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目的探讨儿童幽门螺杆菌(H.pylori)感染及抗H.pylori治疗对儿童肠道菌群状态的影响。方法将浙江大学医学院附属儿童医院2004年410月门诊收治的68例慢性胃炎、十二指肠球炎患儿分为H.pylori阳性组36例、H.pylori阴性组32例二组。称取68例患儿新鲜粪便1.0g,分别进行需氧和厌氧培养,分离肠道菌群中最有代表性的三种需氧菌(肠杆菌、肠球菌、酵母菌)和四种厌氧菌(双歧杆菌、乳杆菌、类杆菌、产气荚膜梭菌),菌落记数,同时计算B/E比值来代表定植抗力。对36例H.pylori阳性组中的26例患儿进行“三联”抗H.pylori治疗1周后留取新鲜粪便进行肠道菌群分析,5例患儿在停药1个月后再次进行肠道菌群分析。结果H.pylori阳性组和H.pylori阴性组上述三种需氧菌和四种厌氧菌的菌落检出率比较,差异无统计学意义(P>0.05)。抗H.pylori治疗1周后双歧杆菌、乳杆菌、类杆菌菌落数量较治疗前明显降低(P<0.05),B/E值明显下降(P<0.01),酵母菌的检出率明显增加(P<0.05),产气荚膜梭菌检出率下降(P<0.05)。5例患儿在停药1个月后,乳酸杆菌数量仍继续下降,肠杆菌数量继续增加,双歧杆菌、类杆菌数量有所恢复,但仍低于治疗前。结论儿童H.pylori感染后对肠道菌群影响不大;三联疗法抗H.pylori治疗对儿童肠道菌群产生明显的影响,因此在治疗H.pylori感染时须考虑到大量抗生素治疗后可能对患儿的副作用及潜在的危险。

Changes of intestinal microbial flora in children after Helicobacter pylori infection and anti-H·pylori therapy

??AbstractObjectiveTo investigate the changes of intestinal microbial flora in children after Helicobacter pylori infection and anti??Helicobacter pylori triple therapeutic regimen.MethodsFresh stool of 68 patients with chronic gastritis and duodenitis (H??pylori + 36 vs H??pylori ??32 ) were adopted and cultivated for three aerobes(Enterobacterium??Enterococcus and Yeast) and four anaerobes (Bifidobacterium,Lactobacillus,Bacteroides and Clostridium perfringens) which represented the intestinal microbial flora.B/E value (Bifidobacterium /Enterobacterium) was calculated as the index of the intestinal colonization resistance.Twenty??six patients with H??pylori infection were reanalyzed the intestinal microbial flora after a seven??day anti??H??pylori therapy with the therapeutic regimen of Omeprazole,amoxicillin and clarithromycin. Five of them were followed up one month after therapy.ResultsThe intestinal microbial flora was not changed significantly after H??pylori infection.The amount of Bifidobacterium,Lactobacillus and Bacteroides were significantly decreased after anti??H??pylori therapy (P<0.05),while the amount of Enterobacterium was significantly increased(P<0.05)??and B/E value was decreased(P<0.01).The isolating rate of Yeast was increased after therapy(P<0.05),and the isolating rate of Clostridium perfringens was decreased after therapy(P<0.05).One month after therapy,the amount of Lactobacillus continued decreasing,while Enterobacterium returned,and the amount of Bifidobacterium and Bacteroides returned to almost normal but was lower than before therapy.ConclusionHelicobacter pylori infection in children does not affect the growth of Enterobacterium??Enterococcus,Yeast,Bifidobacterium,Lactobacillus,Bacteroides and Clostridium perfringens.Anti??H??pylori therapy with Omeprazole,amoxicillin and clarithromycin results in suppression on the growth of Bifidobacterium,Lactobacillus and Bacteroides and increased Enterobacterium and yeast in the intestinal lumen.The action of therapeutic regimen on the intestinal microbial flora remains one month after therapy.The side effects and potential dangers of triple therapy should be considered.