CAJ | 학술논문

目的：观察匹多莫德、葡萄糖酸锌、双歧杆菌三联活菌（培菲康）联合治疗婴幼儿迁延性慢性腹泻的临床疗效及对患儿免疫功能的影响，为临床治疗提供新选择。方法选择80例迁延性慢性腹泻婴幼儿为研究对象，按随机数字表法分为观察组40例和对照组40例，两组患儿进行常规治疗，包括口服 ORS 补液、补充维生素、补充电解质、纠正酸碱平衡失调、蒙脱石散止泻，对照组患儿再给予葡萄糖酸锌、培菲康联合治疗，培菲康20 mg／kg，3次／d，葡萄糖酸锌口服液，10～20 mg／d（以锌计算），3次／d；观察组在对照组治疗基础上再口服匹多莫德口服液，400 mg／次，1次／di，连服3周，所有患儿均随访12个月，治疗前后观察症状改善情况，记录大便次数复常时间、大便性状复常时间，空腹抽血检测免疫球蛋白（IgA、IgG）和 T 淋巴细胞亚群（CD ＋3、CD ＋4、CD ＋8），评价两组临床疗效，统计随访6个月、12个月腹泻复发次数。结果观察组和对照组大便次数复常时间、大便性状复常时间分别为（4．5±1．5）d 和（7．8±2．2）d，（4．3±1．6）d 和（7．5±2．0）d，观察组均明显短于对照组（t ＝7．146、8．108，均 P ＜0．01）；6个月复发次数、12个月复发次数分别为（2．05±1．62）次和（3.73±1.65）次，（3．38±2.12）次和（5．15±2．32）次，观察组均明显少于对照组（t ＝3．845、3．636，均 P ＜0.05）；观察组和对照组治疗后 IgA、IgG、CD ＋3、CD ＋4分别为（1．75±0．10）g／L 和（1．50±0．11）g／L，（8.95±1.42）g／L 和（8．02±1．25）g／L，（57．5±6．6）％和（50．5±6．0）％，（39．5±3．5）％和（35．6±3．6）％，均较治疗前明显升高（t ＝3．633、5．835、9．534、6．427和3．274、3．643、4．732、3．658，均 P ＜0．05）；观察组治疗后 IgA、IgG、CD ＋3、CD ＋4明显高于对照组（t ＝3．553、3．434、3．568、3．336，均 P ＜0．05）；观察组的临床总有效率为90.0％，对照组为72．5％，差异有统计学意义（χ2＝6．664，P ＜0．05）。结论匹多莫德、葡萄糖酸锌、培菲康联合治疗婴幼儿迁延性慢性腹泻可协同调整免疫功能紊乱，提高细胞免疫与体液免疫，预防继发性感染，改善营养，促进黏膜组织修复，既而提高治疗近期疗效及降低远期复发，值得临床推广使用。目的：觀察匹多莫德、葡萄糖痠鋅、雙歧桿菌三聯活菌（培菲康）聯閤治療嬰幼兒遷延性慢性腹瀉的臨床療效及對患兒免疫功能的影響，為臨床治療提供新選擇。方法選擇80例遷延性慢性腹瀉嬰幼兒為研究對象，按隨機數字錶法分為觀察組40例和對照組40例，兩組患兒進行常規治療，包括口服 ORS 補液、補充維生素、補充電解質、糾正痠堿平衡失調、矇脫石散止瀉，對照組患兒再給予葡萄糖痠鋅、培菲康聯閤治療，培菲康20 mg／kg，3次／d，葡萄糖痠鋅口服液，10～20 mg／d（以鋅計算），3次／d；觀察組在對照組治療基礎上再口服匹多莫德口服液，400 mg／次，1次／di，連服3週，所有患兒均隨訪12箇月，治療前後觀察癥狀改善情況，記錄大便次數複常時間、大便性狀複常時間，空腹抽血檢測免疫毬蛋白（IgA、IgG）和 T 淋巴細胞亞群（CD ＋3、CD ＋4、CD ＋8），評價兩組臨床療效，統計隨訪6箇月、12箇月腹瀉複髮次數。結果觀察組和對照組大便次數複常時間、大便性狀複常時間分彆為（4．5±1．5）d 和（7．8±2．2）d，（4．3±1．6）d 和（7．5±2．0）d，觀察組均明顯短于對照組（t ＝7．146、8．108，均 P ＜0．01）；6箇月複髮次數、12箇月複髮次數分彆為（2．05±1．62）次和（3.73±1.65）次，（3．38±2.12）次和（5．15±2．32）次，觀察組均明顯少于對照組（t ＝3．845、3．636，均 P ＜0.05）；觀察組和對照組治療後 IgA、IgG、CD ＋3、CD ＋4分彆為（1．75±0．10）g／L 和（1．50±0．11）g／L，（8.95±1.42）g／L 和（8．02±1．25）g／L，（57．5±6．6）％和（50．5±6．0）％，（39．5±3．5）％和（35．6±3．6）％，均較治療前明顯升高（t ＝3．633、5．835、9．534、6．427和3．274、3．643、4．732、3．658，均 P ＜0．05）；觀察組治療後 IgA、IgG、CD ＋3、CD ＋4明顯高于對照組（t ＝3．553、3．434、3．568、3．336，均 P ＜0．05）；觀察組的臨床總有效率為90.0％，對照組為72．5％，差異有統計學意義（χ2＝6．664，P ＜0．05）。結論匹多莫德、葡萄糖痠鋅、培菲康聯閤治療嬰幼兒遷延性慢性腹瀉可協同調整免疫功能紊亂，提高細胞免疫與體液免疫，預防繼髮性感染，改善營養，促進黏膜組織脩複，既而提高治療近期療效及降低遠期複髮，值得臨床推廣使用。
목적：관찰필다막덕、포도당산자、쌍기간균삼련활균（배비강）연합치료영유인천연성만성복사적림상료효급대환인면역공능적영향，위림상치료제공신선택。방법선택80례천연성만성복사영유인위연구대상，안수궤수자표법분위관찰조40례화대조조40례，량조환인진행상규치료，포괄구복 ORS 보액、보충유생소、보충전해질、규정산감평형실조、몽탈석산지사，대조조환인재급여포도당산자、배비강연합치료，배비강20 mg／kg，3차／d，포도당산자구복액，10～20 mg／d（이자계산），3차／d；관찰조재대조조치료기출상재구복필다막덕구복액，400 mg／차，1차／di，련복3주，소유환인균수방12개월，치료전후관찰증상개선정황，기록대편차수복상시간、대편성상복상시간，공복추혈검측면역구단백（IgA、IgG）화 T 림파세포아군（CD ＋3、CD ＋4、CD ＋8），평개량조림상료효，통계수방6개월、12개월복사복발차수。결과관찰조화대조조대편차수복상시간、대편성상복상시간분별위（4．5±1．5）d 화（7．8±2．2）d，（4．3±1．6）d 화（7．5±2．0）d，관찰조균명현단우대조조（t ＝7．146、8．108，균 P ＜0．01）；6개월복발차수、12개월복발차수분별위（2．05±1．62）차화（3.73±1.65）차，（3．38±2.12）차화（5．15±2．32）차，관찰조균명현소우대조조（t ＝3．845、3．636，균 P ＜0.05）；관찰조화대조조치료후 IgA、IgG、CD ＋3、CD ＋4분별위（1．75±0．10）g／L 화（1．50±0．11）g／L，（8.95±1.42）g／L 화（8．02±1．25）g／L，（57．5±6．6）％화（50．5±6．0）％，（39．5±3．5）％화（35．6±3．6）％，균교치료전명현승고（t ＝3．633、5．835、9．534、6．427화3．274、3．643、4．732、3．658，균 P ＜0．05）；관찰조치료후 IgA、IgG、CD ＋3、CD ＋4명현고우대조조（t ＝3．553、3．434、3．568、3．336，균 P ＜0．05）；관찰조적림상총유효솔위90.0％，대조조위72．5％，차이유통계학의의（χ2＝6．664，P ＜0．05）。결론필다막덕、포도당산자、배비강연합치료영유인천연성만성복사가협동조정면역공능문란，제고세포면역여체액면역，예방계발성감염，개선영양，촉진점막조직수복，기이제고치료근기료효급강저원기복발，치득림상추엄사용。
Objective To observe the effect of pidotimod,zinc gluconate,bifico on immune function in the treatment of infants with persistent chronic diarrhea,and to provide new options for clinical treatment.Methods The infants with persistent chronic diarrhea were selected as study objects,all patients were randomly divided into 40 patients of the observation group and 40 patients of control group,both group were given conventional treatment, which including ORS oral rehydration,vitamin supplements,electrolytes,correct acid -base balance,smecta.The con-trol group were given zinc gluconate and bifico(Bifico 20mg/kg,tid;oral zinc gluconate,10 -20mg/d (zinc compu-ting),tid),the observation group were given pidotimod(400mg/times,qd)on the basis of the control group.Both group had been treated for three weeks and been followed for 12month.The symptoms improvement was observed be-fore and after treatment,the time of stool frequency normalization and stool Characters normalization were recorded,the blood were extracted for detecting immunoglobulin (IgA,IgG)and T lymphocyte subsets (CD +3 ,CD +4 ,CD +8 ),the effect and Diarrhea relapses of follow -up of 6 months were evaluated.Results The time of stool frequency normali-zation and stool characters normalization in the observation group and the control group were (4.5 ±1.5 )d and (7.8 ±2.2)d,(4.3 ±1.6)d and(7.5 ±2.0)d,the observation group were significantly shorter than the control group,t =7.146,8.108,all P <0.01.The number of diarrhea relapses of follow -up of 6 months in observation group and the control group were (2.05 ±1.62)times and (3.73 ±1.65 )times,(3.38 ±2.12)times and (5.15 ± 2.32)times,the observaiton group were significantly less than the control group,t =3.845,3.636,all P <0.05.The IgA,IgG,CD +3 ,CD +4 ,of observation group and control group after treatment were (1.75 ±0.10)g/L vs.(1.50 ± 0.11)g/L,(8.95 ±1.42)g/L vs.(8.02 ±1.25)g/L,(57.5 ±6.6)% vs.(50.5 ±6.0)%,(39.5 ±3.5)% vs. (35.6 ±3.6)%,the observation group were significantly higher than before treatment (t =3.633,5.835,9.534, 6.427 and 3.274,3.643,4.732,3.658,all P <0.05).The IgA,IgG,CD +3 ,CD +4 of observation group after treatment was significantly higher than the control group (t =3.553,3.434,3.568,3.336,all P <0.05).The total effective rate of observation group was 90.0%,the control group was 72.5%,the difference was statistically significant(χ2 =6.664,P <0.05).Conclusion The method containing pidotimod,zinc gluconate and bifico can adjust the immune dysfunction,improve immune and humoral immunity,prevent secondary infection,improve nutrition,promote mucosal tissue repair,improve treatment efficacy and reduce the long -term recurrence,worthy of clinical use in the treatment of infants with persistent chronic diarrhea.