米曲菌胰酶片对功能性消化不良合并小肠细菌过度生长患者的治疗

Effects of Oryz-aspergillus enzyme and pancreatin tablet on small intestinal bacterial overgrowth in patients with functional dyspepsia

目的了解功能性消化不良(FD)中小肠细菌过度生长(SIBO)的发生率,推测临床预测因子并观察米曲菌胰酶片对FD合并SIBO的疗效。方法对112例符合罗马Ⅲ标准的FD患者进行第1次LHBT(f-LHBT),其结果使用Logistic回归分析LHBT阳性的预测因子。26例f-LHBT阳性者随机接受加酶或非加酶治疗,2周后复查LHBT(LHBT-2w),对LHBT-2w持续阳性者继续加酶治疗2周后再次复查LHBT(LHBT-4w)。比较加酶组与非加酶组间症状改善情况及复查LHBT情况。结果 112例FD中,33例(29.46%)f-LHBT阳性,Logistic回归提示上腹胀程度(OR=1.759,95%CI:1.187~2.609)、恶心程度(OR=1.634,95%CI:1.029~2.594)是LHBT阳性的独立预测因子。治疗2周后,两组共17例患者(65.38%)出现LHBT-2w阴转,其症状改善率高于LHBT-2w持续阳性组(t=-2.833,P=0.009)。加酶组(n=14)症状改善率为(75.89±21.92)%、非加酶组(n=12)为(53.84±31.39)%,差异有统计学意义(t=2.100,P=0.046)。加酶组LHBT-2w阴转率为71.4%,非加酶组为58.3%,差异无统计学意义(P=0.683),但加酶组高峰呼气H2浓度减少率显著高于非加酶组(U=-2.315,P=0.021)。7例LHBT-2w持续阳性者经继续加酶治疗2周后复查LHBT-4w,结果4例阴转,3例仍持续阳性,但高峰呼气H_2浓度均有所下降。结论大约29%FD患者会合并SIBO,上腹胀程度及恶心程度是独立预测因子。SIBO转阴后消化不良症状改善,提示FD症状可能与SIBO有关。短期使用米曲菌胰酶片可促进这些患者的症状改善,可能与减少SIBO有关。

Objective To learn the incidence and the clinical predictors of small intestinal bacterial overgrowth（SIBO）in patients with functional dyspepsia（FD）,and observe the effects of digestive enzyme in patients with overlapping FD and SIBO.Methods 112 FD patients based on Rome Ⅲ criteria were given LHBT（fLHBT）to assess the incidence of SIBO;the clinical predictors of positive result of LHBT were evaluated by using Logistic regression.26 patients with positive result of f-LHBT were selected and randomly given treatment with or without Oryz-aspergillus enzyme and pancreatin tablet（OAEP） respectively for two weeks,and then received LHBT at the end of treatment（LHBT-2w）.The patients with positive LHBT-2w results received treatment with Tab OAEP for another two weeks and then LHBT again at the end of the treatment（LHBT-4w）.The results of LHBT and improvement of FD symptoms were compared between OAEP group（n=14）and non-OAEP group（n=12）.Results Of the 112 FD patients,33（29.46%）were f-LHBT positive.Logistic regression analysis revealed that upper abdominal bloating（OR=1.759,95%CI：1.187-2.609） and nausea（OR=1.634,95%CI：1.029-2.594） were the independent predictors of positive LHBT in patients with FD.17 patients（65.38%） had negative results of LHBT-2w,and showed higher rate of symptom improvement than those with positive LHBT-2w（t=-2.833,P = 0.009）.The rate of symptom improvement was（75.89 ± 21.92）%in OAEP group and（53.84±31.39）%in non-OAEP group respectively,with significant difference（t = 2.100,P= 0.046）.The rate of negative LHBT-2w was71.4%in OAEP group vs 58.3%in non-OAEP group（P = 0.683）;however,the decrement rate of peak hydrogen level was significantly higher in OAEP group than in non-OAEP group（17=-2.315,P= 0.021）.4 of the 7 patients with positive LHBT-2w turned to LHBT negative after receiving OAEP treatment for another two weeks（negative LHBT-4w） while the other 3 patients remained positive LHBT-4w results;however,their peak hydrogen levels declined.Conclusion About 29%of FD patients have concurrent SIBO.Upper abdominal bloating and nausea are the independent predictors of SIBO.Eradication of SIBO may lead to significant improvement of dyspeptic symptoms,suggesting that there is some association between FD and SIBO.A short-term treatment with OAEP may achieve an improvement of the symptoms of overlapping FD and SIBO,which may be associated with the inhibition of bacterial overgrowth by OAEP.