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[联合益生菌(双歧杆菌属和嗜热栖热放线菌BB - 12)用于患有食物过敏的胃肠道和皮肤表现儿童的结果]

[The results of the use of a combined probiotic ( and spp. ВB-12) in children with gastrointestinal and skin manifestations of food allergy].

作者信息

Vorobieva O A, Shih E V, Drozdov V N, Shikh N V

机构信息

I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Moscow, Russian Federation.

出版信息

Vopr Pitan. 2023;92(3):79-86. doi: 10.33029/0042-8833-2023-92-3-79-86. Epub 2023 May 29.

Abstract

At present, there are sufficient data on the influence of the gut microbiome on the development of food allergy and its progression. Changes in gut microbiome composition could positive impact on the course of allergic diseases by means of regulating the ratio of pro- and anti-inflammatory cytokines, as well as immunoglobulin E level. of the research was to study the effectiveness of combined probiotic in treatment of food allergies in children. . The prospective randomized controlled study included 92 children aged from 4 to 5 years with symptoms of food allergy, involving the skin and gastrointestinal tract. The main group (n=46) took two chewable tablet Bifiform Kids (Lactobacillus rhamnosus GG >1x10 CFU, Bifidobacterium animalis spp. lactis BB-12 >1x10 CFU, thiamine mononitrate 0.40 mg, pyridoxine hydrochloride 0.50 mg per tablet) 2 times per day during 21 days. The control group (n=46) did not take the complex. The dynamics of the severity of food allergy skin symptoms was assessed using the SCORAD index, of gastrointestinal manifestations - on a point scale after 21 days and after 4 and 6 months (visits 2, 3 and 4). The concentration of immunoglobulin E, interleukins IL-17 and IL-10 was determined by enzyme immunoassay in blood serum at the baseline, as well as after 21 days and after 6 months (visits 1, 2 and 4) after the study initiation. . The SCORAD index among children from the main group decreased from 12.4±2.3 до 7.6±1.8 (р=<0.05) while taking a combined probiotic. It was significantly lower (р=<0.05) compared to the control group (SCORAD index changed from 12.1±2.4 to 12.2±1.9). On the 21st day, a statistically significant decrease in level of pro-inflammatory IL-17 (by 27%) and a statistically significant increase in the concentration of anti-inflammatory IL-10 (by 38.9%) were recorded. In children from the main group, the severity of such gastrointestinal symptoms as pain, rumbling in the abdomen, belching with air, bloating, gas discharge, increased stool and its unformularity, decreased compare to the control group of patients (р=<0.05), in which the intensity of complaints related to gastrointestinal manifestations did not change. In the main group of patients, the most clinical efficacy was noted immediately after the end of the probiotic intake. In the following five months, the intensity of symptoms increased in individual subjects from the main group, but in general, the intensity of complaints remained significantly lower than before probiotic intake (р=<0.05). Children from the main group showed a significant decrease in IgE level from 184±121 kU/l by 43.5% at visit 2 and by 38.0% at visit 4 (p=<0.05), while in children from the control group its level didn't change, amounting to 176±141, 165±121 and 178±132 kU/l, respectively. . The results of the study show the effectiveness of the use of a combined probiotic (Lactobacillus rhamnosus GG, Bifidobacterium animalis spp. lactis ВB-12) with vitamins B1 and B6 in children with mild forms of gastrointestinal and skin manifestations of food allergy, both in relation to the severity reduction of the clinical symptoms of the disease (skin manifestations, pain, rumbling in the abdomen, belching with air, bloating, gas discharge, increased stool and its unformularity), and in relation to the dynamics of biochemical parameters - a decrease in the level of IgE.

摘要

目前,关于肠道微生物群对食物过敏的发生及其进展的影响已有足够的数据。肠道微生物群组成的变化可通过调节促炎和抗炎细胞因子的比例以及免疫球蛋白E水平,对过敏性疾病的病程产生积极影响。本研究的目的是研究联合益生菌治疗儿童食物过敏的有效性。这项前瞻性随机对照研究纳入了92名4至5岁有食物过敏症状(涉及皮肤和胃肠道)的儿童。主要组(n = 46)每天服用两片比菲德氏儿童咀嚼片(鼠李糖乳杆菌GG>1x10 CFU,动物双歧杆菌亚种乳酸亚种BB - 12>1x10 CFU,每片含硝酸硫胺0.40 mg,盐酸吡哆醇0.50 mg),共21天,每天2次。对照组(n = 46)未服用该复合物。使用SCORAD指数评估食物过敏皮肤症状的严重程度动态变化,对于胃肠道表现,在21天以及4个月和6个月后(第2、3和4次就诊)采用评分量表进行评估。在研究开始时的基线以及21天后和6个月后(第1、2和4次就诊),通过酶免疫测定法测定血清中免疫球蛋白E、白细胞介素IL - 17和IL - 10的浓度。服用联合益生菌时,主要组儿童的SCORAD指数从12.4±2.3降至7.6±1.8(p<0.05)。与对照组相比(SCORAD指数从12.1±2.4变为12.2±1.9),该指数显著更低(p<0.05)。在第21天,记录到促炎细胞因子IL - 17水平有统计学意义的下降(下降27%),抗炎细胞因子IL - 10浓度有统计学意义的升高(升高38.9%)。与对照组患者相比,主要组儿童的腹痛、腹部咕噜声、嗳气、腹胀、排气、大便增多及其不成形等胃肠道症状的严重程度有所降低(p<0.05),而对照组中与胃肠道表现相关的主诉强度没有变化。在主要组患者中,益生菌摄入结束后立即观察到最显著的临床疗效。在接下来的五个月里,主要组个别受试者的症状强度有所增加,但总体而言,主诉强度仍显著低于服用益生菌之前(p<0.05)。主要组儿童在第2次就诊时IgE水平从每升184±121 kU显著下降43.5%,在第4次就诊时下降38.0%(p<0.05),而对照组儿童的IgE水平没有变化,分别为每升176±141、165±121和178±132 kU。研究结果表明,对于有轻度胃肠道和皮肤表现的食物过敏儿童,使用联合益生菌(鼠李糖乳杆菌GG、动物双歧杆菌亚种乳酸亚种BB - 12)与维生素B1和B6,在减轻疾病临床症状(皮肤表现、疼痛、腹部咕噜声、嗳气、腹胀、排气、大便增多及其不成形)的严重程度以及生化参数动态变化(IgE水平降低)方面均有效。

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