质子泵抑制剂发生小肠细菌过生长的临床研究

Assessment and intervention of small intestinal bacterial overgrowth during proton pump inhibitor therapy

目的探讨长期口服质子泵抑制剂(proton pump inhibitors,PPI)引发小肠细菌过生长(small intestinal bacterial overgrowth,SIBO)的风险及干预措施。方法选取77例服用PPI为观察组,41例健康志愿者作为对照组,采用前瞻性对照性研究,采用乳果糖氢呼气试验(lactulose hydrogen breath test,LHBT)检测SIBO。SIBO阳性者给予停用PPI或不停用PPI加服左氧氟沙星口服(0.2 g,tid,1周),两种干预均在4周时再次复查SIBO。结果研究开始前和8周后PPI组和对照组SIBO阳性率差异无统计学意义(P>0.05),24周后PPI组SIBO阳性率明显高于对照组(P<0.05)。PPI组随着用药时间的延迟,SIBO发生率升高,0、8、24周间差异有统计学意义(P<0.05)。停药和服用抗菌药物SIBO转阴率差异无统计学意义(P>0.05)。结论服用PPI可增加小肠细菌过生长的风险,且这种风险随服药时间延长而升高,停药或加用抗菌药物可以使SIBO消失。

Objective To investigate the prevalence of small intestinal bacterial overgrowth（SIBO） in patients with longterm treatment with proton pump inhibitors （PPI）, and explore the intervention measures for SIBO. Methods 77 patients treatment of PPI were selected as observation group, 41 healthy volunteers were selected as control group, all subjects were prospectively analysed by lactulose hydrogen breath test（LHBT）. SIBO positive persons were given stopping PPI or levofloxacin （0.2 g, tid, 1 w） and not stoping PPI, and all subjects received SIBO review in 4 weeks. Results The SIBO positive rates had no statistically significant differences between two groups before and 8 weeks after the PPI treatment （P〉0.05）. After 24 weeks, the SIBO positive rate of the PPI group was significantly higher than that of the control group （P〈0.05）. The SIBO positive rate of PPI treatment group was increased with the extension of treatment time. There was significant difference at pre-treatment, 8 weeks post-treatment and 24 weeks post-treatment in PPI treatment group （P〈0.05）. The SIBO negative conversion had no significantly differences between the PPI stopping group and antibiotics treatment group （P〉0.05）. Conclusion Taking PPI can increase the risk of small intestinal bacterial overgrowth, and this risk increases with the time of drug administration, SIBO can be turned negative by using antibiotic or stop taking PPI.