慢性肾脏病患者小肠细菌过度生长情况及危险因素分析

Incidence and risk factors analysis of small intestinal bacterial overgrowth in patients with chronic kidney disease

目的探讨慢性肾脏病(CKD)患者小肠细菌过度生长(SIBO)的发生情况及其可能的危险因素。方法选择92例CKD患者为研究对象。通过乳果糖氢-甲烷呼气试验(LHMBT)检测SIBO,应用多频生物电阻抗技术测定人体脂肪组织指数(FTI),采用胃肠道症状分级评定量表(GSRS)评估胃肠道症状。根据LHMBT结果分为SIBO阳性组与SIBO阴性组,比较两组间在人口统计学资料、实验室及临床指标、胃肠道症状等方面的差异,采用二项Logistic逐步回归分析CKD患者发生SIBO的可能危险因素。结果92例患者中SIBO阳性率为47.8%。与SIBO阴性组比较,SIBO阳性组GSRS得分更高,且差异有统计学意义[(23.27±3.97)分vs(21.13±4.39)分,t=2.451,P=0.016]。多因素Logistic逐步回归分析显示低钾(OR=0.396,95%CI 0.176~0.893,P=0.025)和高FTI(OR=1.182,95%CI 1.037~1.348,P=0.013)是CKD患者发生SIBO的独立危险因素。结论CKD患者SIBO发生率较高,SIBO阳性患者消化不良相关症状更为突出,低钾和高FTI是CKD患者发生SIBO的独立危险因素。

Objective To investigate the incidence and possible risk factors of small intestinal bacterial overgrowth(SIBO)in patients with chronic kidney disease(CKD).Methods 92 patients with CKD were selected as subjects.SIBO was assessed by lactulose hydrogen methane breath test(LHMBT),fat tissue index(FTI)was determined using multifrequency bioelectrical impedance analysis,and gastrointestinal symptoms were evaluated by gastrointestinal symptom rating scale(GSRS).According to the results of LHMBT,the patients were divided into SIBO group and non-SIBO group.The demographic data,laboratory and clinical indicators,gastrointestinal symptoms and other differences between the two groups were compared.Binomial logistic stepwise regression was used to analyze the possible risk factors of SIBO in CKD patients.Results The incidence of SIBO in these 92 patients was 47.8%.Compared with the non-SIBO group,the GSRS score of the SIBO group was higher,and the difference was statistically significant[(23.27±3.97)vs(21.13±4.39),t=2.451,P=0.016].Multivariate stepwise logistic regression analysis showed that low serum potassium(OR=0.396,95%CI 0.176-0.893,P=0.025)and high FTI(OR=1.182,95%CI 1.037-1.348,P=0.013)were independent risk factors for SIBO in patients with CKD.Conclusion The incidence of SIBO is high in CKD patients.Symptoms of dyspepsia are more prominent in SIBO positive patients.Low serum potassium and high FTI are independent risk factors for SIBO in patients with CKD.