杨吉香,周思思

幽门螺杆菌（Helicobacter pylori，Hp）感染是导致慢性胃炎、胃溃疡和胃癌的重要病因。随着人们对健康重视程度的提高及H.pylori感染筛查、规范根除的推广，H.pylori的全球粗略患病率已从1990年前的52.6%下降到2014年至2023年的42.8%[1-3]。由于我国各地区地理环境、饮食习惯、民族风俗、医疗条件等因素的影响，其感染率存在着较大的地域差异（40%到70%不等）[4-6]，其中，西北地区感染率最高为51.3%，青海省患病率达到60.2%。H.pylori感染导致炎症反应、胃肠道黏膜保护屏障破坏及细胞因子损害引起腹痛、腹胀、便秘、腹泻、恶心、呕吐及反酸等一系列非特异性临床症状。铋剂四联疗法是目前治疗Hp感染的主要方法之一，随着抗生素耐药性的增加，全球发现幽门螺杆菌的治疗效果大幅下降[7]。且其副作用显著，如便秘、腹泻、恶心等不良反应。近年来，益生菌作为一种辅助治疗手段，被广泛研究用于改善铋剂四联疗法的效果及减少其副作用。该文主要从益生菌在幽门螺杆菌感染铋剂四联根除治疗中的作用及其对肠道菌群失调的影响，重点分析了益生菌的疗效、安全性及机制，并探讨了未来研究方向。

幽门螺杆菌；益生菌；治疗；胃肠道微生态

[1] Chen,Y-C,Malfertheiner,P,Yu,H-T,et al.Global Prevalence of Helicobacter pylori Infection and Incidence of Gastric Cancer Between 1980 and 2022[J].Gastroenterology,2024,166(4):605-19. [2] Hooi,J K Y,Lai,W Y,Ng,W K,et al.Global Prevalence of Helicobacter pylori Infection:Systematic Review and Meta-Analysis[J]. Gastroenterology,2017,153(2):420-9. [3] Xie,L,Liu,G-W,Liu,Y-N,et al.Prevalence of Helicobacter pylori infection in China from 2014-2023:A systematic review and meta-analysis[J].World Journal of Gastroenterology,2024,30(43):4636-56. [4] Ren,S,Cai,P,Liu,Y,et al.Prevalence of Helicobacter pylori infection in China:A systematic review and meta-analysis[J].J Gastroenterol Hepatol,2022,37(3):464-70. [5] Bai,D,Liu,K,Wang,R,et al.Prevalence Difference of Helicobacter pylori Infection Between Tibetan and Han Ethnics in China:A Meta-analysis on Epidemiologic Studies(SIGES)[J].Asia Pac J Public Health,2023,35(2-3):103-11. [6] 宫月华,董楠楠,李东,等.2008—2019年辽宁省庄河市胃癌筛查人群幽门螺杆菌感染状况及其变化趋势分析[J].中国肿瘤, 2024,33(10):823-8. [7] Fauzia,K A,Tuan,V P.Rising resistance:antibiotic choices for Helicobacter pylori infection[J].Lancet Gastroenterol Hepatol,2024,9(1):7-8. [8] Helicobacter Pylori Study Group,C S O G,Chinese Medical Association.2022中国幽门螺杆菌感染治疗指南[J].胃肠病学, 2022,27(03):150-62. [9] Su,T,Lai,S,Lee,A,et al.Meta-analysis:proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth[J].J Gastroenterol,2018,53(1):27-36. [10] Stavropoulou,E,Bezirtzoglou,E.Probiotics in Medicine:A Long Debate[J].Front Immunol,2020,11:2192. [11] Yoha,K S,Nida,S,Dutta,S,et al.Targeted Delivery of Probiotics:Perspectives on Research and Commercialization[J].Probiotics Antimicrob Proteins,2022,14(1):15-48. [12] Van Zyl,W F,Deane,S M,Dicks,L M T.Molecular insights into probiotic mechanisms of action employed against intestinal pathogenic bacteria[J].Gut Microbes,2020,12(1):1831339. [13] Kober,A K M H,Riaz Rajoka,M S,Mehwish,H M,et al.Immunomodulation Potential of Probiotics:A Novel Strategy for Improving Livestock Health,Immunity,and Productivity[J].Microorganisms,2022,10(2). [14] Javanshir,N,Hosseini,G N G,Sadeghi,M,et al.Evaluation of the Function of Probiotics,Emphasizing the Role of their Binding to the Intestinal Epithelium in the Stability and their Effects on the Immune System[J].Biol Proced Online,2021,23(1):23. [15] Virk,M S,Virk,M A,He,Y,et al.The Anti-Inflammatory and Curative Exponent of Probiotics:A Comprehensive and Authentic Ingredient for the Sustained Functioning of Major Human Organs[J].Nutrients,2024,16(4). [16] Zhao,Y,Yang,Y,Aruna,et al.Saccharomyces boulardii Combined With Quadruple Therapy for Helicobacter pylori Eradication Decreased the Duration and Severity of Diarrhea:A Multi-Center Prospective Randomized Controlled Trial[J].Front Med(Lausanne),2021,8:776955. [17] Coconnier,M H,Lievin,V,Hemery,E,et al.Antagonistic activity against Helicobacter infection in vitro and in vivo by the human Lactobacillus acidophilus strain LB[J].Appl Environ Microbiol,1998,64(11):4573-80. [18] Iino,C,Shimoyama,T,Chinda,D,et al.Influence of Helicobacter pylori Infection and Atrophic Gastritis on the Gut Microbiota in a Japanese Population[J].Digestion,2020,101(4):422-32. [19] Sung,J J Y,Coker,O O,Chu,E,et al.Gastric microbes associated with gastric inflammation,atrophy and intestinal metaplasia 1 year after Helicobacter pylori eradication[J].Gut,2020,69(9):1572-80. [20] Husebye,E.The pathogenesis of gastrointestinal bacterial overgrowth[J].Chemotherapy,2005,51 Suppl 1. [21] Sharma,B K,Santana,I A,Wood,E C,et al.Intragastric bacterial activity and nitrosation before,during,and after treatment with omeprazole[J].Br Med J(Clin Res Ed),1984,289(6447):717-9. [22] Zhong,C,Qu,C,Wang,B,et al.Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth:A Meta-Analysis and Systematic Review of Current Evidence[J].J Clin Gastroenterol,2017,51(4):300-11. [23] Kumar,K,Saadi,M,Ramsey,F V,et al.Effect of Bifidobacterium infantis 35624(Align)on the Lactulose Breath Test for Small Intestinal Bacterial Overgrowth[J].Dig Dis Sci,2018,63(4):989-95. [24] 夏旭婷,刘富林,宋子颛.枳术丸对脾虚证慢传输型便秘小鼠肠道运动及产甲烷菌菌群多样性的影响[J].时珍国医国药, 2023,34(01):41-4. [25] 孙毅,陈锦,王新峰.产甲烷菌抑制剂对便秘小鼠结肠微生物菌群及代谢产物的影响[J].应用与环境生物学报,2020,26(03):506-11. [26] 张鑫.畜禽粪便厌氧发酵产酸产甲烷微生物研究[J].河南农业,2020,(11):51-2+60. [27] Yang,Z,Zhou,Y,Han,Z,et al.The effects of probiotics supplementation on Helicobacter pylori standard treatment:an umbrella review of systematic reviews with meta-analyses[J].Sci Rep,2024,14(1):10069. [28] Lv,Z,Wang,B,Zhou,X,et al.Efficacy and safety of probiotics as adjuvant agents for Helicobacter pylori infection:A meta-analysis[J]. Exp Ther Med,2015,9(3):707-16. [29] 林瑞芳,俞赟丰,徐寅,等.益生菌联合铋剂四联法根除幽门螺杆菌的Meta分析和试验序贯分析[J].中国微生态学杂志,2022, 34(08):885-92. [30] 周羽翙,郑欣晔,叶梦思,等.益生菌辅助含铋剂四联疗法根除幽门螺杆菌的临床研究[J].中国现代医学杂志,2021,31(01):68-73. [31] Si,X B,Lan,Y,Qiao,L.[A meta-analysis of randomized controlled trials of bismuth-containing quadruple therapy combined with probiotic supplement for eradication of Helicobacter pylori][J].Zhonghua Nei Ke Za Zhi,2017,56(10):752-9.

点击下载PDF