溃疡性结肠炎患者小肠细菌过度生长情况分析及意义

Analysis of intestinal bacterial overgrowth in patients with ulcerative colitis and its significance

目的分析不同疾病程度溃疡性结肠炎(UC)患者的肠道屏障功能及小肠细菌过度生长(SIBO)情况。方法选取2016年5月至2018年10月就诊于该院的确诊UC患者126例,按照Southerland疾病活动指数分为症状缓解期组(n=20)、轻度活动组(n=42)、中度活动组(n=46)及重度活动组(n=18),采用乳果糖氢呼气试验(LHBT)检测患者SIBO情况,测定患者红细胞沉降率、C反应蛋白(CRP)、粪便钙卫蛋白(FC)、大便白细胞计数及肠道屏障功能指标水平[血清D-乳酸、二胺氧化酶(DAO)、细菌内毒素(LPS)]。结果除轻度活动组与中度活动组患者CRP水平无明显差异(P>0.05),红细胞沉降率、FC水平、大便白细胞计数、CPR水平在其余各组间两两比较,差异均有统计学意义(P<0.05)。症状缓解期组、轻度活动组、中度活动组、重度活动组患者LHBT阳性率分别为10.0%、4.8%、23.9%、88.9%,差异有统计学意义(χ^2=51.326,P<0.05)。重度活动组患者DAO水平明显高于其他组(P<0.05),4组患者血清D-乳酸及LPS水平无明显差异(P>0.05)。肠道屏障中DAO与患者LHBT阳性率呈正相关(R=0.87,P<0.05),D-乳酸及LPS水平与LHBT阳性率无明显相关性(P>0.05)。结论UC患者肠道屏障受损,主要表现为DAO升高,并与患者SIBO相关,可以通过氢呼气试验检测患者的小肠过度生长情况,为患者病情评估及治疗提供依据。

Objective To analyze the intestinal barrier function and intestinal bacterial overgrowth(SIBO)in patients with ulcerative colitis(UC)with different disease degrees.Methods A total of 126 patients with UC diagnosed in our hospital from May 2016 to October 2018 were selected.According to Southerland disease activity index,they were divided into the symptom remission group(n=20),the mild activity group(n=42),the moderate activity group(n=46)and the severe activity group(n=18).The SIBO of patients was detected by lactulose hydrogen breath test(LHBT).The levels of erythrocyte sedimentation rate,C-reactive protein(CRP),fecal calprotectin(FC),fecal white blood cell count and intestinal barrier function indexes[serum D-lactic acid,diamine oxidase(DAO),bacterial endotoxin(LPS)]were determined.Results There was no significant difference in CRP level between the mild activity group and the moderate activity group(P>0.05),and pairwise comparison of erythrocyte sedimentation rate,FC level,fecal white blood cell count and CPR level among other groups showed statistically significant differences(P<0.05).The positive rate of LHBT in the symptom remission group,the mild activity group,the moderate activity group and the severe activity group was 10.0%,4.8%,23.9%and 88.9%,respectively,and the differences were statistically significant(χ^2=51.326,P<0.05).The level of DAO in the severe activity group was significantly higher than that in other groups(P<0.05),and there were no significant differences in serum D-lactic acid and LPS levels among the 4 groups(P>0.05).DAO in intestinal barrier was positively correlated with LHBT positive rate(R=0.87,P<0.05),while D-lactic acid and LPS levels were not significantly correlated with LHBT positive rate(P>0.05).Conclusion The intestinal barrier was damaged in UC patients,which was mainly manifested as increased DAO,and related to SIBO.Hydrogen breath test could be used to detect the complicated intestinal overgrowth in patients with UC,so as to provide a basis for the condition evaluation and treatment of patients.