摘要
目的 了解不同类型肠易激综合征（IBS）肠道菌群分布情况,观察肠道微生态制剂干预效果.方法 将符合纳入标准患者按症状分为腹泻型IBS组30例、便秘型IBS组30例,同时选取门诊行胃肠镜检查者10例为对照组.三组于研究开始前均行胃镜检查并取十二指肠液行肠道菌群计数及培养,同时行电子结肠镜检查取回肠末端肠液行肠道菌群计数及培养.腹泻型及便秘型IBS组予双歧杆菌三联活菌胶囊治疗,每次2粒,每天3次,治疗4周.4周后复查十二指肠液、回肠末端肠液肠道菌群计数及培养.IBS患者治疗前、后填写肠道症状评分量表并评分.研究结束后比较腹泻型IBS组、便秘型IBS组、对照组在不同肠段细菌菌群分布间差异,同时比较双歧杆菌三联活菌胶囊治疗前后肠道菌群分布差异及IBS症状缓解情况.结果 三组十二指肠液中肠杆菌、拟杆菌、双歧杆菌、肠球菌、乳酸杆菌培养率均低,差异均无统计学意义（均P〉00.05）.与对照组比较,腹泻型IBS组回肠末端肠液培养肠杆菌增加,双歧杆菌及乳酸杆菌显著减少[（2.17±0.26）Log10 CFU/g比（3.26±0.44）Log10 CFU/g、（1.46±0.25）Log10 CFU/g比（2.22±0.25）Log10 CFU/g],差异均有统计学意义（t=4.42、8.98,均P〈0.05）,便秘型IBS组拟杆菌显著增加,差异有统计学意义（t=14.27,P〈0.05）.使用双歧杆菌三联活菌胶囊治疗后腹泻型及便秘型IBS组复查十二指肠液中双岐杆菌数目均增多,但差异无统计学意义.腹泻型IBS组回肠末端肠液培养双歧杆菌明显增加,差异有统计学意义（t=4.42,P〈0.05）,肠杆菌含量明显下降,差异有统计学意义（t=20.30,P〈0.05）;便秘型IBS组拟杆菌细菌含量下降,差异有统计学意义（t=14.27,P〈0.05）.双歧杆菌三联活菌胶囊治疗4周后腹泻型IBS组21例有效,总有效率达70.00%,便秘型IBS组13例有效,总有效率43.33%,腹泻型IBS组症状总积分显著降低,差异有统计学意义（t=10.36,P〈0.05）.结论 腹泻型IBS、便秘型IBS均存在肠道菌群紊乱,以回肠为主.肠道微生态制剂治疗腹泻型、便秘型IBS均有效,以腹泻型效果更明显.
Objective To understand the distribution of intestinal microflora in different types of IBS,and to observe the effect of intestinal microecological intervention. Methods According to the inclusion criteria,the patients were divided into diarrhea group （IBS-D group） and constipation group （IBS-C group）,and the normal control group was also set up. The start of the three groups took gastroscopy examinination and took duodenal fluid for intesti-nal bacteria culture and counting,and electronic colonoscopy to retrieve the terminal ileum fluid for bacteria culture and count. Diarrhea and constipation type IBS patients were given Bifidobacterium triple viable capsules,2 capsules each time,3 times a day,treatment for 4 weeks. After treatment for 4 weeks,took electronic gastroscopy to retrieve the duodenal fluid for bacteria culture and counting,and took electronic colonoscopy examination to retrieve the intestinal fluid for terminal colon intestinal bacteria culture and count. Before and after treatment,IBS patients filled in intestinal symptoms rating scale and the intestinal symptoms were graded. After the test,compared the distribution differences of different segments of bacterial flora with diarrhea type IBS,constipation IBS and normal people. And the differences of intestinal flora bacterial distribution and IBS sympotoms were compared among the three groups after the Bifidobacterium triple viable capsules treatment. Results In the duodenal fluid of the three groups, the culture rate of Escherichia coli,Bacteroides,Bifidobacterium,Enterococcus,Lactobacillus was low,the difference was not statistically significant （all P〉00. 05）. Compared with the normal group,Enterobacter cultured in terminal ileum intestinal in the IBS-D group increased,Bifidobacterium and Lactobacillus decreased significantly[（2. 17 ± 0. 26）Log10 CFU/g vs （3. 26 ± 0. 44）Log10 CFU/g,（1. 46 ± 0. 25）Log10 CFU/g vs （2. 22 ± 0. 25）Log10 CFU/g] （t=4. 42,8. 98,all P〈0. 05）, the Bacteroides in the IBS-C group increased significantly （t=14. 27,P〈0. 05）. After the use of Bifidobacterium triple viable capsule oral treatment,the number of Bifidobacterium in duodenal fluid was increased,but the difference was not statistically significant. The terminal ileum intestinal bifidobacteria culture in the IBS -D group increased significantly （t=4. 42,P=0. 00）,Enterobacter decreased significantly （t=20. 30,P〈0. 05）,the quasi bacterial content in the IBS-C group decreased （t=14. 27,P〈0. 05）. After 4 weeks of Bifidobacterium triple viable capsule treatment,21 cases were effective in the IBS-D group,the total effective rate was 70. 00%. 13 cases were effective in the IBS-C group,the total effective rate was 43. 33%. The total symptoms scores of the IBS-D group decreased significantly （t=10. 36,P〈0. 05）. Conclusion IBS type of diarrhea and constipation both have intestinal flora disorder,mainly in ileum. The results showed that the effect of intestinal microecological treatment is obvious in diarrhea and constipation type IBS,especially in diarrhea type IBS.
出处
《中国基层医药》
CAS
2017年第22期3364-3368,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
广东省佛山市科技局医学类科技攻关项目（2015AB002253）
关键词
肠易激综合征
内窥镜检查
胃肠道
双歧杆菌三联活菌胶囊
Irritable bowel syndrom
Endoscopy
gastrointestinal
Bifidobacterium triple viable capsules
