益生菌与口服免疫球蛋白辅助治疗儿童轮状病毒肠炎的疗效比较

Therapeutic effect of probiotics and oral IgY as supplementary drugs in the treatment of pediatric rotavirus enteritis: a comparative study

摘要:

目的：比较益生菌及口服免疫球蛋白对儿童轮状病毒肠炎的疗效。方法：150例轮状病毒肠炎患儿随机分为3组，每组50例。3组患儿在给予基础治疗的同时给予不同的干预治疗方案。对照组予安慰剂治疗，益生菌组予双歧杆菌乳杆菌三联活菌治疗，免疫球蛋白组予抗轮状病毒鸡卵黄IgY口服治疗。每日记录大便次数、大便性状等临床症状，并于治疗后1、3、5、7、9、11?d收集新鲜大便标本，镜检行大便菌群紊乱分度，放射免疫法检测大便SIgA水平，双抗体夹心酶联免疫法检测大便轮状病毒排泄量。结果：与对照组比较，益生菌治疗组干预用药3 d后菌群失调改善，大便频次减少，继发肠道细菌感染发生率降低（P<0.05）。益生菌组病程与对照组比较差异无统计学意义（P>0.05）。免疫球蛋白组用药1 d后大便SIgA水平显著高于对照组（P<0.05），治疗3 d后腹泻频次及大便病毒排泄量均低于对照组（P<0.05）。免疫球蛋白组病程较对照组显著缩短（4.5±1.0?d vs 5.8±1.7?d，P<0.05）。结论：对儿童轮状病毒肠炎，益生菌能缓解菌群紊乱及预防继发感染，但缓解临床症状较慢，且不能缩短病程。口服免疫球蛋白显效快，能快速清除病毒及促进机体SIgA生成，且能缩短病程。

Abstract:

OBJECTIVE: To compare the therapeutic effect of probiotics and oral immunoglobulin on pediatric rotavirus enteritis. METHODS: A randomized, controlled trial was conducted in 150 children with rotavirus enteritis who were randomly divided into control, probiotic and immunoglobulin groups (n=50 each). In addition to basic treatment, the control group was given placebo, the probiotic group was given live combined bifidobacterium and lactobacillus tablets, and the immunoglobulin group was orally given anti-rotavirus egg yolk immunoglobulin (IgY). Clinical symptoms such as stool frequency and stool properties were recorded every day. Fresh stool samples were collected on days 1, 3, 5, 7, 9 and 11 of treatment. Intestinal flora imbalance was detected and divided into three degrees by microscopic examination of stool. Fecal SIgA level and fecal rotavirus shedding were measured by radioimmunoassay and double-antibody sandwich ELISA respectively. RESULTS: Compared with the control group, the probiotic group had reduced intestinal flora imbalance, decreased stool frequency, and reduced incidence of secondary intestinal bacterial infection after 3 days of treatment (P<0.05). There was no significant difference in disease course between the probiotic and control groups. Compared with the control group, the immunoglobulin group had a significantly increased fecal SIgA level after 1 day of treatment (P<0.05), significantly decreased frequency of diarrhea and fecal rotavirus shedding after 3 days of treatment (P<0.05), and a significantly shorter disease course (4.5±1.0 vs 5.8±1.7 days; P<0.05). CONCLUSIONS: For children with rotavirus enteritis, probiotics can reduce intestinal flora imbalance and prevent secondary intestinal bacterial infection, but probiotics take a long time to relieve clinical symptoms and cannot shorten the course of disease. Oral immunoglobulin takes effect quickly and can rapidly eliminate rotavirus, promote the production of SIgA, and shorten the course of disease.