乳果糖氢呼气试验在顽固性腹泻患者诊治中的应用

Application of lactulose hydrogen breath test in diagnosis and treatment of patients with intractable diarrhea after gsstrectomy

目的探讨乳果糖氢呼气试验([A2]LHBT)在胃大部切除术后合并顽固性腹泻患者诊断与治疗中的作用。方法收集丹阳市人民医院2010年7月至2013年5月89例胃切除术后腹泻患者,经临床诊断顽固性腹泻行LHBT检测,分析LHBT检测值与腹泻症状的相关性;对LHBT阳性腹泻患者给予利福昔明治疗1周,之后应用培菲康治疗3周,观察LHBT阴转率及其与消化道症状改善的关系。结果在89例胃大部切除术后顽固性腹泻患者中,LHBT阳性率为60.7%(54/89),高于胃大部切除术后无腹泻组的15%(3/20),差异有统计学意义(P<0.05);LHBT阳性组与LHBT阴性组的腹泻症状积分分别为13.6±2.8和10.3±2.1,差异有统计学意义(P<0.05)。54例LHBT阳性者中,18例经序贯治疗LHBT阴转;36例仍为LHBT阳性,治疗后LHBT阳性与阴性两组患者的腹泻症状积分和疗效差异均有统计学意义(P<0.05)。结论胃大部切除术后顽固性腹泻患者肠道中存在小肠细菌过度生长的比例较高,通过检测LHBT不仅可以反映小肠细菌的生长情况,同时也能判断发生腹痛、腹泻的程度,并可预测短疗程抗菌治疗对缓解腹痛、腹泻等消化道相关症状的疗效。

Objective To explore the effect of application of lactulose hydrogen breath test （LHBT）in diagnosis and treatment of patients with intractable diarrhea after gastrectomy. Methods Eighty-nine patients with intractable diarrhea confirmed by clinical diagnosis after gastrectomy were underwent LHBT detection from July 2010 to May 2013, the correlation between LHBT detection and diarrhea was analyzed. The intractable diarrhea patients were given rifaximin one week,three weeks after the application biflco treatment, the correlation between LHBT sereconversion rate and gastrointestinal symptoms was analyzed. Results In 89 intractable diarrhea patients after gastrectomy, LHBT positive rate was 60.7%（54/89）, higher than the gastrectomy group without diarrhea 15% （3/20）, the difference was statistically significant （P〈0.05）. The diarrhea symptom scores of LHBT positive group and negative group were （ 13.6± 2.8）and （ 10.3 ± 2.1 ）the difference was statistically significant （P〈0.05）. In 54 LHBT positive patients, 18 cases received sequential treatment LHBT value overcastted, 36 cases remained LHBT positive after the sequential treatment; the diarrhea symptom scores and e^cacy in LHBT positive and negative groups were statistically significantly di^erenent （P〈0.05）. Conclusions The proportion of overgrowth of intestinal bacteria in gastrectomy patients with intractable diarrhea was high., LHBT can not only disclose the growth of bacteria in the small intestine, but also determine the occurrence of abdominal pain, diarrhea, degree, and it can predict the therapeutic effect of antibiotic