炎症性肠病与小肠细菌过度生长关系的荟萃分析

The relationship between inflammatory bowel disease and small intestinal bacterial overgrowth: a Meta-analysis

目的探讨炎症性肠病(inflammatory bowel disease,IBD)与小肠细菌过度生长(small intestinal bacterial overgrowth,SIBO)之间的关系。方法检索PubMed、Web of Science、Cochrane Library、Embase、CNKI、CBM、万方、维普数据库,按标准纳入IBD与SIBO关系的病例对照研究,并手工检索相关的参考文献,采用Cochrane协作网提供的RevMan 5.3软件进行荟萃分析。结果共纳入8项病例对照研究,IBD患者692例,对照组517例。Meta分析结果显示,IBD会增加发生SIBO的风险(阳性率为28.47%),与对照组相比差异有统计学意义(OR=7.04,95%CI:3.34~14.82,P<0.05)。不同地区亚组分析显示,在亚洲地区,IBD患者中SIBO阳性率高于对照组,差异有统计学意义(亚洲地区:OR=8.77,95%CI:3.18~24.21,P<0.05);而在欧美地区差异无统计学意义(OR=5.85,95%CI:0.96~35.76,P>0.05)。对SIBO不同诊断方法进行亚组分析,发现葡萄糖呼气试验(GBT)组中病例组SIBO阳性率高于对照组,差异有统计学意义(OR=8.84,95%CI:3.46~22.59,P<0.05),而乳果糖呼气试验(LBT)组中差异无统计学意义(P>0.05)。对IBD不同疾病分类进行亚组分析,结果显示,无论在克罗恩病(Crohn’s disease,CD)还是在溃疡性结肠炎(ulcerative colitis,UC)中,病例组SIBO阳性率均高于对照组,差异有统计学意义(CD:OR=13.49,95%CI:4.01~45.39,P<0.05;UC:OR=5.29,95%CI:1.93~14.55,P<0.05)。结论IBD患者中SIBO阳性率显著高于正常人群,对IBD患者进行SIBO检测在疾病的诊断和治疗中具有一定临床价值。

Objective To investigate the relationship between inflammatory bowel disease(IBD)and small intestinal bacterial overgrowth(SIBO).Methods PubMed,Web of Science,Cochrane Library,Embase,CNKI,CBM,WanFang and VIP database were searched for the case-control studies of the relationship between IBD and SIBO,and the relevant references were retrieved.The RevMan 5.3 software was used for statistical analysis.Results A total of 8 literatures were included in the study(692 cases in IBD group and 517 normal people in control group).The results of Meta-analysis showed that IBD increased the prevalence of SIBO(positive rate was 28.47%),and the difference was statistically significant compared with control group(OR=7.04,95%CI:3.34-14.82,P<0.05).The results of subgroup analysis showed that the positive rate of SIBO in Asian region was higher than that in control group(OR=8.77,95% CI:3.18-24.21,P<0.05);but there was no significant difference in European and American area:(OR=5.85,95% CI:0.96-35.76,P>0.05).Based on different diagnostic methods of SIBO,the positive rate of SIBO in the GBT group was higher than that in control group,and the difference was statistically significant(OR=8.84,95% CI:3.46-22.59,P<0.05).But there was no significant difference in LBT group.Based on different disease types,the positive rate of SIBO in case group was higher than that in control group,and the difference was statistically significant,whether in Crohn’s disease(CD)or in ulcerative colitis(UC)(CD:OR=13.49,95% CI:4.01-45.39,P<0.05;UC:OR=5.29,95% CI:1.93-14.55,P<005).Conclusion The positive rate of SIBO in IBD patients is significantly higher than that in normal persons,and the detection of SIBO in patients with IBD has certain value in clinical diagnosis and treatment.