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小肠细菌过度生长相关轻微肝性脑病口–盲通过时间差异性分析
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Abstract:
目的:探讨小肠细菌过度生长(Small Intestinal Bacterial Overgrowth, SIBO)相关性轻微肝性脑病(Minimal Hepatic Encephalopathy, MHE)患者口–盲通过时间(the Oral-Cecal Transit Time, OCTT)情况。方法:选择2021年12月至2023年10月在青岛大学附属医院消化内科住院的符合入选要求的110例肝硬化确诊患者,通过数字连接试验(Number Connection Test-A and Number Connection Test-B, NCT-A和NCT-B)诊断轻微肝性脑病,乳果糖氢呼气试验(Lactulose Hydrogen Breath Test, LHBT)诊断小肠细菌过度生长及明确口–盲通过时间,分为小肠细菌过度生长阳性轻微肝性脑病组、小肠细菌过度生长阴性轻微肝性脑病组、非肝性脑病组,比较三组间口–盲通过时间差异,采用SPSS软件对数据进行统计学分析。呈正态分布的计量资料采用双尾t检验,以 表示。计数资料以例数和百分数表示,组间比较采用ANOVA检验。结果:110例肝硬化住院患者中,轻微肝性脑病阳性率为53.6% (59/110),在轻微肝性脑病患者中,小肠细菌过度生长阳性率71.19% (42/59),三组间在口–盲通过时间方面有统计学差异(F = 3.671, P < 0.05),其中SIBO阳性MHE组与非MHE组在口–盲通过时间方面有统计学差异(P < 0.05),与SIBO阴性MHE组在口–盲通过时间有统计学差异(P < 0.05)。结论:小肠细菌过度生长相关轻微肝性脑病的肝硬化患者口–盲通过时间相较于无小肠细菌过度生长和轻微肝性脑病的肝硬化患者延长,消化道动力明显障碍。
Objective: To investigate the oral-cecal transit time (OCTT) of patients with minimal hepatic en-cephalopathy (MHE) associated with small intestinal bacterial overgrowth (SIBO). Methods: 110 pa-tients with liver cirrhosis admitted to the Department of Gastroenterology, Affiliated Hospital of Qingdao University from December 2021 to October 2023 were studied. The minimal hepatic en-cephalopathy was diagnosed by number connection test (NCT-A and NCT-B), and the small intestinal bacterial overgrowth was diagnosed by lactulose hydrogen breath test (LHBT), and the oral-cecal transit time was determined as above. They were divided into three groups: the minimal hepatic encephalopathy group with positive small intestinal bacterial overgrowth, the minimal hepatic en-cephalopathy group without small intestinal bacterial overgrowth, and the negative minimal he-patic encephalopathy group. The differences of oral-cecal transit time among the three groups were compared by SPSS software. The measurement data with normal distribution adopts two-tailed t test, which is expressed by . Counting data were expressed by the number of cases and per-centage, and ANOVA test was used for comparison between groups. Results: Among 110 in patients with liver cirrhosis, the positive rate of minimal hepatic encephalopathy was 53.6% (59/110), among which the positive rate of small intestine bacterial overgrowth in small intestine was 71.19%(42/59). There was a statistical difference among the three groups (F = 3.671, P < 0.05). There was a statistical difference in oral-cecal transit time between SIBO positive MHE group and non-MHE group (P < 0.05), and so as between SIBO negative MHE group (P < 0.05). Conclusions: The oral-cecal transit time of patients with cirrhosis associated with small intestinal bacterial
[1] | 曹彬, 丰义宽, 李国庆. 轻微肝性脑病的诊断与治疗进展[J]. 现代消化及介入诊疗, 2006, 11(4): 239-242. |
[2] | Gimenez-Garzo, C., Garces, J.J., Urios, A., et al. (2017) The PHES Battery Does Not Detect All Cir-rhotic Patients with Early Neurological Deficits, Which Are Different in Different Patients. PLOS ONE, 12, e0171211.
https://doi.org/10.1371/journal.pone.0171211 |
[3] | 谢丛, 马敏阁, 孟毓珊, 等. 肝性脑病的影像学表现研究现状[J]. 分子影像学杂志, 2022, 45(2): 289-293. |
[4] | 鲁冰洁, 赵亚红, 安泳潼, 等. 肠道微生物在肝硬化及相关并发症中的研究进展[J]. 临床肝胆病杂志, 2018, 34(11): 2433-2437. |
[5] | 季利江. 乳果糖氢呼气试验测定口盲通过时间在慢性功能性便秘诊断及分类中的价值[D]: [硕士学位论文]. 南京: 南京中医药大学, 2005. |
[6] | 秦子文, 刘晶涛, 范晓红, 等. 肠道菌群与肝性脑病的关系[J]. 胃肠病学和肝病学杂志, 2021, 30(1): 34-37. |
[7] | Massey, B.T. and Wald, A. (2021) Small Intestinal Bacterial Overgrowth Syndrome: A Guide for the Appropriate Use of Breath Testing. Digestive Diseases and Sciences, 66, 338-347. https://doi.org/10.1007/s10620-020-06623-6 |
[8] | 郭栗良子, 王立生. 肝硬化患者肠道菌群失衡的研究现状[J]. 中国微生态学杂志, 2018, 30(1): 104-108, 113. |
[9] | Oumi, M. and Yamamoto, T. (2000) A Scanning Electron Microscope Study on the Effects of Different Bile Salts on the Epi-thelial Lining of Jejunal Mucosa. Medical Electron Microscopy, 33, 11-15.
https://doi.org/10.1007/s007950000002 |
[10] | Ghosh, G. and Jesudian, A.B. (2019) Small Intestinal Bacterial Over-growth in Patients with Cirrhosis. Journal of Clinical and Experimental Hepatology, 9, 257-267. https://doi.org/10.1016/j.jceh.2018.08.006 |
[11] | Galati, J. S., Holdeman, K.P., Bottjen, P.L., et al. (1997) Gastric Emptying and Orocecal Transit in Portal Hypertension and End-Stage Chronic Liver Disease. Liver Transplantation and Surgery, 3, 34-38.
https://doi.org/10.1002/lt.500030105 |
[12] | Morencos, F.C., De Las Heras Castano, G., Martin Ramos, L., et al. (1995) Small Bowel Bacterial Overgrowth in Patients with Alcoholic Cirrhosis. Digestive Diseases and Sciences, 40, 1252-1256. https://doi.org/10.1007/BF02065533 |
[13] | Liu, Q., Duan, Z.P., Ha, D.K., et al. (2004) Synbiotic Mod-ulation of Gut Flora: Effect on Minimal Hepatic Encephalopathy in Patients with Cirrhosis. Hepatology, 39. 1441-1449. https://doi.org/10.1002/hep.20194 |
[14] | Gupta, A., Dhiman, R.K., Kumari, S., et al. (2010) Role of Small Intestinal Bacterial Overgrowth and Delayed Gastrointestinal Transit Time in Cirrhotic Patients with Minimal Hepatic Encephalo-pathy. Journal of Hepatology, 53, 849-855. https://doi.org/10.1016/j.jhep.2010.05.017 |
[15] | Chesta, J., Silva, M., Thompson, L., et al. (1991) [Bacterial Overgrowth in Small Intestine in Patients with Liver Cirrhosis. Revista Médica de Chile, 119, 626-632. |
[16] | Lunia, M.K., Sharma, B.C. and Sachdeva, S. (2013) Small Intestinal Bacterial Overgrowth and Delayed Orocecal Transit Time in Patients with Cirrhosis and Low-Grade Hepatic Encephalopathy. Hepatology In-ternational, 7, 268-273.
https://doi.org/10.1007/s12072-012-9360-9 |
[17] | Pande, C., Kumar, A. and Sarin, S.K. (2009) Small-Intestinal Bacterial Overgrowth in Cirrhosis Is Related to the Severity of Liver Disease. Alimentary Pharmacology & Therapeutics, 29, 1273-1281.
https://doi.org/10.1111/j.1365-2036.2009.03994.x |
[18] | 曹彬, 王玉, 丰义宽, 等. 小肠细菌过度生长相关性轻微肝性脑病患者的血浆内毒素水平[J]. 胃肠病学和肝病学杂志, 2009, 18(7): 618-620. |
[19] | 曹彬, 丰义宽, 李国庆. 肝硬化患者小肠细菌过度生长与轻微肝性脑病的相关性研究[J]. 国际内科学杂志, 2008, 35(2): 65-67. |
[20] | Roland, B.C., Ciarleglio, M.M., Clarke, J.O., et al. (2015) Small Intestinal Transit Time Is Delayed in Small Intestinal Bacterial Overgrowth. Journal of Clinical Gastroenterology, 49, 571-576.
https://doi.org/10.1097/MCG.0000000000000257 |
[21] | Van Thiel, D.H., Fagiuoli, S., Wright, H.I., et al. (1994) Gastrointestinal Transit in Cirrhotic Patients: Effect of Hepatic Encephalopathy and Its Treatment. Hepatology, 19, 67-71. https://doi.org/10.1002/hep.1840190112 |
[22] | Madrid, A.M., Brahm, J., Buckel, E., et al. (1997) Orthotopic Liver Transplantation Improves Small Bowel Motility Disorders in Cirrhotic Patients. The American Journal of Gastroenter-ology, 92, 1044-1045. |
[23] | Ding, X.W., Liu, Y.X., Fang, X.C., et al. (2017) The Relationship between Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome. European Review for Medical and Pharmacological Sciences, 21, 5191-5196. |
[24] | Pisarek, W. (2021) Minimal Hepatic Encephalopathy—Diagnosis and Treatment. Przegl?d Gastroen-terologiczny, 16, 311-317. https://doi.org/10.5114/pg.2021.111389 |
[25] | Zhang, Y., Feng, Y., Cao, B., et al. (2015) Effects of SIBO and Rifaximin Therapy on MHE Caused by Hepatic Cirrhosis. International Journal of Clinical and Experimental Medicine, 8, 2954-2957. |
[26] | Yokoyama, K., Sakamaki, A., Takahashi, K., et al. (2022) Hydro-gen-Producing Small Intestinal Bacterial Overgrowth Is Associated with Hepatic Encephalopathy and Liver Function. PLOS ONE, 17, e0264459.
https://doi.org/10.1371/journal.pone.0264459 |
[27] | Bajaj, J.S., Heuman, D.M., Wade, J.B., et al. (2011) Rifaximin Improves Driving Simulator Performance in a Randomized Trial of Patients with Minimal Hepatic Encephalopathy. Gas-troenterology, 140, 478-487.E1.
https://doi.org/10.1053/j.gastro.2010.08.061 |
[28] | Sidhu, S.S., Goyal, O., Mishra, B.P., et al. (2011) Rifaximin Im-proves Psychometric Performance and Health-Related Quality of Life in Patients with Minimal Hepatic Encephalopathy (The RIME Trial). American Journal of Gastroenterology, 106, 307-316. https://doi.org/10.1038/ajg.2010.455 |