刘玲佩 李小兵 陈跃华 赖盼建

[摘要] 目的 探討微生态制剂对过敏性紫癜患儿肠道菌群状态的影响。 方法 选取2017年6月至2019年6月我院收治的80例过敏性紫癜患儿，随机数表法分为两组，对照组40例利用常规药物治疗，试验组40例在此基础上加用微生态制剂治疗。比较两组的临床疗效，治疗前后免疫学及尿蛋白指标水平、肠道菌群水平和治疗6个月内的复发情况。 结果 治疗结束后，试验组治疗有效率（95.00%）高于对照组（77.50%）（P<0.05）;两组治疗后血清球蛋白A（IgA）、补体C3、尿白蛋白（Alb）和β2-微球蛋白（β2-MG）水平均低于治疗前;治疗后，试验组血清IgA、C3和尿液Alb 、β2-MG水平均低于对照组（P<0.05）;两组治疗后大肠杆菌水平低于治疗前，双歧杆菌和B/E值高于治疗前;治疗后，试验组的大肠杆菌水平均低于对照组，双歧杆菌和B/E值高于对照组（P<0.05）;对两组患儿随访6个月，试验组复发率为10.00%，低于对照组的27.50%（P<0.05）。 结论 口服酪酸梭菌活菌散可提高过敏性紫癜患儿临床疗效，改善肠道菌群失调状态，减少复发率，安全性较高。

[关键词] 过敏性紫癜;微生态制剂;肠道菌群;儿童

[中图分类号] R554.6          [文献标识码] A          [文章编号] 1673-9701（2021）13-0005-04

Observation of the effect of microecological preparation on the intestinal flora of children with allergic purpura

LIU Lingpei1   LI Xiaobing2   CHEN Yuehua1   LAI Panjian2

1.Department of General Medicine， Affiliated Jinhua Hospital， Zhejiang University School of Medicine， Jinhua   321000， China; 2.Department of Padiatrics， Affiliated Jinhua Hospital， Zhejiang University School of Medicine， Jinhua   321000， China

[Abstract] Objective To explore the effect of microecological preparation on the state of intestinal flora in children with allergic purpura. Methods Eighty patients with allergic purpura admitted to the hospital from June 2017 to June 2019 were selected. The patients were divided into 2 groups by random number table method. The control group （40 cases） was treated with conventional drugs， and the experimental group（40 cases） was added with microecological preparation based on the above treatment. The clinical efficacy， immunological and urinary protein index levels before and after treatment， intestinal flora levels， and relapse within 6 months of treatment were compared between the two groups. Results After treatment， the effective rate of treatment in the experimental group was 95.00%， higher than that（77.50%） in the control group （P<0.05）. The serum globulin A （IgA）， complement C3， urinary albumin （Alb） and β2-microsphere protein（β2-MG） after treatment in both groups were lower than those before treatment. After treatment， the levels of serum IgA， C3 and urine Alb and β2-MG in the experimental group were lower than those in the control group（P<0.05）. After treatment， the E. coli level in two groups was lower than that before treatment， and the Bifidobacterium and B/E values were higher than those before treatment. After treatment， the E. coli level in the experimental group was lower than that in the control group， and the Bifidobacterium and B/E values in the experimental group were higher than those of the control group（P<0.05）. The two groups of children were followed up for 6 months. The recurrence rate of the experimental group was 10.00%， lower than that 27.50% of the control group（P<0.05）. Conclusion The oral administration of Clostridium butyricum live bacteria powder can improve the clinical efficacy of children with allergic purpura， improve the state of intestinal flora imbalance， reduce the recurrence rate， and has higher safety.

[Key words] Allergic purpura; Microecological preparation; Intestinal flora; Children

过敏性紫癜是3～10岁儿童高发的过敏性疾病之一，据统计，亚洲<5岁患儿约占总患病儿童的50%[1]。过敏性紫癜根据侵犯部位的不同，分为单纯型、肾型、关节型、腹型、混合型五种，临床症状各不相同[2-4]。过敏性紫癜患儿治疗周期长且病情反复，同时并发症多，给患儿及其家长带来极大的痛苦[5]。既往研究揭示了肠道菌群与过敏性疾病之间存在密切关系，两者可能互为因果，相互影响，一般来说肠道微生态稳定的过敏性疾病患儿，临床症状会出现一定程度的缓解，因此肠道微生态的相关与过敏性疾病的防治研究息息相关，临床对于微生态制剂在过敏性疾病中的应用越发重视[6-7]。本研究討论了微生态制剂对过敏性紫癜患儿肠道菌群状态的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年6月至2019年6月我院收治的80例过敏性紫癜患儿，随机数表法分为试验组和对照组，每组各40例。两组患儿的性别、年龄、发病病程、临床症状比较，差异无统计学意义（P>0.05），具有可比性。见表1。

1.2 纳入、排除标准

纳入标准：①符合《诸福棠实用儿科学》中过敏性紫癜的诊断标准[9];②年龄3～14岁;③肾功能正常;④研究方案报送医院伦理委员会批准，每例患者均征求家长知情同意。排除标准：①合并肾病综合征者;②合并心、脑血管、肝、肾、消化道及造血系统等严重原发性疾病;③已使用微生态制剂、抗生素的治疗;④合并原发性免疫缺陷疾病及精神病者;⑤中途退出治疗者。

1.3 治疗方法

对照组：采用常规方式治疗，嘱咐患儿卧床休息，避免剧烈运动，严格控制患儿饮食，同时给予相应的抗血小板聚集、抗过敏及补液等常规治疗……