临床误诊误治

目的 分析益生菌辅助治疗儿童难治性癫痫(CRE)的临床效果及对肠道微生态、炎性因子、免疫因子的影响。方法 选择2016年6月—2019年9月应用益生菌(双歧杆菌乳杆菌三联活菌散)辅助治疗的62例CRE进行随访研究，评估患儿治疗4、8、12周的临床疗效，比较患儿治疗前后的肠道微生态、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6、IL-17A]及免疫球蛋白(IgA、IgG、IgM)水平变化。结果 62例CRE经益生菌辅助治疗4、8、12周后，总有效率分别为38.71%、66.13%、85.48%,整体总有效率随治疗时间延长呈逐渐上升趋势，不同时间比较差异有统计学意义(P<0.05)。经益生菌辅助治疗12周后，患儿大肠杆菌及粪肠球菌菌落数较治疗前显著降低，双歧杆菌、乳酸杆菌菌落数较治疗前显著升高，IgA、IgG、IgM水平较治疗前显著升高，TNF-α、IL-1β、IL-6、IL-17A水平较治疗前显著降低(P<0.05)。结论 益生菌辅助治疗CRE具有良好的临床效果，可显著降低炎性因子水平，调节机体免疫功能，促进患儿病情恢复。

Objective To analyze the clinical efficacy of probiotics in adjuvant treatment of children with refractory epilepsy(CRE) and its effects on intestinal microecology, inflammatory factors and immune factors. Methods A total of 62 CRE who were treated with probiotics(Bifidobacterium Lactobacillus Triple Viable Powder) from June 2016 to September 2019 was selected for follow-up study. The clinical efficacy of children at 4, 8, and 12 weeks after treatment was evaluated. Intestinal microecology, inflammatory factors [tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6), interleukin-17 A(IL-17 A)], immunoglobulin(IgA, IgG, IgM) levels in children before and after treatment were compared. Results At 4, 8, and 12 weeks after probiotic adjuvant treatment for CRE in 62 patients, the total effective rates were 38.71%, 66.13%, and 85.48%, respectively. The total effective rate showed a gradual upward trend with the prolongation of treatment, and there were statistical differences at different time points(P<0.05). At 12 weeks after probiotic adjuvant treatment, the number of Escherichia coli and Enterococcus faecalis colonies in the children was significantly lower than that before treatment, while the number of Bifidobacterium and Lactobacillus colonies was significantly higher than that before treatment; the levels of IgA, IgG and IgM were significantly higher than those before treatment, while the levels of TNF-α, IL-1β, IL-6 and IL-17 A were significantly lower than those before treatment(P<0.05). Conclusion Probiotics have good clinical effects in adjuvant treatment of CRE, which can significantly reduce the level of inflammatory factors, regulate the immune function of the body, and promote disease recovery in children.