Ruchkina I N, Fadeeva N A
Loginov Moscow Clinical Scientific Center.
Research Institute of Health Organization and Medical Management.
Ter Arkh. 2021 Apr 15;93(4):431-434. doi: 10.26442/00403660.2021.04.200808.
To study the effectiveness of the combined probiotic Bifiform and the enzyme lactase in the treatment of secondary lactase deficiency (SLD).
We examined 79 patients with SLD, isolated from the group of patients with post-infectious irritable bowel syndrome (IBS) with a predominance of diarrhea. The age of patients reached 273.5 years, women predominated by gender 62%. Diagnosis of SLD was carried out in biopsies of the small intestine mucosa using a color rapid test. To diagnose small intestinal bacterial overgrowth (SIBO) all patients underwent lactulose breath test (LBT) during 2 hours by gas analyzer. All patients with lactase deficiency (LD) were divided into 2 groups: group 1 included 54/79 patients who received the combined probiotic Bifiform (1 capsule per day), group 2 was treated with the enzyme lactase [1 capsule (3450 ME) 3 times a day]. The effectiveness of therapy was evaluated by the dynamics of clinical symptoms, indicators of LBT and the detection of hypolactasia in biopsies of the small intestine mucosa twice, before and 2 weeks after treatment.
In the group of patients with LD, as a result of 14-day therapy with the combined probiotic Bifiform, 85.2% showed positive clinical dynamics, the values of SIBO in the small intestine decreased from 5814 to 219 ppm, p0.05, and the activity of the lactase enzyme was completely restored. In 14.8% of patients, LD was preserved against the background of persistent SIBO. In the second group of 25 patients, 84% of patients did not achieve a positive dynamics of the disease as a result of taking the lactase enzyme, and hypolactasia and changes in the lumen microflora of the small intestine were preserved after repeated examination of small intestine biopsies. Recovery of the activity of the lactase enzyme was observed in a small percentage of patients, which was 16%.
In 85.2% of patients, as a result of therapy with the combined probiotic Bifiform, the activity of the lactase enzyme was restored, due to the suppression of bacterial contamination in the lumen of the small intestine. Replacement therapy with the enzyme lactase only led to remission of LN in 14.2%, while in the majority 85.8% hypolactasia and SIBO remained. Pathogenetic therapy of LN in the adult population includes the appointment of a combined probiotic Bifiform 1 capsule 3 times a day, a course of at least 14 days. As a symptomatic therapy for LN, replacement therapy with the enzyme lactase can be prescribed.
研究复合益生菌必孚（Bifiform）和乳糖酶治疗继发性乳糖酶缺乏症（SLD）的疗效。
我们对79例SLD患者进行了研究，这些患者选自以腹泻为主的感染后肠易激综合征（IBS）患者群体。患者年龄达273.5岁，女性占62%。采用彩色快速检测法对小肠黏膜活检组织进行SLD诊断。为诊断小肠细菌过度生长（SIBO），所有患者均通过气体分析仪进行2小时的乳果糖呼气试验（LBT）。所有乳糖酶缺乏（LD）患者分为2组：第1组包括54/79例患者，接受复合益生菌必孚（每天1粒胶囊）治疗；第2组用乳糖酶治疗[每天3次，每次1粒胶囊（3450酶活力单位）]。通过临床症状变化、LBT指标以及治疗前和治疗2周后小肠黏膜活检组织中乳糖酶缺乏的检测情况来评估治疗效果。
在LD患者组中，经过14天复合益生菌必孚治疗，85.2%的患者临床症状呈阳性变化，小肠中SIBO值从5814降至219 ppm，p<0.05，乳糖酶活性完全恢复。14.8%的患者在持续存在SIBO的情况下仍存在LD。在第2组的25例患者中，84%的患者服用乳糖酶后疾病未出现阳性变化，再次检查小肠活检组织后仍存在乳糖酶缺乏及小肠腔内微生物群变化。仅一小部分（16%）患者观察到乳糖酶活性恢复。
85.2%的患者经复合益生菌必孚治疗后，由于小肠腔内细菌污染受到抑制，乳糖酶活性得以恢复。仅用乳糖酶替代治疗仅使14.2%的LN患者病情缓解，而大多数（85.8%）患者仍存在乳糖酶缺乏和SIBO。成人LN的病因治疗包括每天3次服用复合益生菌必孚1粒胶囊，疗程至少14天。作为LN的对症治疗，可开具乳糖酶替代治疗处方。
