小肠细菌过度生长与慢性肝病

Small intestinal bacterial overgrowth and chronic liver disease

小肠细菌过度生长(small intestinal bacterial overgrowth,SIBO)以小肠细菌种类改变和(或)数量增加为特征,常见的危险因素包括胃肠解剖结构改变、胃酸分泌过少、小肠运动障碍、免疫功能低下、胰腺功能不全和慢性肝病等。SIBO诊断的金标准为小肠液细菌培养。氢呼气试验具有无创、简便和可重复性的特点,现已成为临床上最常用的SIBO诊断方法。同时检测呼气中的甲烷丰度有助于提高SIBO的检出率。荟萃分析发现,36%~68%的慢性肝病患者合并有SIBO。肝硬化伴门脉高压患者合并SIBO会促进肝硬化并发症的发生。以微生物学为基础的治疗可调整肠-肝轴的运转、减少SIBO,由此改善肝硬化患者的预后。肠道不吸收的抗生素是治疗SIBO最有效的药物。

Small intestinal bacterial overgrowth(SIBO)is characterized by the alteration of bacterial species in the small intestine and their number increase.The risk factors of SIBO include anatomical alteration,dysmotility,immunodeficiency,pancreatitis,and chronic liver disease.Culture of intestinal aspirates is the gold standard for SIBO diagnosis.The hydrogen breath test,noninvasive,simple and repeatable technique,became the most common method to assess patients for SIBO.Measurement of exhaled methane helps with the positive rate.A meta-analysis indicated that SIBO was found in 36%-68%of chronic liver disease patients and has been linked to the progression of cirrhosis and its complications.Therapy targeting gut microbiota which affects gut-liver axis is beneficial to improve the prognosis of cirrhosis.Antibiotics that are not absorbed in the intestine may be the most effective drugs for the treatment of SIBO.