Distribution of intestinal flora in children with rotavirus enteritis and its correlation with intestinal mucosal barrier function and humoral immunity

BACKGROUND

Rotavirus enteritis (RVE) is a disease that seriously affects the life and health of infants and young children worldwide. In recent years, it has been gradually recognized that intestinal flora disturbance plays an important role in the occurrence of RVE. However, there is little validation data on the effect of gut microbiota on the severity of illness and humoral immunity in children with RVE.

AIM

To analyze the correlation between intestinal flora and disease severity, intestinal mucosal barrier function, and humoral immunity in children with RVE.

METHODS

A total of 131 children with RVE diagnosed at our hospital from January 2019 to May 2021 were selected and divided into a mild group (39 cases), a moderate group (58 cases), and a severe group (34 cases) according to the severity of the disease. The number of intestinal bacteria and the distribution of dysbiosis grades were analyzed, and the relationship of the number of intestinal bacteria and dysbiosis grades with disease severity was analyzed. The intestinal mucosal barrier function indicators [serum D-lactic acid (D-LA), diamine oxidase (DAO), and endotoxin (ET)] and humoral immune indexes [serum immunoglobulin (Ig)A, IgG, and IgM] levels in children with different intestinal flora dysbiosis grades were measured, and the correlation between intestinal mucosal barrier function, humoral immunity, and the grade of intestinal flora imbalance was analyzed.

RESULTS

The number of intestinal bifidobacteria and lactobacilli was negatively correlated with the severity of the disease, while the number of intestinal Escherichia coli and the grade of dysbacteriosis were positively correlated with the severity of the disease (r = -0.727, -0.734, 0.757, and 0.748, respectively, P < 0.05). Serum D-LA, DAO, and ET were positively correlated with the grade of intestinal flora imbalance, and serum IgA, IgG, and IgM were negatively correlated with the grade of intestinal flora dysbiosis (r = 0.752, 0.717, 0.748, -0.715, -0.703 , and -0.787, respectively, P < 0.05).

CONCLUSION

The number of intestinal bacteria and the grade of disorders in children with RVE are significantly correlated with the severity of the disease, intestinal mucosal barrier function, and humoral immunity.

Changes in humoral immunity, myocardial damage, trace elements, and inflammatory factor levels in children with rotavirus enteritis

OBJECTIVE

To investigate the changes and significance of humoral immunity, myocardial damage, trace elements and inflammatory factors levels in children with rotavirus enteritis.

METHODS

One hundred children with rotavirus enteritis admitted to our hospital from January 2019 to December 2020 were retrospectively selected as the case group, and they were divided into a no dehydration group (33 cases), mild dehydration group (41 cases), and moderate dehydration group (26 cases). Another 100 children with rotavirus-negative enteritis during the same period were selected as the control group. Serum immunoglobulin, cardiac enzyme profile, trace elements, and interleukin-6 (IL-6) levels were compared between the two groups, and among the case groups for different degrees of dehydration.

RESULTS

Serum immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), zinc, magnesium, and calcium in the case group were lower than in controls (P<0.05). Serum lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB) in the case group were higher than in controls (P<0.05). Serum IL-6, interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) were also higher in cases than controls (P<0.05). Serum IgA, IgG, IgM, zinc, magnesium, and calcium in children with rotavirus enteritis with mild dehydration were lower than those without dehydration, but higher than those with moderate dehydration (P<0.05). Serum LDH, α-HBDH, CK, and CK-MB in children with rotavirus enteritis with mild dehydration were higher than those without dehydration, but lower than those with moderate dehydration (P<0.05). Serum IL-6, IL-8, and TNF-α in children with rotavirus enteritis with mild dehydration were higher than those without dehydration, but lower than those with moderate dehydration (P<0.05).

CONCLUSION

Children with rotavirus enteritis with more severe dehydration exhibited lower levels of humoral immunity and trace elements and greater myocardial damage and inflammatory response. Early detection can accurately assess the condition and provide a reference for clinical treatment.

Drug therapy combined with systematic nursing for children with rotavirus enteritis: Therapeutic effect and impact on serum cytokines

AIM

To investigate the therapeutic effect of drug therapy combined with systematic nursing in children with rotavirus enteritis and the effect on serum cytokines.

METHODS

A total of 90 children with rotavirus enteritis treated at our hospital from July 2015 to August 2017 were selected and equally divided into either an observation group (Saccharomyces boulardii sachets + systematic nursing) or a control group (Saccharomyces boulardii sachets). After 3 d of treatment, the clinical efficacy of the two groups was evaluated, time to remission of clinical symptoms and the hospitalization time were recorded, and the levels of serum interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α were measured.

RESULTS

The total effective rate was significantly higher in the observation group than in the control group (93.33% vs 77.78%, P < 0.05). The time to remission of fever, dehydration, and diarrhea and hospitalization time were significantly shorter in the observation group than in the control group (3.02 d ± 0.97 d vs 4.57 d ± 1.04 d, 3.36 d ±1.67 d vs 5.84 d ± 1.49 d, 5.32 d ± 1.13 d vs 6.28 d ± 1.25 d, 5.98 d ± 2.11 d vs 7.83 d ±2.16 d; P < 0.05). After treatment, serum levels of IL-6, IL-10, and TNF-αin both groups significantly decreased (P < 0.05), and the decrease was significantly greater in the observation group than in the control group (70.21 pg/mL ± 16.84 pg/mL vs 78.58 pg/mL ± 18.63 pg/mL, 12.18 pg/mL ± 8.97 pg/mL vs 16.86 pg/mL ± 9.14 pg/mL, 3.48 pg/mL ± 1.08 pg/mL vs 4.39 pg/mL ± 1.13 pg/mL; P < 0.05).

CONCLUSION

Saccharomyces boulardii sachets combined with systematic nursing is an effective way to shorten the time to remission of clinical symptoms and hospitalization time and lower the levels of IL-6, IL-10, and TNF-α in children with rotavirus enteritis.

Effect of probiotics on immunity in children with enteritis

AIM

To investigate the clinical effects of probiotics in children with rotavirus enteritis and the effect on immune function.

METHODS

Ninety patients with rotavirus enteritis were randomly divided into either a control group or an observation group. The control group was treated with immunoglobulins. The observation group was treated with probiotics. The levels of T lymphocyte subsets were measured by flow cytometry before and after treatment. The clinical effects of the two groups were compared.

RESULTS

After treatment for 7 d, times to stopping diarrhea (2.43 d ± 0.49 d), vomiting (1.379 d ± 0.24 d), and fever (1.429 d ± 0.47 d) and hospitalization time (3.219 d ± 1.02 d) were significantly shorter in the observation group than in the control group (t = 20.53, 18.99, 22.15, 19.35, P < 0.05); the levels of CD3⁺ T cells (67.42 ± 10.92 vs 58.51 ± 11.24), CD4⁺ T cells (36.43 ± 6.32 vs 32.41 ± 5.46) and CD4⁺/CD8⁺ ratio (1.43 ± 0.3 vs 1.21 ± 0.32) were significantly higher in the observation group than in the control group (P < 0.05), but the level of CD8⁺ T cells in the observation group was significantly lower than that in the control group (23.41±4.53 vs 27.43±4.01, P < 0.05).

CONCLUSION

The use of probiotics in children with rotavirus enteritis can reduce the incidence of microflora dysfunction and complications. Immunoglobulins can shorten the hospitalization time and should be selected according to the situation of each patient.

Efficacy and safety of interferon for treating rotavirus enteritis: A meta-analysis

AIM

To systematically review the efficacy and safety of interferon for treating rotavirus enteritis.

METHODS

We searched the databases including PubMed, EMBASE, The Cochrane Library, CBM, CNKI, and WanFang Data for collecting randomized controlled trials (RCTs) about interferon for treating rotavirus enteritis from the inception of databases to April 2016. Two of the authors assessed trial eligibility and risk of bias, extracted and analyzed the data by using Revman5.2 and Stata12.0 software.

RESULTS

Twenty-two trials, enrolling 2135 children, met our inclusion criteria. The results of meta-analysis showed that, compared with the control group (conventional therapy group), the interferon group had a higher total effective rate (RR = 1.33, 95%CI: 1.19-1.48, P < 0.00001) and shorter time to fever relief [MD = -0.90, 95%CI: -1.17-(-0.63), P < 0.00001], time to diarrhea relief [MD = -1.66, 95%CI: -2.10-(-1.22), P < 0.00001], and length of hospital stay [MD = -1.46, 95%CI: -1.83-(-1.08), P < 0.00001]. There was no significant difference in the rate of adverse reactions between the two groups.

CONCLUSION

Using interferon to treat rotavirus enteritis is an effective and safe therapeutic method. However, with the impact of the quality of the included studies, our findings should be confirmed by more high-quality RCTs.

Effects of lactose-free milk in adjunctive treatment of infants with rotavirus enteritis and lactose intolerance: An analysis 30 cases

AIM: To explore the effects of lactose-free milk in adjunctive treatment of infants with rotavirus enteritis and lactose intolerance (RV-SLI).

METHODS: Ninety patients with RV-SLI were randomly divided into three groups: a zinc gluconate group (n = 30), a lactose-free milk group (n = 30) and a combination group (n = 30). All the patients were treated with conventional oral rehydration solution, oral lactase, and bifid triple viable. On the basis of this treatment, the zinc gluconate group was treated with zinc gluconate, the lactose-free milk group was treated with lactose-free milk powder, and the combination group was treated with zinc gluconate and lactose-free milk powder. The clinical effects, total course, time to relief of clinical symptoms, and myocardial enzyme spectrum [aspartate aminotransferase (AST), lactic dehydrogenase (LDH), creatine kinase (CK), creatine kinase-MB (CK-MB)] were compared before and after treatment for the two groups.

RESULTS: The effective rates rate for the two monotherapy groups were significantly lower than that for the combination group (83.33%, 80.00% vs 96.67%, P < 0.05). The total course and time to relief of clinical symptoms were significantly longer in the two monotherapy groups than in the combination group (7.32 d ± 2.14 d, 7.41 d ± 2.03 d vs 5.52 d ± 1.81 d; 5.15 d ± 0.46 d, 5.23 d ± 0.44 d vs 3.18 d ± 0.77 d; P < 0.05). AST, LDH, CK and CK-MB levels were significantly lower after treatment than prior treatment in all the three groups (39.66 U/L ± 3.28 U/L vs 64.02 U/L ± 5.75 U/L, 108.25 U/L ± 10.18 U/L vs 161.08 U/L ± 12.17 U/L, 117.27 U/L ± 9.86 U/L vs 153.59 U/L ± 12.85 U/L, 32.55 U/L ± 3.50 U/L vs 57.45 U/L ± 6.77 U/L, 40.17 U/L ± 3.31 U/L vs 63.89 U/L ± 5.63 U/L, 112.27 U/L ± 11.08 U/L vs 160.12 U/L ± 12.49 U/L, 120.07 U/L ± 9.92 U/L vs 153.62 U/L ± 12.80 U/L, 33.06 U/L ± 3.52 U/L vs 57.68 U/L ± 6.73 U/L, 26.75 U/L ± 2.68 U/L vs 64.11 U/L ± 5.88 U/L, 86.88 U/L ± 6.30 U/L vs 159.62 U/L ± 12.30 U/L, 87.20 U/L ± 6.34 U/L vs 154.10 U/L ± 12.97 U/L, 24.11 U/L ± 2.62 U/L vs 57.56 U/L ± 6.39 U/L; P < 0.05). AST, LDH, CK and CK-MB after treatment were significantly higher in the two monotherapy groups than in the combination group (39.66 U/L ± 3.28 U/L, 40.17 U/L ± 3.31 U/L vs 26.75 U/L ± 2.68 U/L; 108.25 U/L ± 10.18 U/L, 112.27 U/L ± 11.08 U/L vs 86.88 U/L ± 6.30 U/L; 117.27 U/L ± 9.86 U/L, 120.07 U/L ± 9.92 U/L vs 87.20 U/L ± 6.34 U/L; 32.55 U/L ± 3.50 U/L, 33.06 U/L ± 3.52 U/L vs 24.11 U/L ± 2.62 U/L; P < 0.05).

CONCLUSION: Lactose-free mild has good effects in adjunctive treatment of infants with rotavirus enteritis and lactose intolerance, and it can shorten the total course and improve clinical symptoms and myocardial enzyme spectrum.

Significance of zinc supplementation in infants with rotavirus enteritis

AIM: To explore the therapeutic effect and significance of zinc preparation in infants with rotavirus enteritis.

METHODS: One hundred and three patients with rotavirus enteritis were randomly and equally divided into either a treatment group or a control group. Both groups were given conventional treatment, and the treatment group was additionally given zinc gluconate. The therapeutic effect and hospital stay were observed.

RESULTS: The total effective rate was significantly higher in the treatment group than in the control group (80% vs 63.08%, P < 0.05). Length of hospital stay was significantly shortened in the treatment group compared to the control group (P < 0.05).

CONCLUSION: Zine supplementation is effective in the treatment of infantile rotavirus diarrhea and can obviously shorten the length of hospital stay.

Multiple treatments for infantile rotavirus enteritis: a network meta-analysis

AIM: To evaluate the efficacy and safety of probiotics and/or montmorillonite in the treatment of infantile rotavirus enteritis.

METHODS: According to the requirement of systematic review, the following electronic databases were searched for randomized controlled trials (RCTs) and clinical trials evaluating the efficacy and safety of probiotics and/or montmorillonite for infantile rotavirus: CNKI, CBMdisc, VIP database, and Wanfang database. A network meta-analysis of the eligible RCTs was conducted.

RESULTS: Forty RCTs involving 2 906 participants met the criteria, of which five administrations were identified as intervention therapies and one administration as basic support control. Pooled data showed that probiotics and/or montmorillonite, either applied alone or in combination, significantly improved rotavirus enteritis compared to basic treatments. Adverse effects were not observed in the probiotic groups.

CONCLUSION: Probiotics and montmorillonite, either applied alone or in combination, can significantly improve infantile rotavirus enteritis. However, because of the limitations of the method and the included studies, the results should be interpreted with caution.