益生菌联合肠内营养辅助治疗肠结核的临床疗效评价:一项前瞻性随机对照研究

doi:10.19982/j.issn.1000-6621.20260360

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (10): 1571-1578.doi: 10.19982/j.issn.1000-6621.20260360

益生菌联合肠内营养辅助治疗肠结核的临床疗效评价:一项前瞻性随机对照研究

刘欣¹, 古丽加娜提·努尔买买提¹, 李健²(), 王泉³(), 吕文娟¹, 丁丽娜¹

¹ 新疆维吾尔自治区第六人民医院临床营养科, 乌鲁木齐 830000
² 新疆维吾尔自治区第六人民医院普通外科, 乌鲁木齐 830000
³ 新疆维吾尔自治区第六人民医院检验科, 乌鲁木齐 830000

收稿日期:2026-06-23 出版日期:2026-10-10 发布日期:2026-09-30
通信作者: 李健,Email:52984594@qq.com;王泉,Email:3197606@qq.com
基金资助:
新疆维吾尔自治区“天山英才”医药卫生高层次人才培养计划(TSYC202301B135);新疆维吾尔自治区第六人民医院科研项目(2025011JY)

Clinical efficacy evaluation of probiotics combined with enteral nutrition in the adjuvant treatment of intestinal tuberculosis: a prospective randomized controlled study

Liu Xin¹, Gulijianati Nuermaimaiti¹, Li Jian²(), Wang Quan³(), Lyu Wenjuan¹, Ding Lina¹

¹ Department of Clinical Nutrition, The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China
² Department of General Surgery, The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China
³ Department of Clinical Laboratory, The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China

Received:2026-06-23 Online:2026-10-10 Published:2026-09-30
Contact: Li Jian, Email: 52984594@qq.com;Wang Quan, Email: 3197606@qq.com
Supported by:
Talent Training Program for HighLevel Medical and Health Talents of “Tianshan Talents”, Xinjiang Uygur Autonomous Region(TSYC202301B135);Scientific Research Project of the Sixth People’s Hospital of Xinjiang Uygur Autonomous Region(2025011JY)

摘要/Abstract

摘要：

目的: 评估在标准化抗结核治疗方案联合应用肠内营养基础上是否使用益生菌与对肠结核患者营养状态、临床症状及治疗相关胃肠道不良反应的干预效果。方法: 采用前瞻性、随机、对照、开放性试验设计,纳入2019年1月至2021年12月于新疆维吾尔自治区第六人民医院确诊的235例肠结核住院患者作为研究对象,并随机分为观察组(118例)和对照组(117例)。对照组接受标准化2H-R-Z-E/4H-R(H:异烟肼;R:利福平;Z:吡嗪酰胺;E:乙胺丁醇)抗结核方案及常规肠内营养支持(整蛋白型制剂,热量供给30~40kcal·kg^-1·d^-1,持续28d);观察组在对照组基础上加用复合益生菌制剂(含嗜酸乳杆菌、长双歧杆菌、鼠李糖乳杆菌、副干酪乳杆菌,4g/d,28d)。比较两组治疗前后血清总蛋白、白蛋白、血红蛋白、体质量指数、腹痛及腹泻症状、炎症因子(肿瘤坏死因子-α、白细胞介素-1、白细胞介素-10、C-反应蛋白)水平及胃肠道不良反应发生情况。结果: 治疗28d后,观察组血清总蛋白、白蛋白、血红蛋白及体质量指数水平均明显高于对照组[分别为(70.56±5.48)g/L对(65.38±5.92)g/L、(38.92±5.63)g/L对(33.27±4.85)g/L、(106.83±15.46)g/L对(99.85±17.62)g/L、(19.35±2.28)kg/m²对(18.21±2.58)kg/m²],差异均有统计学意义(t值分别为6.918、8.120、3.186、3.552,P值均<0.001),且各指标变化值亦明显大于对照组。观察组临床症状显效率明显高于对照组[47.5%(56/118)对20.5%(24/117)],差异有统计学意义(χ²=19.285,P<0.001)。重复测量方差分析显示,两组血清肿瘤坏死因子-α、白细胞介素-1、白细胞介素-10及C-反应蛋白水平随时间变化的趋势存在明显差异(时间×组别交互效应,P值均<0.01),治疗14d及28d时观察组各炎症因子水平均明显低于对照组(P值均<0.001)。观察组腹胀[4.2%(5/118)对16.2%(19/117)]、腹泻新发或加重[2.5%(3/118)对12.8%(15/117)]及便秘[3.4%(4/118)对14.5%(17/117)]发生率均明显低于对照组,差异均有统计学意义(χ²值分别为9.151、9.211、9.022,P值分别为0.003、0.002、0.003)。观察组住院时间为(21.5±6.8)d,明显短于对照组的(26.8±7.5)d,差异有统计学意义(t=-5.684,P<0.001)。结论: 在肠内营养支持基础上补充益生菌可显著改善肠结核患者营养状况,加速临床症状缓解,降低全身炎症负荷,并减少抗结核治疗相关的胃肠道不良反应。

关键词: 结核,胃肠, 肠道营养, 营养支持, 治疗结果, 随机对照试验

Abstract:

Objective: To evaluate the intervention effects of probiotic supplementation based on standardized antituberculosis regimens combined with enteral nutrition on nutritional status, clinical symptoms and treatment related gastrointestinal adverse reactions in patients with intestinal tuberculosis. Methods: A prospective, randomized, controlled, openlabel trial was performed. A total of 235 hospitalized patients diagnosed with intestinal tuberculosis at The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to December 2021 were enrolled and randomly assigned to the observation group (118 cases) and the control group (117 cases). The control group received the standardized antituberculosis regimen 2H-R-Z-E/4H-R (H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol) plus routine enteral nutrition support (intactprotein formula, caloric supply 30-40 kcal·kg^-1·d^-1 for 28 days). On the basis of the control group regimen, the observation group was additionally given compound probiotic preparation (containing Lactobacillus acidophilus, Bifidobacterium longum, Lactobacillus rhamnosus, Lactobacillus paracasei) at 4 g/d for 28 days. Serum total protein, albumin, hemoglobin, body mass index, abdominal pain and diarrhea symptoms, inflammatory factors (tumor necrosis factorα, interleukin-1, interleukin-10, C-reactive protein), and the incidence of gastrointestinal adverse reactions were compared between the two groups before and after treatment. Results: After 28 day treatment, serum total protein, albumin, hemoglobin and body mass index in the observation group were significantly higher than those in the control group ((70.56±5.48) g/L vs. (65.38±5.92) g/L, (38.92±5.63) g/L vs. (33.27±4.85) g/L, (106.83±15.46) g/L vs. (99.85±17.62) g/L, (19.35±2.28) kg/m² vs. (18.21±2.58) kg/m², respectively), with statistically significant differences (t=6.918, 8.120, 3.186, 3.552; all P<0.001); the changes of these indicators were also significantly greater in the observation group. The markedresponse rate of clinical symptoms in the observation group was significantly higher than that in the control group (47.5% (56/118) vs. 20.5% (24/117)), with statistically significant difference (χ²=19.285, P<0.001). Repeatedmeasures analysis of variance revealed significant differences in the timedependent trends of serum tumor necrosis factorα, interleukin-1, interleukin-10 and C-reactive protein between the two groups (timebygroup interaction effect, all P<0.01). Levels of these inflammatory factors were significantly lower in the observation group at day 14 and day 28 of treatment (all P<0.001). The incidences of abdominal distension (4.2% (5/118) vs. 16.2% (19/117)), newonset or aggravated diarrhea (2.5% (3/118) vs. 12.8% (15/117)) and constipation (3.4% (4/118) vs. 14.5% (17/117)) in the observation group were markedly lower than those in the control group (χ²=9.151, 9.211, 9.022; P=0.003, 0.002, 0.003, respectively). The length of hospital stay in the observation group was (21.5±6.8) d, which was significantly shorter than (26.8±7.5) d in the control group (t=5.684, P<0.001). Conclusion: Probiotic supplementation on the basis of enteral nutrition support can remarkably improve nutritional status, accelerate the relief of clinical symptoms, reduce systemic inflammatory burden, and mitigate antituberculosisrelated gastrointestinal adverse reactions in patients with intestinal tuberculosis.

Key words: Tuberculosis, gastrointestinal, Enteral nutrition, Nutritional support, Treatment outcome, Randomized controlled trial

中图分类号:

刘欣, 古丽加娜提·努尔买买提, 李健, 王泉, 吕文娟, 丁丽娜. 益生菌联合肠内营养辅助治疗肠结核的临床疗效评价:一项前瞻性随机对照研究[J]. 中国防痨杂志, 2026, 48(10): 1571-1578. doi: 10.19982/j.issn.1000-6621.20260360

Liu Xin, Gulijianati Nuermaimaiti, Li Jian, Wang Quan, Lyu Wenjuan, Ding Lina. Clinical efficacy evaluation of probiotics combined with enteral nutrition in the adjuvant treatment of intestinal tuberculosis: a prospective randomized controlled study[J]. Chinese Journal of Antituberculosis, 2026, 48(10): 1571-1578. doi: 10.19982/j.issn.1000-6621.20260360

图/表 5

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参考文献 26

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指标	观察组(118例)	对照组(117例)	统计检验值	P值
性别[例(构成比,%)]			χ²=0.114	0.736
男性	68(57.6)	65(55.6)
女性	50(42.4)	52(44.4)
年龄(岁,$\bar{x}±s$)	42.6±14.3	43.1±15.0	t=0.267	0.790
病程[月,M(Q₁,Q₃)]	3.5(2.0,6.0)	3.8(2.0,7.0)	Z=-0.632	0.527
合并肺结核[例(发生率,%)]	87(73.7)	84(71.8)	χ²=0.111	0.739
营养风险筛查2002量表评分(分,$\bar{x}±s$)	4.26±1.08	4.31±1.12	t=0.349	0.727
体质量指数(kg/m²,$\bar{x}±s$)	17.86±2.51	17.92±2.63	t=0.182	0.855
血清总蛋白(g/L,$\bar{x}±s$)	59.84±6.27	60.12±6.45	t=0.342	0.733
血清白蛋白(g/L,$\bar{x}±s$)	29.15±4.86	29.38±5.02	t=0.357	0.721
血红蛋白(g/L,$\bar{x}±s$)	93.46±18.72	94.18±19.35	t=0.294	0.769
腹痛评分(分,$\bar{x}±s$)	5.86±1.92	5.79±1.88	t=0.287	0.774
腹泻评分(分,$\bar{x}±s$)	5.12±2.08	5.06±2.14	t=0.222	0.824

指标	观察组(118例)	对照组(117例)	组间差值	t值	P值
血清总蛋白(g/L)
治疗前	59.84±6.27	60.12±6.45	-0.28	-0.342	0.733
治疗后	70.56±5.48	65.38±5.92	5.18	6.918	<0.001
变化值	10.72±6.14	5.26±5.38	5.46	7.234	<0.001
血清白蛋白(g/L)
治疗前	29.15±4.86	29.38±5.02	-0.23	-0.357	0.721
治疗后	38.92±5.63	33.27±4.85	5.65	8.120	<0.001
变化值	9.77±5.28	3.89±4.21	5.88	9.356	<0.001
血红蛋白(g/L)
治疗前	93.46±18.72	94.18±19.35	-0.72	-0.294	0.769
治疗后	106.83±15.46	99.85±17.62	6.98	3.186	0.002
变化值	13.37±15.12	5.67±12.03	7.70	4.241	<0.001
体质量指数(kg/m²)
治疗前	17.86±2.51	17.92±2.63	-0.06	-0.182	0.855
治疗后	19.35±2.28	18.21±2.58	1.14	3.552	<0.001
变化值	1.49±1.78	0.29±1.38	1.20	5.736	<0.001

组别	例数	显效[例 (显效率,%)]	有效[例 (有效率,%)]	无效[例 (无效率,%)]	总有效[例 (总有效率,%)]
观察组	118	56(47.5)	61(51.7)	1(0.8)	117(99.2)
对照组	117	24(20.5)	89(76.1)	4(3.4)	113(96.6)
χ²值		19.285			-
P值		<0.001			0.212^a

指标	观察组(118例)	对照组(117例)	t值	P值
肿瘤坏死因子-α(μg/L)
治疗前	87.36±16.82	86.95±17.24	0.185	0.854
治疗14d	58.42±12.36	67.28±13.15	-5.283	<0.001
治疗28d	41.26±9.84	54.73±11.26	-9.643	<0.001
白细胞介素-1(μg/L)
治疗前	11.02±2.14	10.96±2.08	0.218	0.828
治疗14d	5.83±1.56	7.42±1.84	-7.037	<0.001
治疗28d	2.98±0.86	4.35±1.12	-10.389	<0.001
白细胞介素-10(μg/L)
治疗前	2.86±0.52	2.81±0.49	0.768	0.443
治疗14d	1.95±0.41	2.42±0.46	-8.169	<0.001
治疗28d	1.21±0.32	1.69±0.38	-10.545	<0.001
C-反应蛋白(mg/L)
治疗前	92.84±15.36	91.76±14.92	0.548	0.585
治疗14d	56.28±12.48	68.95±13.64	-7.313	<0.001
治疗28d	38.46±10.22	52.83±11.95	-9.819	<0.001

不良反应	观察组(118例)	对照组(117例)	χ²值	P值
腹胀	5(4.2)	19(16.2)	9.151	0.003
腹泻(新发或加重)	3(2.5)	15(12.8)	9.211	0.002
便秘	4(3.4)	17(14.5)	9.022	0.003
恶心	5(4.2)	8(6.8)	0.787	0.375
呕吐	2(1.7)	4(3.4)	-	0.445^a

益生菌联合肠内营养辅助治疗肠结核的临床疗效评价:一项前瞻性随机对照研究

Clinical efficacy evaluation of probiotics combined with enteral nutrition in the adjuvant treatment of intestinal tuberculosis: a prospective randomized controlled study

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