单次法氢-甲烷呼气试验在小肠细菌过度生长诊断中的应用价值初探  

Single hydrogen-methane breath test for the diagnosis of small intestinal bacterial growth

作　　者：黄欢 李慧臻[2] 王艳荣[3] 宋岩 王邦茂[1] 曹海龙[1] 姜葵[1] Huang Huan;Li Huizhen;Wang Yanrong;Song Yan;Wang Bangmao;Cao Hailong;Jiang Kui(Department of Gastroenterology,General Hospital,Tianjin Medical University,Tianjin 300052,China;Department of Gastroenterology,Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300150,China;Department of Gastroenterology,Tianjin Fourth Central Hospital,Tianjin 300142,China)

机构地区：[1]天津医科大学总医院消化科,天津300052 [2]天津中医药大学第二附属医院消化科,天津300150 [3]天津市第四中心医院消化科,天津300142

出　　处：《中华内科杂志》2023年第11期1335-1340,共6页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金(82070545)。

摘　　要：目的探究单次法氢-甲烷呼气试验(SHMBT)在小肠细菌过度生长(SIBO)诊断中的应用价值。方法横断面研究。招募2021年6月至2022年3月就诊于天津医科大学总医院、天津中医药大学第二附属医院和天津市第四中心医院三家医疗中心消化科门诊有消化道症状的患者162例作为病例组,同期招募年龄和性别相匹配的69名健康志愿者作为对照组;对两组受试者均进行问卷调查及SHMBT,比较两组人群SHMBT结果的差异性,采用受试者工作特征(ROC)曲线分析消化科门诊患者行SHMBT检查时甲烷(CH4)和氢气(H2)的截断值,并应用上述医疗机构内2655例有消化道症状的患者的SHMBT存档数据(验证集)评估SHMBT在SIBO诊断中的应用价值。统计分析方法包括卡方检验、Mann-Whitney U检验、Spearman相关性分析和Z检验。结果按照SIBO国际推荐诊断标准(空腹CH4≥10 ppm或H2≥20 ppm),SHMBT阳性率病例组(35.2%,57/162)和对照组(21.7%,15/69)差异有统计学意义(χ^(2)=4.08,P=0.043)。病例组CH4和H2产生量高于对照组[CH4:3(2,7)比3(1,3)ppm;H2:11(4,22)ppm比10(5,15)ppm],CH4产生量差异有统计学意义(Z=6.22,P=0.001)。以受试者是否有消化道症状为判断标准绘制ROC曲线,单独CH4、单独H2和CH4联合H2的ROC曲线下面积(AUC)分别为0.633、0.531和0.620,截断值分别为空腹CH4≥4 ppm、空腹H2≥13 ppm和空腹CH4≥5 ppm(或CH4≥4 ppm且H2≥24 ppm);单独CH4或CH4联合H2均可以有效区分有消化道症状的患者和无症状人群(P<0.05)。单独CH4与CH4联合H2作为诊断SIBO的指标时,验证集SHMBT阳性率分别为34.2%(907/2655)和30.4%(806/2655),与国际推荐诊断标准条件下所得SIBO阳性率(32.0%,849/2655)之间差异无统计学意义(P>0.05)。单独CH4与CH4联合H2作为SIBO阳性判断值时的特异度分别为79.9%和85.0%,准确率分别为68.8%和71.7%。结论空腹一次测定呼出气中CH4和H2含量可能成为诊断SIBO的方法之一,单次法氢-甲烷呼气试验中Objective To investigate the diagnostic value of a single hydrogen-methane breath test(SHMBT)for small intestinal bacterial overgrowth(SIBO).Method The current investigation was a cross-sectional study.Questionnaires and SHMBTs were administered to 162 patients with gastrointestinal symptoms(case group)and 69 healthy volunteers(control group).Differences in SHMBT results between the two groups were assessed,and cut-off values of CH4(methane)and H2(hydrogen)were analyzed via receiver operating characteristic(ROC)curves.Lastly,archived SHMBT data from 2655 patients with gastrointestinal symptoms(validation set)were used to evaluate the diagnostic value of the SHMBT with respect to SIBO.The Chi-square test,the Mann-Whitney U test,Spearman′s Rank correlation analysis,and the Z test were used for statistical analysis.Results Based on the international recommended diagnostic criteria for SIBO,which are fasting CH4≥10 ppm(parts per million)or H2≥20 ppm,the SHMBT-positive rate in the case group was significantly higher than that of control group(35.2%vs.21.7%,χ^(2)=4.08,P=0.043).Levels of CH4 and H2 were higher in the case group than in the control group[CH4:3(2,7)vs.3(1,3)ppm,H2:11(4,22)vs.10(5,15)ppm],and the difference in CH4 levels was statistically significant(Z=6.22,P=0.001).ROC curves were generated based on whether the subjects had gastrointestinal symptoms.The areas under the ROC curves were 0.633 for CH4 alone,0.531 for H2 alone,and 0.620 for CH4 combined with H2.The cut-off values were fasting CH4≥4 ppm,fasting H2≥13 ppm,and fasting CH4≥5 ppm(or CH4≥4 ppm and H2≥24 ppm),respectively.Measuring CH4 alone and CH4 combined with H2 was effective for determining the presence of gastrointestinal symptoms(P<0.05).When CH4 alone or CH4 combined with H2 were used as diagnostic indicators of SIBO,the respective SHMBT-positive rates in the validation set were 34.2%and 30.4%.These rates did not significantly differ from the SIBO-positive rate of 32.0%obtained via the international recommended diagnostic cr

关 键 词：甲烷 氢 呼气 小肠细菌过度生长 

分 类 号：R446.5[医药卫生—诊断学]