腹泻型IBS患者小肠细菌过度生长和抗菌素的影响

Small intestinal bacterial overgrowth in patients with diarrhea-predominant irritable bowel syndrome and the effects of antibiotics

目的观察腹泻型肠易激综合征(IBS-D)患者乳果糖氢呼气试验(LHBT)的阳性率、以及短期抗菌素治疗的疗效。方法 89例符合罗马Ⅲ标准的IBS-D患者接受LHBT检测,分析LHBT结果与肠易激综合征(IBS)症状的相关性;16例LHBT阳性IBS-D患者接受"替硝唑或司帕沙星"治疗1周,观察LHBT阴转率及其与症状改善的关系。结果 89例IBS-D患者中,46例(51.7%)LHBT阳性。LHBT阳性组与LHBT阴性组IBS患者在腹痛程度和频率、腹胀程度和频率的差异有统计学意义(P<0.05)。16例LHBT阳性的IBS-D患者经1周抗菌素治疗后10例(62.5%)LHBT阴转,IBS症状改善率(Y)与H2呼出量减少率(X)存在正相关关系(回归方程Y=31.3+0.34X,r=0.61,P=0.03)。结论 51.7%IBS-D患者存在小肠细菌过生长(SIBO),SIBO与IBS-D患者的腹痛、腹胀症状有关;短程抗菌素治疗后可以使IBS-D的部分症状获得缓解。

Objective To investigate the positive rate of lactulose hydrogen breath test（LHBT） and the effect of short-term administration of antibiotics in patients with diarrhea-predominant irritable bowel syndrome（IBS-D）.Method The LHBTs were detected and the relationship between LHBT and symptom scores of irritable bowel syndrome（IBS） were detected in 89 cases of patients with IBS-D.Antibiotics（tinidazole or sparfloxacin） were administered to 16 patients with LHBT-positive IBS-D for one week,and their effects on the symptom scores of IBS were investigated.Result Among the 89 cases of IBS-D,46 cases（51.7%） were LHBT positive.There were significant difference between the LHBT-positive and-negative IBS-D patients（P0.05） in terms of the degree and the frequency of abdominal pain,as well as abdominal distention.After treatment with antibiotics,ten cases（62.5%） with LHBT-positive turned to LHBT negative and there was a positive correlation between the symptom-improvement rate（Y） and the reduction rate（X） of H2 breath（Y=31.3＋0.34X,r=0.61,P=0.03）.Conclusion These results indicate that 51.7% of IBS-D patients have small intestinal bacterial overgrowth（SIBO）,which contributes to the symptom of abdominal pain and abdominal distension.A short-term antibiotic treatment improves the symptoms in some LHBT-positive IBS-D patients.