肝硬化失代偿期患者病因及分级与小肠细菌过度生长的关系研究

Relationship between etiology and classification of decompensated cirrhosis and small intestinal bacterial overgrowth

目的研究肝硬化失代偿期患者肝硬化病因及肝硬化分级与小肠细菌过度生长的关系。方法选取2018年1月至2019年1月洪湖市中医医院收治的178例肝硬化失代偿期患者(Child-Pugh分级B级98例,C级80例)作为观察组,120例肝纤维化患者作为肝纤维化组,另选择同期50例体检健康者作为对照组。将观察组分为小肠细菌过度生长阳性组与阴性组。采用乳果糖氢呼气试验(LHBT)检测被研究者小肠细菌过度生长情况,分析肝硬化失代偿期患者肝硬化病因及肝硬化分级与小肠细菌过度生长的关系。结果观察组小肠细菌过度生长阳性率及LHBT集值均高于肝纤维化组,差异有统计学意义(P<0.05);肝纤维化组小肠细菌过度生长阳性率及LHBT集值均高于对照组,差异有统计学意义(P<0.05)。Child-Pugh分级C级肝硬化患者小肠细菌过度生长阳性率及LHBT集值均高于B级患者,差异有统计学意义(P<0.05)。K-M生存曲线结果显示,小肠细菌过度生长阳性组患者3年生存率为40.5%,小肠细菌过度生长阴性组患者3年生存率为79.8%,两组生存情况差异有统计意义(χ2=3.146,P=0.016)。受试者工作特征曲线分析结果显示,LHBT集值超过101 ppm时,其诊断肝硬化失代偿期的价值最高,曲线下面积为0.76(95%CI=0.704~0.826),诊断灵敏度、特异度分别为89.9%和65.8%。结论肝硬化失代偿期患者小肠细菌过度生长发生率高,且随着肝功能分级的升高,小肠细菌过度生长发生风险升高。小肠细菌过度生长可能促进肝硬化失代偿期病情发展。

Objective To study the relationship between the etiology and classification of liver cirrhosis and small intestinal bacterial overgrowth in patients with decompensated cirrhosis.Methods Totally 178 patients with decompensated cirrhosis[Child-Pugh grade B(98 cases)and grade C(80 cases)]received from January 2018 to January 2019 were selected as observation group,120 patients with liver fibrosis as liver fibrosis group and 50 healthy people were selected as control group.The observation group was divided into positive small intestinal bacterial overgrowth group and negative small intestinal bacterial overgrowth group.Lactulose hydrogen breath test(LHBT)was used to detect the bacterial overgrowth in the small intestine of the subjects,the relationship between the etiology and classification of liver cirrhosis and small intestinal bacterial overgrowth in patients with decompensated cirrhosis was analyzed.Results The positive rates of small intestinal bacterial overgrowth and the LHBT concentration values in the observation group were significantly higher than those in the liver fibrosis group(P<0.05);the positive rate of small intestinal bacterial overgrowth and LHBT concentration in liver fibrosis group were significantly higher than those in control group(P<0.05).The positive rate of small intestinal bacterial overgrowth and LHBT concentration in Child-Pugh grade C cirrhosis patients were significantly higher than those in Child-Pugh B grade cirrhosis patients(P<0.05).The results of K-M survival curve showed that the 3-year survival rate of patients with positive small intestinal bacterial overgrowth was 40.5%,and that of patients with negative small intestinal bacterial overgrowth was 79.8%,there was significant difference between the two groups(χ2=3.146,P=0.016).The analysis of receiver operating characteristic curve showed that LHBT had the highest value in the diagnosis of liver cirrhosis when the set value of LHBT exceeded 101 ppm,the area under the curve was 0.76(95%CI=0.704-0.826),the sensitivity and specificity were 89.9%and 65.8%respectively.Conclusion The incidence of small intestinal bacterial overgrowth is high in patients with decompensated cirrhosis,and the risk of intestinal bacterial overgrowth increases with the increase of liver function grade.Small intestinal bacterial overgrowth may promote the development of decompensated cirrhosis.