慢性肝病与小肠细菌过度生长——氢呼气试验的结果

Chronic Liver Disease and Small Intestinal Bacterial Overgrowth: Results of Hydrogen Breath Test

背景:慢性肝病时胃肠道局部的免疫防御机制受损,肠道的微环境遭到破坏,有利于细菌的生长。小肠液细菌培养为诊断的“金标准”,但此法操作复杂,技术要求高。以碳水化合物为基质的氢呼气试验则相对简单。目的:观察慢性乙型肝炎和肝炎后肝硬化患者是否存在小肠细菌过度生长。方法:38例慢性乙型病毒性肝炎、26例乙型肝炎后肝硬化患者和40名正常对照者行乳果糖氢呼气试验(LHBT),检测小肠细菌过度生长的情况。结果:64例慢性肝病患者中LHBT阳性者22例(34．4％),40名正常对照者LHBT均阴性。LHBT阳性组3 h累积平均氢呼出量、平均氢浓度峰值显著高于LHBT阴性组和正常对照组(P均<0．01);其峰值出现时间显著早于LHBT阴性组和正常对照组(P均< 0．01)。结论:部分慢性肝病患者LHBT阳性,提示存在小肠细菌过度生长;乳果糖氢呼气试验检测小肠细菌过度生长具有快速、较准确、患者易于接受等特点。

Background： Impaired local immune defense and microenvironment of gastrointestinal tract in patients with chronic liver diseases are in favor of bacteria overgrowth. Cultivation of small intestinal juice has been regarded as the ＂gold standard＂ for the diagnosis of small intestinal bacterial orergrowth, but it is quite complex and needs high techniques. Hydrogen breath test is relatively simple. Aims： To investigate the occurrence of small intestinal bacterial overgrowth in patients with chronic liver diseases by laetulose hydrogen breath test （LHBT）. Methods： LHBT was performed in 64 patients with chronic liver diseases including 38 patients with chronic hepatitis B and 26 patients with post-hepatitis B cirrhosis, Forty healthy subjects served as controls. Results： Positive LHBT was observed in 22 patients （34.3%） with chronic liver disease, including 12 patients with chronic hepatitis B （31.6%） and 10 patients with post-hepatitis B cirrhosis （38.4%）, suggesting the existence of small intestinal bacterial overgrowth. None of heahhy subjects was LHBT positive. The hydrogen concentration and amount of hydrogen produced in 3 hours,peak of hydrogen concentration and appearance of peak of hydrogen concentration in LHBT positive patients were much more higher and earlier than those in LHBT negative patients and healthy controls. Conclusions： Small intestinal bacterial overgrowth occurred in a number of patients with chronic liver diseases. LHBT has the benefits of test,quite accurate and good patient compliance.