肠道微生态制剂治疗致病菌阴性急性腹泻的临床研究

急性腹泻是一种消化系统常见症状，主要表现为排便的次数明显超过平时的习惯频率，粪便稀薄、含水分较多，可伴有腹痛、发热，主要由肠道致病菌及肠毒素等造成。发病率高，是门、急诊的常见病，既往多着重于抗菌治疗。近年来对肠道微生态的研究得到了很大的发展，肠道微生态制剂的应用受到重视。为了观察肠道微生态制剂在急性腹泻治疗中的作用，我们应用培菲康（双歧杆菌、嗜酸乳杆菌、肠球菌三联活菌制剂）对急性腹泻患者进行治疗，报告如下。     

双歧杆菌四联活菌片联合锌制剂治疗小儿腹泻的临床效果

目的探究双歧杆菌四联活菌片联合锌制剂治疗小儿腹泻的临床效果。方法选取小儿腹泻患者80例,按随机数字表法分为2组。对照组40例,予以双歧杆菌四联活菌片治疗;观察组40例,予以双歧杆菌四联活菌片联合锌制剂治疗。对比2组治疗效果、肠道菌群情况及症状消失时间。结果与对照组比较,观察组治疗总有效率及乳酸杆菌、双歧杆菌、类杆菌数值均明显升高,肠杆菌、肠球菌数值均明显降低,临床症状消失时间明显缩短,差异均有统计学意义(均P<0.05)。结论双歧杆菌四联活菌片联合锌制剂可以改善肠道菌群情况,提高小儿腹泻的治疗效果,加快患儿恢复健康。     

严重烧伤伴腹泻患者口服双歧杆菌制剂的疗效观察及护理

目的：观察双歧杆菌制剂治疗严重烧伤病人腹泻的作用。方法：选取烧伤后腹泻病人26例，从腹泻当天开始喂服双歧杆菌活菌制剂，于喂服前及喂服后第3天及第6天采集粪便做粪便菌群分析。另选10名健康成年人粪便标本为对照组。结果：严重烧伤后粪便菌群总菌量较正常显下降，肠杆菌轻度下降，双歧杆菌下降近1000倍，酵母样真菌显升高，说明肠道菌群发生紊乱。用双歧杆菌制剂治疗6d后腹泻均停止，肠道菌群趋向正常，与对照组和治疗前比较均存在显性差异（P＜0．05或P＜0．01）。结论：口服双歧杆菌制剂能调整肠道菌群紊乱，起到治疗腹泻的作用。注意饭后给药，低温（4℃）存放药物。     

双歧杆菌四联活菌片联合复方谷氨酰胺肠溶胶囊治疗老年人肠道菌群失调相关性腹泻的临床观察

目的观察双歧杆菌四联活菌片（商品名：思连康）联合复方谷氨酰胺肠溶胶囊对老年人肠道菌群失调相关性腹泻的临床疗效。方法肠道菌群失调相关性腹泻老年住院患者68例,根据随机数字表法按入院先后顺序随机分为治疗组和对照组各34例,治疗组服用双歧杆菌四联活菌片1 g加复方谷氨酰胺肠溶胶囊0.4 g,均3次/天;对照组仅服用双歧杆菌四联活菌片1 g,3次/天,比较两组总有效率及粪检结果。结果治疗组显效28例、有效5例、无效1例,总有效率为97.05%;对照组显效16例、有效10例、无效8例,总有效率为76.47%,两组总有效率比较差异有统计学意义（P〈0.05）;两组粪检杆球比例倒置、细菌计数减少、真菌感染等差异均有统计学意义（P〈0.05）。结论双歧杆菌四联活菌片联合复方谷氨酰胺肠溶胶囊治疗老年人肠道菌群失调相关性腹泻,疗效确切,安全可靠。     

应用双歧杆菌预防亚胺培南继发肠道真菌感染

双歧杆菌 (培菲康 )为乳酸杆菌、双歧杆菌及肠球菌的三联活菌。亚胺培南 (泰能 )为强有力的广谱抗生素。近年来 ,随着泰能的应用 ,真菌感染问题日益受到视重。为了探讨经济、可行、有效的预防真菌感染的方法 ,我科对 1998～ 2 0 0 1年收住的、需使用泰能抗感染的患者进行了培菲康预防肠道真菌感染的效果观察 ,现报告如下。1　资料与方法1.1　病例　研究对象为 12 6例呼吸科住院患者 ,依病情需使用泰能抗感染治疗 ,已剔除合并糖尿病、入住ICU、使用深静脉导管及肿瘤化疗病例。其中男性 5 0例 ,女性 76例 ,年龄6 3～ 82岁 ,平均 74 .5岁。其…     

微生态制剂预防抗生素相关性腹泻的临床研究

【目的】探讨微生态制剂对抗生素相关性腹泻（AAD）的预防作用。【方法】选择患有严重肺和（或）腹腔感染，静脉应用2种以上抗菌药物且连续治疗〉5d，排除慢性胃肠道疾病的住院成年患者150例患者，随机分思连康治疗组（A组，50例）和金双歧治疗组（B组，50例）及对照组（C组，50例）。入选患者在抗感染治疗的同时，A组加用双歧杆菌、乳杆菌、肠球菌、蜡样芽孢杆菌四联活菌片（思连康），B组加用双歧杆菌、乳杆菌、嗜热链球菌三联活菌片（金双歧），比较分析各组患者AAD的发生情况。【结果】C组患者AAD发生率（24％）明显高于A、B两组患者（P〈0．01）；A组患者AAD发生率（4％）明显低于B组患者（10％）。【结论】应用抗菌药物治疗同时，口服微生态制剂思连康或金双歧均能有效预防AAD的发生，且思连康的效果更为明显。     

双歧杆菌四联活菌片(思连康)防治抗生素相关性腹泻疗效分析

目的 观察双歧杆菌四联活菌片(思连康)防治抗生素相关性腹泻的疗效.方法 将200例患者随机分为治疗组100例和对照组100例,比较两组的止泻时间、治疗总疗程、疗效等指标,在患者康复后对治疗组继续使用双歧杆菌四联活菌片(思连康)进行巩固预防,并进行回访.结果 治疗组的止泻时间和治疗总疗程均显著低于对照组(P＜0.01);治疗组的显效率和有效率分别为85.0%、95.0%,明显高于对照组的51.7%、80.0%(P＜0.05).结论 双歧杆菌四联活菌片(思连康)对于防治相关性腹泻可以很快控制病情,效果非常明显,同时没有明显不良反应,值得推广应用.     

联合用药治疗小儿消化不良性腹泻50例临床观察

通过选取收治的小儿消化不良性腹泻患儿98例,分为两组,对照组采用双歧杆菌四联活菌片治疗,观察组在对照组基础上给予小儿肠胃康颗粒治疗,均3d为1个疗程,连续治疗3个疗程。观察组总有效率(98.00%)显著高于对照组(83.33%),差异有统计学意义(P0.05)。双歧杆菌四联活菌片联合小儿肠胃康颗粒治疗小儿消化不良性腹泻疗效确切,值得临床借鉴。     

双歧杆菌活菌制剂佐治婴幼儿腹泻临床观察

目的:观察双歧杆菌活菌制剂对婴幼儿腹泻的疗效.方法:将136例婴幼儿腹泻按就诊顺序随机分为两组,治疗组56例,对照组80例.两组均给予常规抗病毒、对症支持治疗,治疗组在此基础上给予双歧杆菌制剂常乐康散剂口服3～7天.结果:治疗组3天及7天总有效率分别为91.1%、98.2%,对照组3天及7天总有效率分别为67.5%、85.0%,两组比较差异有显著性意义(P＜0.01).结论:双歧杆菌活菌制剂对婴幼儿腹泻可提高治疗效果,值得临床推广应用.     

双歧杆菌四联活菌片联合蒙脱石散治疗对腹泻患儿的炎症因子水平的影响

目的 探究双歧杆菌四联活菌片联合蒙脱石散治疗腹泻患儿的临床疗效,分析其对患儿炎症因子水平的影响。方法 采用随机数字表法将我院2017年1月至2019年12月收治的68例腹泻患儿分为对照组和观察组各34例。对照组给予蒙脱石散治疗,观察组在对照组的基础上加用思连康（双歧杆菌四联活菌片）治疗。比较两组临床疗效、症状改善时间、炎症因子水平、肠道菌群数量和不良反应。结果 观察组治疗总有效率高于对照组,差异有统计学意义（P<0.05）;治疗后,观察组退热时间、腹泻停止时间、住院时间均少于对照组,差异有统计学意义（P<0.05）;治疗后,观察组IL-6、CRP、TNF-α水平均低于对照组,差异有统计学意义（P<0.05）;治疗后,观察组肠杆菌数量少于对照组,双歧杆菌、乳酸杆菌数量多于对照组,差异有统计学意义（P<0.05）;两组不良反应比较,差异无统计学意义（P>0.05）。结论采用思连康联合蒙脱石散治疗儿童小儿腹泻,可缓解患儿临床症状,促进机体恢复,提高治疗效果,有效改善患儿炎症反应和肠道菌群数量,且安全性较高。     

国产微生态制剂金双歧片治疗肠道菌群失调症的临床疗效和菌群分析

本文采用国产微生态制剂金双歧片治疗肠道菌群失调症 10例 ,以观察其临床疗效和肠道菌群变化。研究结果表明 ,10例肠道菌群失调症患者中 ,经治疗后 ,8例有效 ,临床有效率 80 % (8/10 ) ,其中 7例真菌性肠炎 1例无效 ,1例进步 ,5例有效。菌群分析结果显示 :治疗后厌氧菌和需氧菌数量均明显增加 (P <0 0 5 ) ,7例真菌性肠炎经治疗 6例大便培养真菌消失 ,1例虽然未消除但量有所减少。在 10例病例中未发现不良反应。以上说明 ,金双歧片是治疗肠道菌群失调症较好的微生态制剂。     

金双歧、思密达联用治疗小儿腹泻的疗效观察

目的　探讨金双歧、思密达对小儿腹泻的疗效。方法　 116例腹泻患儿随机分为两组 ,治疗组给予金双歧、思密达口服 ,对照组给予小儿利宝口服 ,并进行疗效判断。结果　治疗组总有效率为 96.7% ,对照组总有效率为 75 % ,治疗组疗效明显优于对照组 ,经统计学处理 ,两组差异非常显著 (P <0 .0 0 1)。结论　金双歧、思密达联用疗效满意 ,是治疗小儿腹泻的一种有效的方法     

2012－2014年乌鲁木齐市5岁以下急性腹泻儿童患者诺如病毒感染及基因型研究

目的了解2012 — 2014年新疆维吾尔自治区（新疆）乌鲁木齐市＜5岁住院儿童患者诺如病毒的分子流行病学特征。方法收集2012 — 2014年乌鲁木齐市895例＜5岁急性腹泻儿童患者粪便标本和流行病学资料,应用实时荧光反转录聚合酶链式反应（RT-PCR）进行诺如病毒检测,阳性样本通过RT-PCR扩增、测序和序列分析。结果诺如病毒的检出率为16.8%（150/895）,不同年份阳性率差异有统计学意义（χ2＝21.080,P＜0.05）;不同年龄组阳性率差异有统计学意义（χ2=13.367,P＝0.020）。 137份样本获得聚合酶区序列,其中89份获得衣壳蛋白区序列。聚合酶区和衣壳区分别包括11和9个基因型。根据89株双分型结果,GⅡ.4 Den Haag 2006b和GⅡ.Pe/GⅡ.4 Sydney 2012分别占21.3%和32.6%,GⅡ.P12/GⅡ.3占29.2%。 根据衣壳区分型结果,在GⅡ.4基因型中,2012 — 2014年GⅡ.4 DenHaag 2006b所占比例分别为90.0%、0%和0%;GⅡ.Pe/GⅡ.4 Sydney 2012所占比例分别为10.0%、100%和100%。结论新疆乌鲁木齐市急性腹泻儿童诺如病毒具有遗传多样性;GⅡ.Pe/GⅡ.4 Sydney 2012在新疆地区出现,逐渐替代GⅡ.4 DenHaag 2006b成为新的流行优势株。     

蒙脱石散联合双歧杆菌乳杆菌三联活菌片治疗小儿急性腹泻的效果及对患儿细胞因子水平的影响

目的探讨蒙脱石散联合双歧杆菌乳杆菌三联活菌片治疗小儿急性腹泻的效果及对患儿细胞因子水平的影响。方法选取2014年5月至2019年5月我院收治的急性腹泻患儿98例,按照随机数字表法将其分为对照组与研究组,各49例。对照组应用蒙脱石散治疗,研究组应用蒙脱石散联合双歧杆菌乳杆菌三联活菌片治疗。比较两组治疗效果。结果研究组患儿的治疗总有效率高于对照组(P<0.05)。治疗后,研究组患儿的IL-6、IL-10及TNF-α水平均低于对照组与治疗前(P<0.05)。治疗后,研究组患儿的乳酸杆菌、双歧杆菌均多于对照组与治疗前,肠球菌及肠杆菌均少于对照组与治疗前(P<0.05)。结论蒙脱石散联合双歧杆菌乳杆菌三联活菌片治疗小儿急性腹泻可以调节患儿肠道内菌群平衡,缓解炎症反应,可在临床中进一步推广应用。     

双岐杆菌四联活菌片治疗婴幼儿秋季腹泻的临床研究

目的观察双岐杆菌四联活菌片联合蒙脱石散治疗婴幼儿轮状病毒性肠炎（RV肠炎,秋季腹泻）的疗效。方法142例患儿随机分为两组,A组65例用蒙脱石散治疗,B组77例在A组治疗基础上加用双岐杆菌四联活菌片。结果B组的总有效率（93．5％）明显高于A组（76．9％）,差异有显著性（P〈0．05）。A组平均止泻时间（133．20±41．89）h高于B组平均止泻时间（68．63±29．48）h,差异有显著性（P〈0．05）。结论双岐杆菌四联活茵片联合蒙脱石散治疗婴幼儿秋季腹泻的疗效显著,止泻时间短。     

Efficacy and safety of a novel once-daily extended-release ciprofloxacin tablet formulation for treatment of uncomplicated urinary tract infection in women

The efficacy and safety of a novel once-daily extended-release ciprofloxacin (ciprofloxacin ER) 500-mg dose were compared with those of an immediate-release ciprofloxacin (ciprofloxacin IR) 250-mg twice-daily dose, each administered orally for 3 days in the treatment of acute uncomplicated urinary tract infection (uUTI) in women. Adult female outpatients (mean age, 39 years) with clinical signs and symptoms of acute uUTI and a positive pretreatment urine culture (> or =10(5) CFU/ml) were enrolled in a multicenter, randomized, double-blind, noninferiority trial. Patients were assessed at a test-of-cure visit (4 to 11 days posttreatment) and a late-posttreatment visit (4 to 6 weeks posttreatment) for microbiological and clinical outcomes and safety. The primary efficacy endpoint and microbiological eradication rate at the test-of-cure visit in the ciprofloxacin ER group (254/272; 93.4%) were noninferior to those in the ciprofloxacin IR group (225/251; 89.6%) (95% confidence interval [CI] of difference, -0.99%, 8.59%). Clinical-cure rates at the test-of-cure visit were 85.7% (233/272) for ciprofloxacin ER and 86.1% (216/251) for ciprofloxacin IR (95% CI of difference, -6.37%, 5.57%). At the late-posttreatment visit, microbiological and clinical outcomes were similar for the two treatments and consistent with test-of-cure results. Both treatments were well tolerated, but the frequencies of nausea and diarrhea were lower in the ciprofloxacin ER group than in the ciprofloxacin IR group (nausea, ER, 0.6%; IR, 2.2%; P = 0.033; diarrhea, ER, 0.2%; IR, 1.4%; P = 0.037). Once-daily ciprofloxacin ER was safe, effective, and noninferior to twice-daily ciprofloxacin IR in the treatment of acute uUTI. Additionally, ciprofloxacin ER was associated with significantly reduced frequencies of nausea and diarrhea.     

Loracarbef (LY163892) versus cefaclor in the treatment of acute bacterial bronchitis.

In this double-blind study, 319 patients (133 men, 186 women) with acute bronchitis were randomly assigned to receive 200 mg of loracarbef twice daily (n = 160; mean age, 42 years) or 250 mg of cefaclor thrice daily (n = 159; mean age, 43 years) for seven days. Clinical and bacteriologic responses were assessed in 63 loracarbef-treated and 56 cefaclor-treated patients in whom pretreatment positive cultures of pathogens susceptible to loracarbef and cefaclor were found. Among these evaluable patients, a clinical cure was found in 68.3% of the loracarbef-treated patients and in 66.1% of the cefaclor-treated patients and improvement in 27.0% and 28.6%, respectively; the pathogen was eliminated in 7.9% and 10.7% and presumed eliminated in 82.5% and 82.1%, respectively. Three in the loracarbef group discontinued treatment because of adverse events, two of which (nausea, nausea/diarrhea/vomiting) were presumably related to the drug. Headache was reported by 9.4% of the 160 patients in the loracarbef group and 6.9% of the 159 patients in the cefaclor group; diarrhea by 5.6% and 6.9%, respectively; and dyspepsia/abdominal pain/gastrointestinal disorders by 5.6% and 4.4%, respectively. It is concluded that both loracarbef and cefaclor are safe and effective in the treatment of acute bacterial bronchitis.     

2009-2015年福建省福州市急性腹泻儿童中诺如病毒基因多样性及动态变化研究

目的 通过定点监测了解2009-2015年福建省福州市急性腹泻儿童中诺如病毒基因多样性及动态变化趋势。方法 采集2009-2015年福州市儿童医院因急性腹泻入院的5岁以下儿童的粪便标本,应用实时荧光定量聚合酶链反应（Real-time PCR）筛查诺如病毒阳性标本。应用反转录聚合酶链反应（RT-PCR）方法扩增完整的VP1区和部分RdRp区并测序,应用在线基因分型工具和种系进化分析方法了解福州市5岁以下儿童中诺如病毒基因型/亚型的分布。结果 在随机抽取的93份标本中,Real-time PCR法检测阳性有91份;共获得其中73份完整VP1区和72份部分RdRp区基因序列。在完整的VP1分型中,GⅡ.4_2006b型43份,GⅡ.4 Syndeny_2012型16份,GⅡ.3型10份,GⅡ.4 New Orleans_2009型2份,GⅡ.12型1份,GⅡ.7型1份。在部分RdRp区分型中,共发现GⅡ.P4_2006b型43份,GⅡ.Pe型16份,GⅡ.P12型10份,GⅠ.P4型1份,GⅠ.Pa型1份,GⅡ.P21型1份。结论 应用双命名系统分型的方法,发现2009-2015年福州市急性腹泻儿童中诺如病毒具有遗传多样性,其中2009-2012年流行的优势毒株为GⅡ.P4_2006b/GⅡ.4_2006b型,2013-2015年流行的优势毒株为GⅡ.Pe/GⅡ.4 Sydney_2012型。此外,GⅡ.P12/GⅡ.3为福州市持续流行的型别。     

Diagnosis of intestinal graft-versus-host disease and thrombotic microangiopathy after allogeneic stem cell transplantation

Severe diarrhea is a serious complication after allogeneic hematopoietic stem cell transplantation (HSCT). Acute graft-versus-host disease (GVHD) has been one of the major causes of diarrhea after HSCT, which is triggered by donor-derived cytotoxic T-lymphocytes. On the other hand, intestinal thrombotic microangiopathy (TMA) sometimes coexists with acute GVHD, and intensified immunosuppression to treat acute GVHD could exacerbate intestinal TMA, presumably through the vascular endothelial cell damage. The differential diagnosis between intestinal TMA and acute GVHD of the gut has mainly relied on the pathological findings, as clinical diagnosis of intestinal TMA has not been established. Therefore, we aimed to assess the feasibility of our clinical diagnosis for the patients with diarrhea after HSCT. We made tentative clinical criteria for intestinal TMA and acute GVHD of the gut, based on the clinical manifestations, laboratory data and colonoscopic findings, and started treatment before pathological diagnosis were made. Subsequently, a pathologist retrospectively assessed the accuracy of clinical diagnosis in a blind manner. In this study, we enrolled 19 patients complicating watery diarrhea after HSCT, and diagnosed as having acute GVHD (n = 10), intestinal TMA (n = 3), or both (n = 6) according to our criteria. We demonstrated that our clinical diagnosis for intestinal TMA and acute GVHD of the gut was overall correct, in terms of the response to the therapy and the pathological diagnosis. The present study may provide a clue on making clinical diagnosis of patients with watery diarrhea after HSCT, which enables us to start a prompt therapy.     

The insect peptide coprisin prevents Clostridium difficile-mediated acute inflammation and mucosal damage through selective antimicrobial activity

Clostridium difficile-associated diarrhea and pseudomembranous colitis are typically treated with vancomycin or metronidazole, but recent increases in relapse incidence and the emergence of drug-resistant strains of C. difficile indicate the need for new antibiotics. We previously isolated coprisin, an antibacterial peptide from Copris tripartitus, a Korean dung beetle, and identified a nine-amino-acid peptide in the α-helical region of it (LLCIALRKK) that had antimicrobial activity (J.-S. Hwang et al., Int. J. Pept., 2009, doi:10.1155/2009/136284). Here, we examined whether treatment with a coprisin analogue (a disulfide dimer of the nine peptides) prevented inflammation and mucosal damage in a mouse model of acute gut inflammation established by administration of antibiotics followed by C. difficile infection. In this model, coprisin treatment significantly ameliorated body weight decreases, improved the survival rate, and decreased mucosal damage and proinflammatory cytokine production. In contrast, the coprisin analogue had no apparent antibiotic activity against commensal bacteria, including Lactobacillus and Bifidobacterium, which are known to inhibit the colonization of C. difficile. The exposure of C. difficile to the coprisin analogue caused a marked increase in nuclear propidium iodide (PI) staining, indicating membrane damage; the staining levels were similar to those seen with bacteria treated with a positive control for membrane disruption (EDTA). In contrast, coprisin analogue treatment did not trigger increases in the nuclear PI staining of Bifidobacterium thermophilum. This observation suggests that the antibiotic activity of the coprisin analogue may occur through specific membrane disruption of C. difficile. Thus, these results indicate that the coprisin analogue may prove useful as a therapeutic agent for C. difficile infection-associated inflammatory diarrhea and pseudomembranous colitis.