益生菌联合四联抗幽门螺杆菌治疗在冠心病患者长期抗血小板所致上消化道黏膜损害中的应用效果  

Therapeutic effects of probiotics combined with quadruple antiHelicobacter pylori therapy in coronary artery disease patients with long-term antiplatelet-induced upper gastrointestinal mucosal damage

作　　者：朱书渊 沈海萍 Shu-Yuan Zhu;Hai-Ping Shen(Department of Gastroenterology,The Second People’s Hospital of Lishui,Lishui 323000,Zhejiang Province,China)

机构地区：[1]浙江省丽水市第二人民医院消化内科,浙江省丽水市323000

出　　处：《世界华人消化杂志》2022年第19期838-844,共7页World Chinese Journal of Digestology

摘　　要：背景长期抗血小板治疗易造成冠心病患者上消化道黏膜损害,益生菌作为有益菌群,不仅能改善肠道微生态,还可有效拮抗幽门螺杆菌(Helicobacter pylori,H.pylori).本研究拟定益生菌能改善冠心病长期抗血小板所致上消化道黏膜损害,通过对照试验进行论证.目的探讨益生菌联合四联抗H.pylori治疗在冠心病患者长期抗血小板所致上消化道黏膜损害中的应用效果.方法选取2019-01/2021-06我院220例长期抗血小板治疗的冠心病患者,患者均伴有H.pylori阳性的上消化道黏膜损害.随机分为两组,各110例.对照组予以四联抗H.pylori治疗,观察组予以益生菌四联抗H.pylori治疗.观察两组临床疗效、H.pylori根除率及治疗前后消化道黏膜病理评分、胃肠功能指标[胃蛋白酶原Ⅱ(pepsinogenⅡ,PGⅡ)、胃蛋白酶原Ⅰ(pepsinogenⅠ,PGⅠ)及胃泌素-17(gastrin-17,G-17)]、炎症因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)和白细胞介素-8(interleukin-8,IL-8)]变化情况,并记录终点事件.结果观察组临床治疗总有效率88.18%高于对照组78.18%(P<0.05);观察组停药后6个月H.pylori根除率高于对照组(P<0.05);观察组治疗后炎症、萎缩、肠上皮化生、异型增生评分均较对照组低(P<0.05);观察组治疗后血清PGⅠ、PGⅡ、G-17水平均较对照组低(P<0.05);观察组治疗后血清TNF-α、IL-6、IL-8水平均较对照组低(P<0.05);两组心血管不良事件、消化道出血及全因死亡率比较,差异无统计学意义(P>0.05).结论在冠心病患者长期抗血小板所致上消化道黏膜损害治疗中添加益生菌对临床疗效是有益的,可有效提高H.pylori根除率、减轻炎症反应、降低癌变风险.BACKGROUND Long-term antiplatelet therapy may cause damage to the upper gastrointestinal mucosa of patients with coronary heart disease.Probiotics can not only improve intestinal micro-ecology,but also effectively antagonize Helicobacter pylori(H.pylori).In this study,we explored whether probiotics can improve the upper gastrointestinal mucosa damage caused by long-term antiplatelet therapy in patients with coronary heart disease.AIM To investigate the effect of probiotics combined with quadruple anti-H.pylori therapy in coronary artery disease patients with long-term antiplatelet-induced upper gastrointestinal mucosal damage.METHODS A total of 220 patients with coronary artery disease on long-term antiplatelet therapy at our hospital from January 2019 to June 2021 were selected,and all of them had upper gastrointestinal mucosal damage and were positive for H.pylori.The patients were randomly divided into either a control group or an observation group(110 cases each).The control group was treated with quadruple anti-H.pylori therapy,and the observation group was treated with probiotics combined with quadruple anti-H.pylori therapy.The clinical efficacy,eradication rate of H.pylori,and changes of gastrointestinal mucosal pathology score,gastrointestinal function indexes[pepsinogenⅡ(PGⅡ),pepsinogenⅠ(PGⅠ),and gastrin-17(G-17)],inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin(IL)-6,and IL-8]were compared in the two groups,and endpoint events were recorded.RESULTS The total clinical treatment efficiency of the observation group was 88.18%,which was significantly higher than that of the control group(78.18%;P<0.05).The eradication rate of H.pylori at 6 mo after drug discontinuation was significantly higher in the observation group than in the control group(P<0.05).Inflammation,atrophy,intestinal epithelial chemosis,and heterotypic hyperplasia scores were significantly lower in the observation group than in the control group after treatment(P<0.05).Serum PGⅠ,PGⅡ,and G-17 levels were signific

关 键 词：益生菌 冠心病 上消化道黏膜损害 炎症因子 

分 类 号：R541.4[医药卫生—心血管疾病]