低FODMAP饮食治疗腹泻型肠易激综合征的效果分析

Treatment Effect of Low FODMAP Diet on the Diarrhea-predominant Irritable Bowel Syndrome

目的:研究低发酵(fermentable)寡糖(oligosaccharides)、单糖(monosaccharides)、双糖(disaccharides)及多元醇(polyols)(FODMAP)饮食治疗腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,IBS-D)的治疗临床效果及可能机制。方法:选择2015年6月至2017年6月我院收治的107例IBS-D患者作为研究对象,并采用随机数字表法将其分为低FODMAP饮食组54例(LFD)和正常饮食组53例(ND),分别给予低FODMAP饮食、正常饮食。实验前采集患者的一般情况,于实验的第0天、28天完善IBS症状积分量表(IBS-severity scoring system,IBS-SSS)、生活质量评分量表(IBS-Quality of Life,IBS-QOL)、完善粪便双歧杆菌、乳杆菌及大肠杆菌检查,计算相应积分及菌群计数。结果:两组患者实验前一般情况、IBS-SSS、IBS-QOL比较差异无统计学意义(P>0.05),具有可比性。实验28天时,LFD患者IBS-SSS(156.35±95.44vs223.18±66.96)、IBS-QOL(64.81±19.27vs54.62±18.98)较实验前明显改善,且IBS-SSS(156.35±95.44vs201.42±91.28)及IBS-QOL(64.81±19.27vs55.76±20.38)评分明显优于ND组(P<0.05);低FODMAP饮食组肠道乳杆菌(6.33±0.95vs6.45±1.12)、双歧杆菌(8.57±0.84vs 8.61±0.79)的活菌数量无显著变化(P>0.05),而大肠杆菌数量较前减少(8.01±1.12vs8.65±1.11)(P<0.05);LFD患者BMI指数间与0天(23.42±2.38vs22.67±3.75)及ND(23.42±2.38vs 22.93±2.43)相比差异无统计学意义(P>0.05)。结论:低FODMAP饮食治疗IBS-D患者的效果明显,其机制除了食物的直接作用,还可能与肠道菌群的改变有关。

Objective: To investigate the clinical effect and possible mechanism of low FODMAP (fermentable oligosaccharides, monosaccharides, disaccharides, polyols) in the treatment of patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Methods: During June 2015 to June 2017, a total of 107 eligible IBS-D patients were randomly assigned into two groups: low FODMAP (LFD) group(54 cases) and normal diet(ND) group(53 cases). Before experiment, general conditions(age, gender, BMI, smoking history, drinking history) were collected. Quality of Life Scale (IBS-QOL) and IBS Symptom Score Scale (IBS-SSS) of the two groups were recorded on the baseline and day 28. Fecal microbiota (Escherichia coli, Lactobacillus and Bifidobacterium) was examined on the baseline and 28th day of the experiment. Results: No statistical difference was found in the general conditions, IBS-QOL, IBS-SSS between two groups before experiment. On the 28th day of experiment, the IBS-SSS(156.35±95.44vs223.18±66.96) of LFD group was evidently lower (P=0.000) while IBS-QOL (64.81±19.27vs54.62±18.98) was significantly higher (P=0.007) than those before experiment, the IBS-SSS (156.35±95.44vs201.42±91.28) of LFD group was evidently lower (P=0.014) while IBS-QOL (64.81± 19.27vs55.76±20.38) was significantly higher (P=0.020) than those of the ND group, the Escherichia coli of LFD (8.01±1.12) was lower(P=0.004) than that before experiment(8.01±1.12vs8.65±1.11) while no statistical difference (P>0.05) of bifidobacterium (8.57± 0.84 vs 8.61±0.79) and lactobacillus (6.33±0.95vs6.45±1.12) was observed, the BMI of LFD group at 4th week (23.42±2.38)(P=0. 217) had no significant difference than that before experiment (22.67±3.75). Conclusion: Low FODMAP diet showed significant effect on IBS-D, the mechanism may not only related to the direct role of food, but also with the intestinal flora change.