2026 年第 8 期 第 21 卷

基于肠道微生态与黏膜免疫双轴探讨消旋卡多曲协同益生菌治疗儿童迁延性腹泻的效果

Efficacy of racecadotril combined with probiotics in the treatment of persistent diarrhea in children based on the gut microbiota-mucosal immune axis

作者：刘艳荣1彭景莉2张雪芸1吴亚婧1

英文作者：Liu Yanrong1 Peng Jingli2 Zhang Xueyun1 Wu Yajing1

单位：1河北省胸科医院儿科，石家庄050047；2河北省胸科医院妇产科，石家庄050047

英文单位：1Department of Pediatrics Hebei Chest Hospital Shijiazhuang 050047 China; 2Department of Obstetrics and Gynecology Hebei Chest Hospital Shijiazhuang 050047 China

关键词：迁延性腹泻；双歧三联活菌片；消旋卡多曲；肠道微生态；免疫

英文关键词：Persistentdiarrhea;Bifidobacteriumtriplelivebacteriatablets;Racecadotril;Gutmicrobiota;Immunity

• 摘要：

• 目的 基于肠道微生态与黏膜免疫双轴探讨消旋卡多曲协同益生菌治疗儿童迁延性腹泻的效果。方法 纳入2022年9月至2025年8月河北省胸科医院儿科收治的迁延性腹泻患儿120例，依据分层随机数字表法分为益生菌组（双歧杆菌乳杆菌三联活菌片治疗）与联合组（消旋卡多曲协同双歧杆菌乳杆菌三联活菌片治疗），每组60例。比较2组患儿疗效及治疗前后免疫功能［免疫球蛋白G（IgG）、免疫球蛋白A（IgA）］、炎症因子［白细胞介素6（IL-6）、IL-10、肿瘤坏死因子α（TNF-α）、高敏C反应蛋白（hs-CRP）］、氧化应激指标［超氧化物歧化酶（SOD）、丙二醛］水平、肠道微生态、肠黏膜免疫屏障功能［二胺氧化酶（DAO）、5-羟色胺（5-HT）、分泌型免疫球蛋白A（sIgA）］改变，比较2组用药安全性。结果 联合组治疗后总有效率较益生菌组高［95.0%（57/60）比83.3%（50/60）］（P=0.040）。2组治疗后血清IgG、IgA、IL-10、SOD、粪便sIgA均高于治疗前，血清IL-6、TNF-α、hs-CRP、丙二醛、DAO、5-HT均低于治疗前（均P＜0.05）；联合组治疗后血清IgG、IgA、IL-10、SOD、粪便sIgA均高于益生菌组（均P＜0.05）；血清 IL-6、TNF-α、hs-CRP、丙二醛、DAO、5-HT均低于益生菌组（均P＜0.05）。2组治疗后双歧杆菌、乳酸杆菌、类杆菌数量均高于治疗前，肠球菌、大肠杆菌数量均低于治疗前（均P＜0.05），联合组治疗后双歧杆菌、乳酸杆菌、类杆菌数量高于益生菌组，肠球菌、大肠杆菌数量低于益生菌组（均P＜0.05）。2组不良反应发生率比较差异无统计学意义（P＞0.05）。结论 消旋卡多曲协同益生菌治疗儿童迁延性腹泻可通过调节肠道微生态平衡、抑制炎症、减轻氧化应激、强化机体免疫、修复肠黏膜免疫屏障等途径改善腹泻症状，临床效果及安全性均较高。

• Objective To investigate the efficacy of racecadotril combined with probiotics in the treatment of persistent diarrhea in children based on the gut microbiota-mucosal immune dual axis. Methods A total of 120 children with persistent diarrhea admitted to the Department of Pediatrics, Hebei Chest Hospital from September 2022 to August 2025 were enrolled. The patients were divided into probiotic group (treated with bifidobacterium, lactobacillus and streptococcus triple viable tablets) and combined group (treated with racecadotril plus bifidobacterium, lactobacillus and streptococcus triple viable tablets) by stratified random number table method, with 60 cases in each group. The clinical efficacy, immune function indexes ［immunoglobulin G (IgG), IgA］, inflammatory factors ［interleukin-6 (IL-6), IL-10, tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP)］, oxidative stress indicators ［superoxide dismutase (SOD), malondialdehyde］, gut microbiota, intestinal mucosal immune barrier function indexes ［diamine oxidase (DAO), 5-hydroxytryptamine (5-HT), secretory immunoglobulin A (sIgA)］ before and after treatment, as well as medication safety were compared between the two groups. Results The total effective rate after treatment in the combined group was higher than that in the probiotic group ［95.0%(57/60) vs 83.3%(50/60)］(P=0.040). After treatment, serum IgG, IgA, IL-10, SOD and fecal sIgA levels in both groups were elevated, while serum IL-6, TNF-α, hs-CRP, malondialdehyde, DAO and 5-HT levels were decreased compared with baseline (all P＜0.05). After treatment, serum IgG, IgA, IL-10, SOD and fecal sIgA in the combined group were significantly higher, whereas serum IL-6, TNF-α, hs-CRP, malondialdehyde, DAO and 5-HT were significantly lower than those in the probiotic group (all P＜0.05). The counts of Bifidobacterium, Lactobacillus and Bacteroides increased, while the counts of Enterococcus and Escherichia coli decreased after treatment in both groups (all P＜0.05). The combined group presented higher counts of Bifidobacterium, Lactobacillus and Bacteroides, and lower counts of Enterococcus and Escherichia coli than the probiotic group after treatment (all P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P＞0.05). Conclusions Racecadotril combined with probiotics can relieve diarrhea symptoms by regulating gut microbiota balance, inhibiting inflammatory response, alleviating oxidative stress, enhancing systemic immunity and repairing intestinal mucosal immune barrier, with favorable clinical efficacy and safety profile for children with persistent diarrhea.