目的 觀察蒙脫石散聯(lián)合益生菌治療急性腹瀉伴發(fā)熱患兒的臨床療效，及對(duì)腸道菌群平衡、腸屏障功能及免疫功能的影響。方法 選取2021年10月—2023年10月齊齊哈爾市中醫(yī)醫(yī)院接診的急性腹瀉伴發(fā)熱患兒118例，通過(guò)計(jì)算機(jī)產(chǎn)生隨機(jī)數(shù)字表法均等分為聯(lián)合組（蒙脫石散聯(lián)合益生菌治療）、單用組（蒙脫石散治療）各59例。單用組在常規(guī)治療的基礎(chǔ)上給予蒙脫石散治療，1歲以下每日1袋，≥1、≤2歲每日1～2袋，＞2歲每日2～3袋，溫水搖勻后沖服，首次劑量加倍。聯(lián)合組在單用組的基礎(chǔ)上加用酪酸梭菌二聯(lián)活菌散劑，每次1袋，每天2次，涼開(kāi)水搖勻后沖服。兩組均治療7 d。比較兩組恢復(fù)速度、治療效果；比較兩組治療前后腸道菌群平衡、腸屏障功能及免疫功能。結(jié)果 聯(lián)合組退熱、大便性狀改善、止瀉、腸鳴音恢復(fù)時(shí)間均短于單用組（P＜0.05、0.001）；聯(lián)合組治療總有效率高于單用組（88.14%vs 72.88%，P＜0.05）。兩組治療前雙歧桿菌（B）、乳酸桿菌（E）、腸桿菌數(shù)量及B/E比值比較，差異無(wú)統(tǒng)計(jì)學(xué)意義；治療后聯(lián)合組腸桿菌數(shù)量低于單用組（P＜0.05），B和E的數(shù)量及B/E值均高于單用組（P＜0.05、0.001）。兩組治療前二胺氧化酶（DAO）、脂多糖結(jié)合蛋白（LBP）、D-乳酸比較，差異無(wú)統(tǒng)計(jì)學(xué)意義；治療后聯(lián)合組DAO、LBP、D-乳酸均低于單用組（P＜0.001）。兩組治療前外周血CD4⁺、CD8⁺ T淋巴細(xì)胞占比、CD4⁺/CD8⁺比較，差異無(wú)統(tǒng)計(jì)學(xué)意義；治療后聯(lián)合組外周血CD4⁺ T淋巴細(xì)胞占比、CD4⁺/CD8⁺均高于單用組（P＜0.001），CD8⁺ T淋巴細(xì)胞占比均低于單用組（P＜0.001）；兩組均無(wú)明顯不良反應(yīng)。結(jié)論 蒙脫石散聯(lián)合益生菌可促進(jìn)急性腹瀉伴發(fā)熱患兒恢復(fù)，改善治療效果，促進(jìn)腸道菌群平衡，增強(qiáng)腸屏障功能及免疫功能，且安全性高。

Objective To observe the clinical efficacy of montmorillonite powder combined with probiotics in children with acute diarrhea and fever, and its effect on intestinal flora balance, intestinal barrier function and immune function. Methods One hundred eighteen children with acute diarrhea and fever admitted to Qiqihar Hospital of traditional Chinese Medicine from October 2021 to October 2023 were randomly divided into two groups by computer-generated random number table: combination group and monotherapy group, 59 cases in each group. The monotherapy group was given montelukast on the basis of conventional treatment, 1 sachet per day for less than 1 year old, 1—2 sachets per day for 1—2 years old, and 2—3 sachets per day for >2 years old, shaken well with warm water, and the first dose was doubled. In the combination group, Clostridium typhimurium was added on the basis of the single-use group, 1 sachet each time, 2 times a day, shaken well with cool boiled water and then taken. Both groups were treated for seven days. The recovery speed and therapeutic effect of two groups were compared. The intestinal flora balance, intestinal barrier function and immune function of the two groups before and after treatment were compared. Results The combination group had shorter time of fever reduction, stool improvement, diarrhea cessation and bowel sound recovery than those in the monotherapy group (P < 0.05, 0.001). The combination group had higher total effective rate than that in the monotherapy group (88.14% vs 72.88%, P < 0.05). After treatment, the combination group had lower number of enterobacteria than the monotherapy group (P < 0.05), higher number of bifidobacteria, lactobacilli and B/E ratio than the monotherapy group (P < 0.05, 0.001). After treatment, the combination group had lower levels of diamine oxidase (DAO), lipopolysaccharide binding protein (LBP) and D-lactic acid than the monotherapy group (P < 0.001). After treatment, the combination group had higher percentage of peripheral blood CD4⁺ T lymphocytes and CD4⁺/CD8⁺ than those in the monotherapy group (P < 0.001), lower percentage of CD8⁺ T lymphocytes than the monotherapy group (P < 0.001). No obvious adverse reactions were observed in both groups. Conclusion Montmorillonite powder combined with probiotics can promote the recovery of children with acute diarrhea and fever, improve the therapeutic effect, intestinal flora balance, intestinal barrier function and immune function, and have high safety.

R985