Influence of infliximab on intestinal flora changes and serum inflammatory factors in patients with inflammatory bowel disease
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摘要: 目的 探讨英夫利西单抗对炎症性肠病患者肠道菌群分布及血清炎性因子水平的影响。方法 将2020年全年绍兴市中心医院医共体总院收治经多项检查结果诊断为炎症性肠病患者128例，按照随机数字表法分为常规组(n=64)和英夫利西单抗组(n=64)，常规组给予常规治疗，英夫利西单抗组给予常规治疗联合英夫利西单抗，12周为1个疗程，观察治疗前后患者血清炎性因子水平、肠道菌群水平、免疫功能各项指标。结果 治疗后英夫利西单抗组患者血清炎性因子IL-8、IL-17及TNF-α水平低于常规组(P< 0.05)；IL-10水平高于常规组(P< 0.05)。英夫利西单抗组肠球菌和大肠埃希菌数量较治疗前低(P< 0.05)；英夫利西单抗组肠球菌和大肠埃希菌数量低于常规组(P< 0.05)。英夫利西单抗组乳酸菌和双歧杆菌数量较治疗前升高(P< 0.05)；英夫利西单抗组乳酸菌和双歧杆菌数量高于常规组(P< 0.05)。治疗后患者CD3+、CD4+、CD4+/CD8+升高(P< 0.05)，CD8+显著降低(P< 0.05)；英夫利西单抗组CD3+、CD4+、CD4+/CD8+指标值高于常规组(P< 0.05)；英夫利西单抗组CD8+指标值低于常规组(P< 0.05)。结论 英夫利西单抗可帮助患者肠道菌群恢复平衡，降低血清炎性因子水平，提高患者的免疫功能，且未增加不良反应发生情况。Abstract: Objective To explore the influence of infliximab on intestinal flora changes and serum inflammatory factors in patients with inflammatory bowel disease.Methods A total of 128 patients were diagnosed with inflammatory bowel disease in Shaoxing Central Hospital in 2020. According to the random number table method, they were divided into conventional group(n=64) and infliximab group(n=64). The conventional group received conventional treatment, and the infliximab group received conventional treatment combined with infliximab, 12 weeks as a course. The levels of serum inflammatory factors, the numbers of enterococcus and Escherichia coli, lactic acid bacteria and bifidobacteria, and various indexes of immune function were observed before and after taking corresponding treatment measures.Results After taking corresponding measures, the levels of serum inflammatory factors IL-8, IL-17 and TNF-α in infliximab group were lower than those in conventional group(P< 0.05). The level of IL-10 was higher than that of conventional group(P< 0.05). The number of enterococcus and Escherichia coli in infliximab group was lower than that before taking corresponding measures(P< 0.05); The number of enterococcus and escherichia coli in infliximab group was lower than that in conventional group(P< 0.05). The number of lactic acid bacteria and bifidobacteria in infliximab group was increased compared with that before taking corresponding measures(P< 0.05); The number of lactic acid bacteria and bifidobacteria in infliximab group was higher than that in conventional group(P< 0.05). CD3+, CD4+, CD4+/CD8+increased(P< 0.05), while CD8+decreased significantly(P< 0.05). The index values of CD3+, CD4+and CD4+/CD8+in infliximab group were higher than those in conventional group(P< 0.05). CD8+index value of infliximab group was lower than that of conventional group(P< 0.05).Conclusion Infliximab helps restore balance to the patient's intestinal flora, decreases serum levels of inflammatory factors and improves the patient's immune function without increasing the incidence of adverse reactions.
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表 1 血清炎性因子水平情况
ng/L，X±S 组别 例数 时间 IL-8 IL-10 IL-17 TNF-α 常规组 64 治疗前 39.85±5.76 25.85±4.66 407.75±61.25 86.84±17.81 治疗后 26.35±4.131) 50.23±6.141) 207.75±42.231) 61.26±14.291) 英夫利西单抗组 64 治疗前 38.75±5.71 26.38±4.75 405.28±60.28 88.16±15.83 治疗后 16.64±2.631)2) 65.28±7.231)2) 112.38±30.161)2) 45.27±10.231)2) 与同组治疗前比较，1)P < 0.05；与常规组比较，2)P < 0.05。 
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表 2 肠道菌群变化情况
IgN/g, X±S 组别 例数 时间 肠球菌 大肠埃希菌 乳杆菌 双歧杆菌 酵母菌 消化球菌 常规组 64 治疗前 7.31±0.83 7.25±0.73 4.12±0.42 7.24±0.71 2.30±0.24 4.85±0.52 治疗后 6.95±0.68 7.05±0.70 5.35±0.601) 7.85±0.831) 2.26±0.21 4.64±0.49 英夫利西单抗组 64 治疗前 7.30±0.85 7.28±0.75 4.13±0.44 7.26±0.72 2.33±0.26 4.90±0.54 治疗后 6.36±0.561)2) 6.58±0.641)2) 6.21±0.651)2) 8.35±0.861)2) 2.25±0.20 4.59±0.46 与同组治疗前比较，1)P < 0.05；与常规组比较，2)P < 0.05。
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表 3 免疫功能情况
X±S 组别 例数 时间 CD3+/% CD4+/% CD8+/% CD4+/CD8+ 常规组 64 治疗前 62.33±3.85 33.71±1.89 26.53±1.33 1.27±0.28 治疗后 66.83±2.951) 36.87±1.371) 24.25±1.261) 1.52±0.221) 英夫利西单抗组 64 治疗前 61.78±3.75 33.49±2.05 26.68±1.41 1.25±0.27 治疗后 69.64±2.241)2) 40.32±1.741)2) 22.65±1.121)2) 1.78±0.201)2) 与同组治疗前比较，1)P < 0.05；与常规组比较，2)P < 0.05。
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表 4 2组不良反应发生情况比较
例 组别 呼吸困难 面色潮红 头痛 皮疹 便秘 低血压 总发生率/% 常规组 1 2 1 2 1 1 12.50 英夫利西单抗组 1 2 2 3 2 1 17.19
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