利福昔明联合枯草杆菌二联活菌肠溶胶囊对伴有小肠细菌过度生长的腹泻型IBS的疗效分析  

Effect of rifaximin combined with Live Combined Bacillus Subtilis and Enterococcus Faecium enteric-coated capsules in the treatment of diarrhea-predominant irritable bowel syndrome accompanied with overgrowth of small intestinal bacteria

作　　者：罗哲 李超[1] 王晓辉[1] 李辉[1] 李晓伟 崔立红[1] Luo Zhe;Li chao;Wang Xiao-Hui;Li Hui;Li Xiao-Wei;Cui Li-Hong(Department of Gastroenterology,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心消化内科,北京100048

出　　处：《解放军医学杂志》2021年第10期997-1002,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金面上项目(81670494)。

摘　　要：目的分析利福昔明联合枯草杆菌二联活菌肠溶胶囊治疗伴有小肠细菌过度生长(SIBO)的腹泻型肠易激综合征(IBS-D)的临床效果。方法选择2018年7月-2019年12月解放军总医院第六医学中心消化内科收治的114例伴有SIBO的IBS-D患者,随机分为益生菌组(n=64)与联合组(n=50)。益生菌组给予枯草杆菌二联活菌肠溶胶囊治疗,联合组给予利福昔明联合枯草杆菌二联活菌肠溶胶囊治疗,疗程14 d。比较两组治疗前后的主要症状、伴随症状、血清炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平,以及肠黏膜屏障功能相关因子[D-乳酸(D-LA)、细菌内毒素脂多糖(LPS)]水平。结果治疗前,两组患者的主要症状及伴随症状指标差异无统计学意义(P>0.05)。治疗后,两组的腹痛频率、腹胀程度、肠道症状对生活的困扰、病情严重程度量表(SSS)总分、伴有排便急迫及排黏液便的比例均低于治疗前,联合组的腹痛程度评分及腹部胀气比例低于治疗前,轻症患者比例高于治疗前,差异有统计学意义(P<0.05);联合组腹痛程度、腹痛频率、腹胀程度、SSS总分及腹部胀气比例均低于益生菌组,轻症患者比例高于益生菌组,差异有统计学意义(P<0.05)。治疗后,两组IL-6、TNF-α、D-LA、LPS水平均低于治疗前,联合组IL-6、TNF-α、LPS水平低于益生菌组,差异有统计学意义(P<0.05)。联合组的SIBO转阴率高于益生菌组(76.0%vs. 46.9%),差异有统计学意义(P<0.05)。结论枯草杆菌二联活菌肠溶胶囊与利福昔明均有逆转SIBO、缓解IBS-D症状的作用,二者联用效果优于单用枯草杆菌二联活菌肠溶胶囊,伴有SIBO的IBS-D是利福昔明的合理适应证。Objective To observe the effect of rifaximin with Live Combined Bacillus Subtilis and Enterococcus Faecium enteric-coated capsules on diarrhea-predominant irritable bowel syndrome(IBS-D) in patients with small intestinal bacterial overgrowth(SIBO). Methods From July 2018 to December 2019, 114 IBS-D patients with SIBO were randomly divided into probiotics group(n=64) and combined group(n=50). The probiotics group was treated by Live Combined Bacillus Subtilis and Enterococcus Faecium enteric-coated capsules, while the combined group was treated by rifaximin with Live Combined Bacillus Subtilis and Enterococcus Faecium enteric-coated capsules. The treatment lasted for 14 days. After treatment, the symptom and serum cytokines were compared between the two groups. Results Before treatment, there were no significant differences in the symptom and accompanied symptoms between the two groups(P>0.05). After treatment, the frequency of abdominal pain, the degree of abdominal distension, the obstruction of intestinal symptoms in life, the symptom severity scale(SSS) total score, the number of patients with emergency defecation and mucus stool of the two groups were relieved or reduced as compared with pre-treatment, and the degree of abdominal pain, the number of patients with abdominal distension in the combined group were relieved or reduced than those before treatment(P<0.05). At the same time, the combined group was superior to the probiotics group in the degree ofabdominal pain, the frequency of abdominal pain, the degree of abdominal distension, the SSS total score, the number of mild cases, and the number of patients with abdominal distension(P<0.05). The levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), D-lactic acid(D-LA) and lipopolysaccharide(LPS) in the two groups were lower than those before treatment, and the levels of IL-6, TNF-α and LPS in combined group were lower than those in probiotics group(P<0.05). The negative conversion rate of SIBO in combined group was higher than that in probiotic

关 键 词：肠道微生态 肠易激综合征 小肠细菌过度生长 利福昔明 益生菌 

分 类 号：R574.4[医药卫生—消化系统]