合并小肠细菌过度生长的腹泻型肠易激综合征患者膳食特点研究

The dietary features of diarrhea predominant irritable bowel syndrome patients with small intestinal bowel overgrowth

目的 探讨合并小肠细菌过度生长（SIBO）的腹泻型肠易激综合征（IBS-D）患者膳食的特点,为指导患者合理饮食提供依据.方法 纳入2015年3月至2016年4月就诊于北京大学第三医院的IBS-D患者,同期招募健康志愿者（HC）.全部受试者完成临床问卷、膳食调查及乳果糖甲烷-氢气呼气试验（LMHBT,简称呼气试验）.根据呼气试验结果判断是否合并SIBO;根据膳食中脂肪供能比是否大于50％分为高脂饮食与非高脂饮食.比较不同组间的膳食构成以及与呼气试验结果的关系.结果 共纳入88例IBS-D患者和32例HC.IBS-D的呼气试验阳性率显著高于HC[39.8％（35/88）比12.5％（4/32）,P=0.005].HC中的28例呼气试验阴性者纳入后续研究.（1）IBS-D中呼气试验阳性者（IBS-P）的BMI明显低于呼气试验阴性者（IBS-N）[（21.57±0.54） kg/m^2比（23.30±0.53）kg/m^2,P=0.032].合并SIBO的IBS-D患者腹痛评分更高.（2）IBS-D患者膳食中蛋白质及碳水化合物的摄入比均高于HC（14.39％比12.22％,P=0.001;53.94％比46.25％,P=0.003）.IBS-P患者的脂肪供能比显著高于IBS-N[（47.19±2.62）％比（40.74±1.66）％,P=0.038].（3）IBS-P患者呼气中甲烷基线值显著高于IBS-N[体积分数：（8.69±0.39）×10^-6比（6.39±0.47）×10^-6,P=0.002].IBS-D高脂饮食者的呼气试验阳性率显著高于非高脂饮食者[54.2％（13/24）比17.2％（11/64）,P=0.001].甲烷峰值与脂肪供能比呈正相关（r=0.413,P=0.022）.结论 根据罗马Ⅲ问卷诊断的IBS-D患者约39.8％存在SIBO.IBS-D合并SIBO会影响其营养状况.高脂饮食可能是IBS-D合并SIBO的高危因素之一.合理的膳食结构可以减少IBS-D,特别是合并SIBO的发生.

Objective To explore the diet features of diarrhea predominant irritable bowel syndrome （IBS-D） with small intestinal bacterial overgrowth （SIBO）.Methods IBS-D patients were enrolled in outpatient department of Peking University Third Hospital from March 2015 to April 2016.Healthy volunteers were recruited as controls （HC）.All the subjects completed screening examinations,clinical and food investigation,and lactulose methane and hydrogen breath test （LMHBT）.The high fat diet is defined as the daily total calories supplying from fat is more than 50%.Results Eighty-eight IBS-D patients and 32 HC were finally enrolled.The positive rate of LMHBT in IBS-D was significantly higher than that of HC [39.8% （35/88） vs 12.5% （4/28）,P=0.005].The 28 HC with negative LMHBT were enrolled in the follow-up analysis.（1） The BMI of IBS-P （IBS-D with positive LMHBT） was significantly lower than IBS-N （IBS-D with negative LMHBT） [（21.57 ±0.54） vs （23.30 ±0.53） kg/m^2,P=0.032].IBS-D patients with SIBO had higher scores of abdominal pain assess.（2） The proportion of dietary protein and carbohydrate in IBS-D was significantly higher than that of HC （14.39% vs 12.22%,P =0.001;53.94% vs 46.25%,P =0.003,respectively）.The proportion of diet fat was significantly higher in IBS-P than IBS-N[（47.19 ± 2.62） % vs （40.74 ± 1.66） %,P =0.038].（3） The baseline of breath methane in IBS-P was significantly higher than that of in IBS-N [（8.69 ± 0.39） ×10^-6 vs （6.39 ± 0.47） ×10^-6,P =0.002].IBS-D patients with high fat diet had higher LMHBT positive rate than that of non-high fat diet patients[54.2% （13/24） vs 17.2% （11/64）,P =0.001].Breath methane peak value was positively correlated with the fat proportion of diet （r =0.413,P =0.022）.Conclusions About 39.8% IBS-D patients diagnosed by Rome 11Ⅲ are combined with SIBO.SIBO may affect IBS-D patients＇ nutritional status.High fat diet might be one of the risk factors for IBS-D with SIBO.Proper diet structure might reduce the prevalence of IBS-D,especially for IBS-D with SIBO.