氢气结合甲烷气呼气试验检测肠易激综合征患者小肠细菌过度生长  

Measurement of methane and hydrogen in lactulose breath test on small intestinal bacterial overgrowth in patients with irritable bowel syndrome

作　　者：李宁宁[1] 王智凤[1] 费贵军[1] 朱丽明[1] 陈伟光[1] 李晓青[1] 郑家驹[2] 柯美云[1] 方秀才[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,北京100730 [2]南京医科大学附属苏州医院消化中心

出　　处：《胃肠病学和肝病学杂志》2015年第6期683-687,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金："十一五"国家科技支撑计划资助项目(2007BAI04B01);863计划课题(2010AA023007)

摘　　要：目的通过乳果糖氢气结合甲烷气呼气试验检测肠易激综合征(irritable bowel syndrome,IBS)患者小肠细菌过度生长(small intestinal bacterial overgrowth,SIBO)的发生率,判断SIBO与IBS症状的关系,探讨甲烷呼气试验在不产氢气患者的临床应用价值。方法纳入符合罗马Ⅲ诊断标准的IBS患者和年龄、性别匹配的健康人(对照组),进行乳果糖氢气结合甲烷气呼气试验,计算SIBO阳性发生率,对比各时间点呼气氢与甲烷浓度;将IBS患者分为SIBO阳性组和SIBO阴性组,比较其症状评分。结果共纳入70例IBS患者(IBS组,92.86%为腹泻型和混合型)和30名健康人(对照组)。两组SIBO阳性率分别为71.43%和36.67%(P<0.05)。两组甲烷呼气试验结果与氢呼气试验结果均呈显著线性相关(IBS组:r=0.999,P=0.000;对照组:r=0.745,P=0.003),仅1例腹泻型IBS患者氢呼气试验阴性而甲烷呼气试验阳性。SIBO阳性(n=50)与SIBO阴性(n=20)IBS患者症状评分比较,差异无统计学意义(P>0.05)。结论 IBS患者SIBO阳性率明显高于健康人,提示SIBO与IBS有关,但SIBO并不加重IBS患者的症状;在乳果糖呼气试验中,甲烷气与氢气浓度呈显著线性相关,甲烷气对不产氢气的IBS患者合并SIBO的补充检测作用有限。Objective To measure the incidence of small intestinal bacterial overgrowth （SIBO） by hydrogen and methane in lactulose breath test （LBT） in patients with irritable bowel syndrome （IBS） , to explore the relationship be- tween SIBO and IBS intestinal symptoms, and to evaluate the complement value of measure methane with hydrogen in non-hydrogen producers. Methods Consecutive patients with IBS who met Rome m criteria, and sex and age matched healthy subjects （HS） were enrolled in this study. All subjects underwent hydrogen and methane in laetulose breath test, SIBO was considered as hydrogen and/or methane positive. The concentrations of hydrogen and methane were compared at each time point of detection. Symptom scores were compared between IBS patients of SIBO positive group and negative group. Results Seventy IBS patients （92.86% diarrhea and mixed subtype） and 30 HS were enrolled. The SIBO pos- itive rates in IBS patients and HS were 71.43% and 36.67% , respectively （P 〈0.05）. The concentration of methane in LBT had a linear correlation with hydrogen concentration in IBS patients and HS, respectively （r = 0. 999, P = 0. 000; r = 0. 745, P = 0. 003）. Only one non-hydrogen producer of IBS with diarrhea patient was found to be SIBO positive with increasing methane amounts in LTB. There was no significant difference in symptom scores between SIBO positive （n = 50） and negative （ n = 20） IBS patients （P 〉 0.05）. Conclusion The positive rate of SIBO in IBS pa- tients is obviously higher than that in healthy subjects, which indicate SIBO is associated with IBS. SIBO does not aggra- vate the intestinal symptoms for IBS patients. In LBT, indicates that measure of methane has less complement value for SIBO detection in non-hydrogen producers of IBS patients.

关 键 词：肠易激综合征 小肠细菌过度生长 乳果糖呼气试验 氢气 甲烷气 

分 类 号：R574[医药卫生—消化系统]