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

Research on relationship between small intestinal bacterial overgrowth and minimal hepatic encephalopathy in patients with cirrhosis

目的探讨肝硬化患者小肠细菌过度生长与轻微肝性脑病(MHE)的相关性。方法60例肝硬化患者(肝硬化组)及20名健康志愿者(对照组)全部接受葡萄糖氢呼气试验检测小肠细菌过度生长情况,进行数字连接试验(NCT-A及NCT-BC)和数字符号试验诊断MHE。抗生素抑制小肠细菌过度生长后再进行以上试验,对比治疗前后观察指标的变化。结果对照组检出1例患者(5%)伴小肠细菌过度生长,未检出MHE。肝硬化组共检出20例(33.3%)患者伴小肠细菌过度生长,MHE 26例(43.3%),其中伴小肠细菌过度生长肝硬化患者MHE检出17例,不伴小肠细菌过度生长患者MHE检出9例。应用抗生素抑制小肠细菌过度生长1周后20例小肠细菌过度生长患者有18例葡萄糖氢呼气试验阴性,17例伴小肠细菌过度生长的MHE患者13例数字连接试验和数字符号试验正常。肝硬化患者小肠细菌过度生长与MHE存在相关性,相关系数为0.511(P<0.005)。结论部分肝硬化患者存在小肠细菌过度生长,伴小肠细菌过度生长肝硬化患者的MHE检出率高于不伴小肠细菌过度生长肝硬化患者,应用抗生素抑制小肠细菌过度生长后MHE检出率明显下降,肝硬化患者小肠细菌过度生长与MHE有相关性。

Objective To investigate the relationship between small intestinal bacterial overgrowth （SIBO）and minimal hepatic encephalopathy（ MHE ） in cirrhotic patients. Methods Sixty patients with confirmed liver cirrhosis and 20 healthy volunteers were selected. In all subjects,SIBO were tested with glucose hydrogen breath test（ GHBT）, and MHE were tested with psychometric tests（ NCT-A, NCT-BC and DST）. After antibiotics therapy to inhibit SIBO, experiments above were repeated. The data between two times tests were compared. Results One patient（5% ）was with SIBO and no MHE was found in control group. There were 20 patients（33.3% ） with SIBO and 26（43.3% ）patients with MHE in cirrhotic group. There were 17 MHE among patients with SIBO and 9 MHE among patients without SIBO. After antibiotics therapy, there were 18 patients whose GHBT turned negative among 20 patients with SIBO. There were 13 patients whose NCT-A, NCT-BC and DST turned to be normal among 17 patients with MHE and SIBO. A significant correlation was observed between SIBO and MHE （r = 0. 511 ,P 〈 0. 005 ）in cirrhotic patients. Conclusion Some cirrhotic patients have SIBO and the rate of MHE in patients with SIBO was higher than that in patients without SIBO. The rate of MHE decreased obviously after antibiotics therapy. There was significant correlation between SIBO and MHE in cirrhotic pafients.