双歧杆菌三联活菌辅助非布司他治疗痛风发作间歇期患者的疗效研究

目的:探讨双歧杆菌三联活菌辅助非布司他治疗痛风发作间歇期患者的疗效及其对患者肠道菌群的影响。方法:选取2019年3月至2021年3月该院收治的痛风间歇期患者110例,采用区组随机化分组法分为非布司他组55例和活菌辅助组55组。两组患者均控制饮食、口服非布司他,活菌辅助组患者在此基础上口服双歧杆菌三联活菌胶囊,两组患者均连续治疗8周。比较两组患者治疗前后血清白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、黄嘌呤氧化酶(XOD)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)和红细胞沉降率(ESR)等指标水平,肠道菌群变化和治疗期间的痛风发作情况。结果:治疗后,两组患者血清IL-1β、IL-6、XOD、UA和ESR水平均较治疗前降低,且活菌辅助组患者的IL-1β(P=0.018)、IL-6(P=0.044)、XOD(P=0.000)、UA(P=0.000)和ESR(P=0.003)水平均明显低于非布司他组,差异有统计学意义。两组患者治疗前后的BUN、CR水平比较,组内、组间的差异均无统计学意义(P>0.05)。非布司他组患者治疗前后双歧杆菌、乳酸杆菌、粪肠球菌、拟杆菌和肠杆菌数量的差异均无统计学意义(P>0.05)。治疗后,活菌辅助组患者双歧杆菌、乳酸杆菌、粪肠球菌和拟杆菌数量增加,肠杆菌数量减少,与治疗前、非布司他组治疗后比较,差异均有统计学意义(P<0.05)。治疗期间,活菌辅助组患者的痛风急性发作率为3.64%(2/55),低于非布司他组的12.96%(7/54),但差异无统计学意义(P>0.05)。结论:痛风发作间歇期患者采用双歧杆菌三联活菌进行辅助治疗,可以降低UA水平,减轻炎症反应,减少痛风急性发作;其机制可能与双歧杆菌三联活菌参与嘌呤氧化代谢,促进UA分解、排泄有关。

Efficacy of Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules Combined with Febuxostat in the Treatment of Patients with Intermittent Gout Attack

OBJECTIVE:To probe into the efficacy of live combined Bifidobacterium,Lactobacillus and Enterococcus capsules combined with febuxostat in the treatment of patients with gout attack intermission and its effects on intestinal flora.METHODS:A total of 110 patients with intermittent gout admitted into this hospital from Mar.2019 to Mar.2021 were extracted to be divided into the febuxostat group(n=55)and the viable bacteria group(n=55)by block randomization method.Patients in both groups were given the controlled diet and oral febuxostat,while the viable bacteria group received oral live combined Bifidobacterium,Lactobacillus and Enterococcus capsules on this basis,and both groups were treated continuously for 8 weeks.The levels of interleukin 1β(IL-1β),interleukin 6(IL-6),xanthine oxidase(XOD),urea nitrogen(BUN),creatinine(Cr),uric acid(UA)and erythrocyte sedimentation rate(ESR)before and after treatment,changes of intestinal flora and gout attack during treatment were compared between two groups.RESULTS:After treatment,the levels of IL-1β,IL-6,XOD,UA and ESR in two groups were all lower than those before treatment.The levels of IL-1β(P=0.018),IL-6(P=0.044),XOD(P=0.000),UA(P=0.000)and ESR(P=0.003)in the viable bacteria group were significantly lower than those in the febuxostat group,the differences were statistically significant.There were no significant differences in levels of BUN and CR between two groups before and after treatment(P>0.05).Differences in the number of Bifidobacterium,Lactobacillus,Enterococcus faecalis,Bacteroidetes and Enterobacteriaceae in the febuxostat group before and after treatment were not statistically significant(P>0.05).After treatment,the number of Bifidobacterium,Lactobacillus,Enterococcus faecalis and Bacteroides in the viable bacteria group increased,and the number of Enterobacteriaceae decreased,compared with the febuxostat group before and after treatment,the differences were statistically significant(P<0.05).During treatment,the rate of acute gout attacks was 3.64%(2/55)in the viable bacteria group,lower than 12.96%(7/54)in the febuxostat group,the difference was not statistically significant(P>0.05).CONCLUSIONS:Adjuvant therapy with live combined Bifidobacterium,Lactobacillus and Enterococcus capsules in patients with intermittent gout attack can lower the uric acid levels,reduce the inflammatory response and acute gout attacks;the mechanism may be related to the involvement of live combined Bifidobacterium,Lactobacillus and Enterococcus capsules in purine oxidation metabolism and promotion of uric acid decomposition and excretion.