Effects of azathioprine tablets combined with microbioecologics on intestinal barrier function, microflora and IL-17BR level in patients with inflammatory bowel disease
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摘要: 目的：观察硫唑嘌呤片结合微生态制剂对炎症性肠病（IBD）患者的肠屏障功能、肠道菌群及白介素-17B受体（IL-17BR）水平的影响。方法：选取96例IBD患者按照随机数字表法分为对照组和研究组。对照组患者给予英夫利昔单抗，研究组在对照组基础上联合硫唑嘌呤片结合微生态制剂，观察2组患者肠屏障功能指标包括内毒素、D-乳酸，炎性相关指标包括C-反应蛋白（CRP）、降钙素原（PCT）、粪便钙卫蛋白（FCP），粪便培养并分析肠道菌群的变化，采用流式细胞术检测外周血单个核细胞（PBMC）中IL-BR的表达情况以及比较2组不良反应的发生情况。结果：治疗前2组患者各项观察指标水平之间差异无统计学意义（P>0.05）；与同组治疗前比较，2组患者治疗后的内毒素、D-乳酸、CRP、PCT、FCP、IL-17BR水平均显著降低（P<0.05）；研究组治疗后与对照组治疗后比较，血清内毒素、D-乳酸、CRP、PCT、FCP、IL-17BR水平降低更为显著（P<0.05）。肠道菌群检测结果显示，与同组治疗前比较，2组患者肠球菌、大肠埃希氏菌显著降低，乳杆菌、双歧杆菌显著升高（P<0.05），差异有统计学意义，研究组治疗后与对照组治疗后比较，肠球菌、大肠埃希氏菌降低更为显著，而乳杆菌、双歧杆菌升高更为显著（P<0.05）。2组患者不良反应发生率比较，差异无统计学意义。结论：硫唑嘌呤片结合微生态制剂能够改善IBD患者的肠屏障功能，抑制体内炎性指标，改善肠道菌群，降低IL-17BR水平，且不增加不良反应发生率，具有临床推广应用的价值。Abstract: Objective: To observe the effect of azathioprine tablets combined with microbioecologics on intestinal barrier function, intestinal flora and IL-17BR level in patients with inflammatory bowel disease. Methods: 96 patients with IBD were randomLy divided into two groups:control group and study group. The patients in the control group were treated with infliximab, and the patients in the study group were treated with azathioprine tablets combined with microbioecologics on the basis of the control group. The intestinal barrier function indexes of the two groups were observed, including endotoxin and D-lactic acid. Inflammatory related indexes included C-reactive protein(CRP), procalcitonin(PCT), fecal calcitonin(FCP), fecal culture and analyzed the changes of intestinal flora. Flow cytometry was used to detect the expression of IL-BR in(PBMC) of peripheral blood mononuclear cells and to compare the occurrence of adverse reactions between the two groups. Results: There was no significant difference in the levels of observed indexes between the two groups before treatment, but the levels of endotoxin, D-lactic acid, CRP, PCT, FCP and IL-17BR in the two groups decreased significantly after treatment. After treatment, the levels of serum endotoxin, D-lactic acid, CRP, PCT, FCP and IL-17BR in the study group were significantly lower than those in the control group. The results of intestinal flora detection showed that compared with those before treatment, enterococci and Escherichia coli decreased significantly, while Lactobacillus and Bifidobacterium increased significantly in the two groups(P<0.05). Compared with the control group after treatment, enterococcus and Escherichia coli decreased more significantly, while Lactobacillus and Bifidobacterium increased more significantly(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion: Azathioprine tablets combined with microbioecologics can improve intestinal barrier function, inhibit inflammatory indexes, improve intestinal flora and reduce the level of IL-17BR in patients with inflammatory bowel disease, and do not increase the incidence of adverse reactions, which has the value of clinical application.
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