乳糖酶缺乏与乳糖不耐受症状的临床特点分析

目的探讨乳糖酶缺乏及乳糖不耐受症状的临床特点。方法回顾性分析了84例于广东省人民医院门诊就诊的以腹痛、腹泻、腹胀、肠鸣为主要症状的患者,并接受胃肠镜、腹部CT、抽血及氢呼气试验等检查评估,根据患者的主要诊断,氢呼气试验结果及乳糖不耐受症状进行分组,比较各组的临床指标,包括年龄、性别、体质量指数、血常规、过敏原检测、血清总蛋白及白蛋白、C-反应蛋白、血沉等指标及氢呼气试验结果。结果功能性腹泻、肠易激综合征组相较于其他功能性胃肠病组、器质性疾病组,出现乳糖不耐受症状的比例更高(P<0.05)。相比乳糖不耐受症状阴性组,乳糖不耐受症状阳性组患者的体质量指数、血清总蛋白及血清白蛋白水平降低,且差异均具有统计学意义(P<0.05)。不同乳糖酶缺乏程度各组患者在合并器质性疾病、食物不耐受、乳糖不耐受症状上无明显差别(P>0.05),白细胞计数、血红蛋白、中性粒细胞计数、血清总蛋白、血清白蛋白、C-反应蛋白及血沉等指标比较差异也无统计学意义(P>0.05)。结论进食乳制品后是否出现症状与乳糖酶是否缺乏或缺乏程度之间缺乏一致性。是否存在乳糖酶缺乏似乎对患者的营养情况并无明显影响,但出现自我报告的乳糖不耐受症状的患者相比无症状者长期营养状况趋于下降。

Preliminary discussion for the degrees of adult lactase deficiency and its clinical significance

Objective The aim of this study is to investigate the clinical characteristics of objective lactase deficiency and subjective lactose intolerance symptoms.Methods 84 outpatients with abdominal pain,diarrhea,abdominal distension and borborygmus as the main symptoms were included and evaluated by endoscope,abdominal CT,blood sampling and hydrogen breath test(HBT).The patients were divided into different groups according to the main diagnosis,HBT results and subjective lactose intolerance symptoms.The clinical indexes of each group were compared including age,sex,body mass index,blood routine,detection of allergen,serum total protein,albumin,C-reaction protein,erythrocyte sedimentation rate and the results of HBT.Results The incidence of subjective lactose intolerance symptoms was higher in patients with irritable bowel syndrome and functional diarrhea compared to patients with other functional diseases or organic diseases(P<0.05).Compared with patients without subjective lactose intolerance symptoms,those with symptoms showed lower level of BMI,serum total protein and serum albumin,the differences were statistically significant(P<0.05).There was no significant difference on the coexistence of organic diseases,the incidence of food intolerance and subjective lactose intolerance,white blood cell count,neutrophil count,hemoglobin,serum total protein,serum albumin,ESR and CRP among patients with different degrees of lactase deficiency(P>0.05).Conclusion there is a lack of consistency between subjective lactose intolerance symptoms and objective lactase deficiency.Objective lactase deficiency does not seem to have a significant effect on the nutritional status of patients,but the long-term nutritional status of patients with subjective lactose intolerance symptoms tends to be declined compared with asymptomatic patients.