摘要
目的：观察匹多莫德、葡萄糖酸锌、双歧杆菌三联活菌（培菲康）联合治疗婴幼儿迁延性慢性腹泻的临床疗效及对患儿免疫功能的影响，为临床治疗提供新选择。方法选择80例迁延性慢性腹泻婴幼儿为研究对象，按随机数字表法分为观察组40例和对照组40例，两组患儿进行常规治疗，包括口服 ORS 补液、补充维生素、补充电解质、纠正酸碱平衡失调、蒙脱石散止泻，对照组患儿再给予葡萄糖酸锌、培菲康联合治疗，培菲康20 mg／kg，3次／d，葡萄糖酸锌口服液，10～20 mg／d（以锌计算），3次／d；观察组在对照组治疗基础上再口服匹多莫德口服液，400 mg／次，1次／di，连服3周，所有患儿均随访12个月，治疗前后观察症状改善情况，记录大便次数复常时间、大便性状复常时间，空腹抽血检测免疫球蛋白（IgA、IgG）和 T 淋巴细胞亚群（CD ＋3、CD ＋4、CD ＋8），评价两组临床疗效，统计随访6个月、12个月腹泻复发次数。结果观察组和对照组大便次数复常时间、大便性状复常时间分别为（4．5±1．5）d 和（7．8±2．2）d，（4．3±1．6）d 和（7．5±2．0）d，观察组均明显短于对照组（t ＝7．146、8．108，均 P ＜0．01）；6个月复发次数、12个月复发次数分别为（2．05±1．62）次和（3.73±1.65）次，（3．38±2.12）次和（5．15±2．32）次，观察组均明显少于对照组（t ＝3．845、3．636，均 P ＜0.05）；观察组和对照组治疗后 IgA、IgG、CD ＋3、CD ＋4分别为（1．75±0．10）g／L 和（1．50±0．11）g／L，（8.95±1.42）g／L 和（8．02±1．25）g／L，（57．5±6．6）％和（50．5±6．0）％，（39．5±3．5）％和（35．6±3．6）％，均较治疗前明显升高（t ＝3．633、5．835、9．534、6．427和3．274、3．643、4．732、3．658，均 P ＜0．05）；观察组治疗后 IgA、IgG、CD ＋3、CD ＋4明显高于对照组（t ＝3．553、3．434、3．568、3．336，均 P ＜0．05）；观察组的临床总有效率为90.0％，对照组为72．5％，差异有统计学意义（χ2＝6．664，P ＜0．05）。结论匹多莫德、葡萄糖酸锌、培菲康联合治疗婴幼儿迁延性慢性腹泻可协同调整免疫功能紊乱，提高细胞免疫与体液免疫，预防继发性感染，改善营养，促进黏膜组织修复，既而提高治疗近期疗效及降低远期复发，值得临床推广使用。
Objective To observe the effect of pidotimod,zinc gluconate,bifico on immune function in the treatment of infants with persistent chronic diarrhea,and to provide new options for clinical treatment.Methods The infants with persistent chronic diarrhea were selected as study objects,all patients were randomly divided into 40 patients of the observation group and 40 patients of control group,both group were given conventional treatment, which including ORS oral rehydration,vitamin supplements,electrolytes,correct acid -base balance,smecta.The con-trol group were given zinc gluconate and bifico（Bifico 20mg/kg,tid;oral zinc gluconate,10 -20mg/d （zinc compu-ting）,tid）,the observation group were given pidotimod（400mg/times,qd）on the basis of the control group.Both group had been treated for three weeks and been followed for 12month.The symptoms improvement was observed be-fore and after treatment,the time of stool frequency normalization and stool Characters normalization were recorded,the blood were extracted for detecting immunoglobulin （IgA,IgG）and T lymphocyte subsets （CD ＋3 ,CD ＋4 ,CD ＋8 ）,the effect and Diarrhea relapses of follow -up of 6 months were evaluated.Results The time of stool frequency normali-zation and stool characters normalization in the observation group and the control group were （4.5 ±1.5 ）d and （7.8 ±2.2）d,（4.3 ±1.6）d and（7.5 ±2.0）d,the observation group were significantly shorter than the control group,t =7.146,8.108,all P 〈0.01.The number of diarrhea relapses of follow -up of 6 months in observation group and the control group were （2.05 ±1.62）times and （3.73 ±1.65 ）times,（3.38 ±2.12）times and （5.15 ± 2.32）times,the observaiton group were significantly less than the control group,t =3.845,3.636,all P 〈0.05.The IgA,IgG,CD ＋3 ,CD ＋4 ,of observation group and control group after treatment were （1.75 ±0.10）g/L vs.（1.50 ± 0.11）g/L,（8.95 ±1.42）g/L vs.（8.02 ±1.25）g/L,（57.5 ±6.6）% vs.（50.5 ±6.0）%,（39.5 ±3.5）% vs. （35.6 ±3.6）%,the observation group were significantly higher than before treatment （t =3.633,5.835,9.534, 6.427 and 3.274,3.643,4.732,3.658,all P 〈0.05）.The IgA,IgG,CD ＋3 ,CD ＋4 of observation group after treatment was significantly higher than the control group （t =3.553,3.434,3.568,3.336,all P 〈0.05）.The total effective rate of observation group was 90.0%,the control group was 72.5%,the difference was statistically significant（χ2 =6.664,P 〈0.05）.Conclusion The method containing pidotimod,zinc gluconate and bifico can adjust the immune dysfunction,improve immune and humoral immunity,prevent secondary infection,improve nutrition,promote mucosal tissue repair,improve treatment efficacy and reduce the long -term recurrence,worthy of clinical use in the treatment of infants with persistent chronic diarrhea.
出处
《中国基层医药》
CAS
2015年第16期2494-2497,共4页
Chinese Journal of Primary Medicine and Pharmacy
