儿童幽门螺杆菌感染和根除治疗对小肠细菌过度生长的影响

Effect of helicobacter pylori eradication therapy on small intestinal bacterial overgrowth in children

目的探讨儿童幽门螺杆菌(helicobacter pylori,HP)感染和根除治疗对小肠细菌过度生长(small intestinal bacterial overgrowth,SIBO)的影响。方法采用病例对照研究方法。选取徐州医科大学附属医院2021年6月至2022年6月收治的具有腹胀、腹痛、腹泻症状,可疑消化系统疾病患儿68例,根据HP感染情况分为HP阴性组和HP阳性组。HP阳性组接受三联标准化HP根除治疗,14 d为1个疗程。比较两组SIBO阳性率、胃肠道症状评定量表(gastrointestinal symptom rating scale,GSRS)评分,HP阳性组于停药4周和12周随访时进行胃肠道症状量化评估和乳果糖氢呼气试验,比较治疗前后SIBO阳性率和GSRS评分的变化。呈正态分布的计量资料以x¯±s表示,两组间比较采用独立样本t检验;非正态分布的计量资料以M(Q1,Q3)表示,两组间比较采用Mann-Whitney U检验;多时点间比较采用Friedman检验,两两比较采用Nemenyi检验;计数资料组间比较采用四格表或配对χ^(2)检验。结果HP阴性组SIBO阳性率低于HP阳性组[36.1%(13/36)比62.5%(20/32)],差异有统计学意义(χ^(2)=4.72,P=0.030)。停药4周后HP阳性组SIBO阳性率高于治疗前[87.5%(28/32)比62.5%(20/32)],停药12周后低于治疗前[21.9%(7/32)比62.5%(20/32)],差异均有统计学意义(χ^(2)=8.00、P=0.008,χ^(2)=13.00、P<0.001)。HP阴性组GSRS评分与HP阳性组比较差异无统计学意义(P=0.098),HP阳性组32例患儿在规范HP根除停药4、12周后临床症状均较治疗前好转,GSRS评分均低于治疗前[8.0(6.0,12.8)、7.0(5.0,9.0)分比15.0(12.0,19.0)分],差异均有统计学意义(Z值分别为-3.91、-4.68,均P<0.001)。结论HP感染可导致可疑消化系统疾病患儿SIBO阳性率增加,规范三联根除HP疗法在治疗HP感染的同时可能造成SIBO进一步加剧,但这种影响可在停药12周后消除。

Objective To investigate the effect of helicobacter pylori(HP)infection and eradication treatment on small intestinal bacterial overgrowth(SIBO)in children.Methods A prospective case-control study was conducted to select 68 children with symptoms of abdominal distension,abdominal pain,diarrhea and suspected digestive system diseases admitted to the Affiliated Hospital of Xuzhou Medical University from June 2021 to June 2022.They were divided into HP negative group and HP positive group according to HP infection.HP positive group received triple standardized HP eradication treatment,14 days as a course of treatment.The baseline SIBO positive rate and gastrointestinal symptom rating scale(GSRS)score of the two groups were compared.The HP positive group was followed up for 4 and 12 weeks after drug withdrawal for quantitative assessment of gastrointestinal symptoms and LHBT.The SIBO positive rate,GSRS score of the two groups and the change of SIBO positive rate and GSRS score of the HP positive group before and after treatment were compared.The measurement data with normal distribution were expressed,and independent sample t-test was used for comparison between the two groups.M(Q1,Q3)was used to represent the measurement data of non normal distribution,and Mann Whitney U test was used to compare the two groups;Friedman test was used for comparison between multiple time points,and Nemenyi test was used for pairwise comparison.Four grid table or pairedχ^(2) test was used to compare the counting data between groups.Results The positive rate of SIBO in HP negative group was lower than that in HP positive group(36.1%(13/36)vs 62.5%(20/32)),the difference was statistically significant(χ^(2)=4.72,P=0.030).Four weeks after drug withdrawal,the SIBO positive rate in HP positive group was higher than that before treatment(87.5%(28/32)vs 62.5%(20/32)),and 12 weeks after drug withdrawal was lower than that before treatment(21.9%(7/32)vs 62.5%(20/32)),with statistically significant differences(χ^(2)=8.00,P=0.008;χ^(2)=13.00,P<0.001).There was no statistically significant difference in GSRS score between HP negative group and HP positive group(P=0.098).The clinical symptoms of 32 children in HP positive group were improved 4 and 12 weeks after HP eradication was stopped.GSRS scores were lower than those before treatment(8.0(6.0,12.8),7.0(5.0,9.0)points vs 15.0(12.0,19.0)points),and the differences were statistically significant(Z values were-3.91,-4.68,respectively;all P<0.001).Conclusions HP infection can increase the positive rate of SIBO in children with suspected digestive system diseases.The standardized triple HP eradication therapy may further aggravate the overgrowth of intestinal bacteria while treating HP infection,but this effect can be eliminated after 12 weeks of treatment.