双歧杆菌四联活菌片联合四联疗法治疗儿童Hp阳性消化性溃疡的起效机制研究

何丽丹; 王红; 蔡振荡; 陈福将

doi:10.16766/j.cnki.issn.1674-4152.004005

双歧杆菌四联活菌片联合四联疗法治疗儿童Hp阳性消化性溃疡的起效机制研究

doi: 10.16766/j.cnki.issn.1674-4152.004005

1.
温州市中西医结合医院儿科，浙江温州 325000
2.
宁波市妇女儿童医院小儿消化科，浙江宁波 315012

基金项目:

浙江省卫生健康科技计划项目 2021KY1059

详细信息

通讯作者:
何丽丹，E-mail: 121548647@qq.com

中图分类号: R725.7
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- 文章访问数: 11
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- 被引次数: 0
出版历程
- 收稿日期: 2024-11-21
- 网络出版日期: 2025-08-14

Study on the mechanism of action of bifidobacterium quadruple active tablets combined with quadruple therapy in the treatment of Hp positive peptic ulcers in children

1.
Department of Pediatrics, Wenzhou Integrated Traditional Chinese and Western Medicine Hospital, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的为提高儿童幽门螺杆菌(Hp)阳性消化性溃疡(PU)的疗效水平，分别从对于肠道免疫功能和细胞因子的影响方面探讨双歧杆菌四联活菌片联合四联疗法的临床疗效和起效机制。方法纳入2021年12月—2024年1月温州市中西医结合医院收治的160例Hp阳性消化性溃疡患儿，采用随机数字表法分为对照组(80例)和研究组(80例)。对照组予以四联疗法(包括2种抗生素、质子泵抑制剂、铋剂)，研究组在四联疗法基础上增加双歧杆菌四联活菌片治疗。评价消化性溃疡疗效水平，检测治疗前后血清胃蛋白酶(PG)、胃泌素(GAS)、细胞因子含量，分析辅助性T细胞17(Th17)/调节性T细胞(Treg)免疫平衡状态，统计Hp转阴及治疗后6个月消化性溃疡复发情况，观察治疗期间药物不良反应。结果研究组治疗总体有效率(93.75%, 75/80)高于对照组(81.25%，65/80)，差异有统计学意义(P < 0.05)。治疗2周后，研究组血清PGⅠ、PGⅡ和GAS均低于对照组(P < 0.001)；研究组血清Th17、Treg、Th17/Treg、白细胞介素17(IL-17)和转化生长因子β(TGF-β)均低于对照组(P < 0.001)。研究组治疗后Hp转阴率(88.75%, 71/80)高于对照组(73.75%, 59/80)，而治疗后6个月消化性溃疡复发率(8.75%, 7/80)低于对照组(22.50%, 18/80)，差异均有统计学意义(P < 0.05)。2组治疗期间药物不良反应发生率比较差异无统计学意义(P>0.05)。结论双歧杆菌四联活菌片联合四联疗法治疗儿童Hp阳性PU，可降低胃蛋白酶、胃泌素分泌水平，提高肠道免疫功能并抑制炎症反应，进而增强PU临床疗效水平，促进Hp转阴，预防PU复发。
- 双歧杆菌四联活菌片 /
- 幽门螺杆菌 /
- 消化性溃疡 /
- 免疫功能 /
- 炎症反应
Abstract: Objective To improve the therapeutic efficacy of Helicobacter pylori (Hp)-positive peptic ulcer (PU) in children, this study investigates the clinical outcomes and mechanistic effects of combining Bifidobacterium quadruple viable tablets with quadruple therapy, focusing on their impacts on intestinal immune function and cytokine levels. Methods A total of 160 children with Hp positive peptic ulcers admitted to Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from December 2021 to January 2024 were included and randomly divided into a control group (80 cases) and an observation group (80 cases). The control group received quadruple therapy (including two kinds of antibiotics, a proton pump inhibitor, and a bismuth agent), while the observation group received treatment with Bifidobacterium quadruple live bacterial tablets in addition to quadruple therapy. The therapeutic effect level of peptic ulcers was evaluated. The levels of serum pepsinogen (PG), gastrin (GAS), and cytokines were measured before and after treatment. The T-helper 17 (Th17)/regulatory T cells (Treg) immune balance status were analyzed. The Hp conversion to negative and recurrence of peptic ulcers 6 months after treatment were statistical analysis. The adverse drug reactions were observed. Results The overall effective rate of treatment in observation group (93.75%, 75/80) was higher than control group (81.25%, 65/80, P < 0.001). After 2 weeks of treatment, the serum levels of PG Ⅰ, PG Ⅱ, GAS in the observation group were lower than those of control group (P < 0.001), and the contents of serum Th17, Treg, Th17/Treg, IL-17, and TGF in the observation group were lower than control group (P < 0.001). The Hp seroconversion rate in the observation group after treatment (88.75%, 71/80) was significantly higher than that in the control group (73.75%, 59/80), while the recurrence rate of peptic ulcers at 6 months after treatment (8.75%, 7/80) was significantly lower than that in the control group (22.50%, 18/80, P < 0.001). The difference in the incidence of adverse drug reactions between the two treatment groups was not statistically significant (P>0.05). Conclusion The combination of bifidobacterium quadruple active tablets and quadruple therapy can improve intestinal cellular immune function, alleviate and reduce the severity of intestinal inflammatory reactions by inhibiting the secretion of gastric protease and gastrin, thereby enhancing the therapeutic effect of Hp positive PU in children and promoting Hp negative conversion rate. It can also prevent and reduce the risk of PU recurrence with fewer adverse reactions.
- Bifidobacterium quadruplex live bacterial tablets /
- Helicobacter pylori /
- Peptic ulcer /
- Immune function /
- Inflammatory reaction

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表 1 2组Hp阳性PU患儿PU临床疗效比较[例(%)]

Table 1. Comparison of the clinical efficacy of PU in two groups of HP-positive PU children[cases(%)]

组别	例数	痊愈	显效	有效	无效	总有效
对照组	80	25(31.25)	21(26.25)	19(23.75)	15(18.75)	65(81.25)
研究组	80	34(42.50)	23(28.75)	18(22.50)	5(6.25)	75(93.75)
注：2组总有效率比较，χ²=5.714，P=0.017。

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表 2 2组Hp阳性PU患儿血清胃蛋白酶及胃泌素水平比较(x±s)

Table 2. Comparison of serum pepsin and gastrin levels in two groups of HP-positive PU children(x±s)

组别	例数	PGⅠ(ng/mL)		PGⅡ(ng/mL)		GAS(pmol/L)
组别	例数	治疗前	治疗2周后	治疗前	治疗2周后	治疗前	治疗2周后
对照组	80	314.51±20.36	150.72±13.34^b	36.59±4.08	12.56±1.83^b	115.84±13.05	80.26±8.34^b
研究组	80	316.43±21.59	111.91±11.83^b	36.18±4.27	9.42±1.72^b	117.23±13.65	68.59±7.51^b
统计量		0.579^a	23.171^c	0.621^a	16.074^c	0.658^a	19.177^c
P值		0.564	＜0.001	0.536	＜0.001	0.511	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 3 2组Hp阳性PU患儿Th17/Treg免疫平衡状态及细胞因子水平比较(x±s)

Table 3. Comparison of Th17/Treg immune balance status and cytokine levels in two groups of HP-positive PU children(x±s)

组别	例数	Th17(%)		Treg(%)		Th17/Treg		IL-17(pg/mL)		TGF-β(ng/mL)
组别	例数	治疗前	治疗2周后	治疗前	治疗2周后	治疗前	治疗2周后	治疗前	治疗2周后	治疗前	治疗2周后
对照组	80	4.31±0.68	3.41±0.61^b	7.82±1.05	6.95±1.10^b	0.52±0.07	0.51±0.10^b	77.03±6.53	58.26±5.48^b	85.28±7.61	68.04±6.12^b
研究组	80	4.39±0.65	2.28±0.56^b	7.70±1.11	5.84±0.92^b	0.54±0.08	0.36±0.06^b	77.69±6.29	47.62±5.19^b	84.52±7.73	62.41±5.73^b
统计量		0.761^a	23.691^c	0.703^a	15.273^c	1.683^a	19.641^c	0.651^a	27.136^c	0.627^a	16.274^c
P值		0.448	＜0.001	0.483	＜0.001	0.094	＜0.001	0.516	＜0.001	0.532	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 4 2组Hp阳性PU患儿治疗期间药物不良反应情况比较[例(%)]

Table 4. Comparison of adverse drug reactions during treatment in two groups of HP-positive PU children[cases(%)]

组别	例数	恶心	便秘	食欲不振	头晕乏力	总发生
对照组	80	5(6.25)	2(2.50)	2(2.50)	3(3.75)	12(15.00)
研究组	80	4(5.00)	1(1.25)	3(3.75)	2(2.50)	10(12.50)
注：2组药物不良反应总发生率比较，χ²=0.211，P=0.646。

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