa＞0.05);自干预治疗的3 d起,益生菌治疗组菌群紊乱状况及大便频次较对照组显著改善(Pa＜0.05).益生菌治疗组及对照组病程分别为(5.50±1.57) d及(5.80±1.68) d,2组比较差异无统计学意义(P>0.05).结论 益生菌治疗对轮状病毒肠炎有效,能在轮状病毒肠炎病程后期明显缓解肠道菌群紊乱状况,减轻腹泻次数,降低继发肠道细菌感染风险.但益生菌制剂起效缓慢,需3 d左右逐渐显效,且不能缩短轮状病毒肠炎病程.