两种泻药的安全性及对肠道菌群影响的对比研究  

A comparative study on the safety and the effects on intestinal microbiota by two cathartic drugs

作　　者：杨伟昂[1] 杨兵[1] 马焕丽[2] 张宏聪 YANG Weiang;YANG Bing;MA Huanli;ZHANG Hongcong(Department of Gastroenterology,Longgang Central Hospital,Longgang District,Shenzhen,Guangdong 518116,China;Department of Clinical Lab,Longgang Central Hospital,Longgang District,Shenzhen,Guangdong 518116,China)

机构地区：[1]深圳市龙岗中心医院消化内科,广东深圳518116 [2]深圳市龙岗中心医院检验科,广东深圳518116

出　　处：《安徽医药》2022年第6期1249-1253,共5页Anhui Medical and Pharmaceutical Journal

基　　金：深圳市龙岗区2018年度医疗卫生科技计划项目(LGKCYLWS2018000022)。

摘　　要：目的明确两种导泻药物对肠道菌群的影响以及是否会导致迟发性药物不良反应,探讨其相关性。方法将2018年10月至2019年6月深圳市龙岗中心医院收治的61例拟行结肠镜检查的病人按随机数字表法、双盲分成两组,A组31例、B组30例分别采用复方聚乙二醇电解质散、20%甘露醇清洁肠道,于导泻前、导泻后d1、d14取粪便送检,标本直接涂片法检测细菌总数、革兰阳性菌数量,稀释性平板菌落计数法+快速细菌鉴定法检测肠球菌、大肠杆菌数量;导泻后d14电话随访病人是否出现迟发性药物不良反应。结果导泻后d1,两组细菌总数[A组:(127.5±30.6)个/油镜比(3409.7±734.6)个/油镜,B组:(110.9±27.8)个/油镜比(3300.0±755.7)个/油镜]、革兰阳性菌数量均显著减少,肠球菌、大肠杆菌数量均显著增加,B组变化更显著(P<0.05)。导泻后d14,两组细菌总数[A组:(3380.7±794.3)个/油镜,B组:(3250.0±813.1)个/油镜]、革兰阳性菌数量基本恢复正常;肠球菌、大肠杆菌数量均仍有不同程度的增加,两组对比差异无统计学意义(P>0.05)。导泻后14 d内,两组均出现迟发性药物不良反应,其发生与肠道菌群的改变有关(r=0.68,P<0.01),B组发生率更高[30.0%(9/30)比6.45%(2/31)](P<0.05)。结论导泻药物会引起肠道菌群数量及构成的显著改变,导致迟发性不良反应的发生。相对于20%甘露醇,复方聚乙二醇电解质散对肠道菌群的影响更小、迟发性药物不良反应发生率更低,更值得临床推广。Objective To observe the effects of two cathartic drugs on intestinal microbiota and the likelihood of delayed adverse drug reactions,followed by exploring their correlations.Methods Sixty-one patients,admitted for colonoscopy examination in Longgang Central Hospital in Shenzhen from October 2018 to June 2019,were assigned into group A(n=31)and group B(n=30)by random number table and double-blind methods.Group A and group B were prepared for intestinal cleansing with polyethylene glycol electrolyte powder and 20%mannitol,respectively.Appropriate amounts of fresh feces were taken for examination before bowel cleansing(base line),1 d and 14 d after the catharsis usages.The counts of total bacteria and Gram-positive bacilli in feces were detected by the direct smear method.Enterococcus and Bacillus Coli counts were determined by diluted plate colony count plus rapid bacteria identification.The patients were given the follow-up visits by telephone in the 14 days after catharsis,in order to identify delayed adverse drug reactions.Results In the 1 d after catharsis,the counts of total bacteria[group A:(127.5±30.6)vs.(3409.7±734.6);group B:(110.9±27.8)vs.(3300.0±755.7)]and Gram-positive bacilli were significantly decreased compared with those in the base line;the counts of Enterococcus and Bacillus Coli were significantly increased in both groups,while group B had more increment than group A(P<0.05).In the 14 d after the catharsis,the counts of total bacteria[group A:(3380.7±794.3);group B:(3250.0±813.1)]and Gram-positive bacilli in both groups were almost recovered to the base line;the counts of Enterococcus and Bacillus Coli remained in increased levels in both groups without significant differences between them(P>0.05).In 14 d after catharsis,both groups had delayed adverse drug reactions,which were correlated with the changes in intestinal microbiota(r=0.68,P<0.01);group B had a higher incidence of delayed adverse drug reactions compared with that of group A[30.0%(9/30)vs.6.45%(2/31);P<0.05].Conclusions The qu

关 键 词：泻药 术前用药法 结肠镜检查 复方聚乙二醇电解质散 甘露醇 肠道准备 不良反应 肠道菌群 对比研究 

分 类 号：R969[医药卫生—药理学]